Tc-99m-RBC scan for liver hemangioma (comparison of plan or images with SPECT)

Introduction Hemangioma is the most common benign tumor of the liver with reported prevalence ranging form 0.5% to 7 %. Hemangioma is most prevalent in women. These lesions are usually asymptomatic and are detected as incidental findings on radiological work up or autopsy. Large lesions can produce compressive symptoms and may also be associated with pain if spontaneous thrombosis or hemorrhage occurs. Due to diagnostic problems (differential diagnosis, with metastasis and hemorrhage in case of biopsy) Tc99m-RBC-liver scan is recommended for patients with suspected hemangioma and reported to have high sensitivity and nearly 100% specificity. Materials and Methods: The study population consisted of 58 patient, 14 males and 45 females, ranging in age from 22 to 77 years (mean age: 47 years) with suspicion of liver bemangioma, who mCi-Tc99m-RBC imaging of the liver in perfusion and blood pool phases were performed then anterior, posterior and lateral views were obtained. If the planar scan was negative for hemangioma liver SPECT was performed (360 degrees, 64 steps, 30 sec/step). Results: The most common chief complaints of patients was pain (65%) and 25% of lesions were detected incidentally. Also 11% had nonspecific signs. In planar Tc99m-RBC scan, 42% of lesion located in the anterior part of right lobe and 45% in the posterior part of right lobe as well as 13% in the left lobe. Planar scan in anterior view showed no lesion smaller than 20 mm and only 2 lesions from 10 lesions) smallest than 25 mm was detected. From 36 lesion greater than 25 mm only 25 were positive for hemangioma (P=O.25). Planar scan in posterior projection shows 2 lesions smallest than common from 10 lesions) and from 39 lesions large than 25 mm only 22 were positive. (P=O.33). In six patients planar scan in anterior view was negative but in posterior view was positive. The smallest lesion that detected in liver SPECT was about 14 mm. Lesions greater than 25 mm in diameter are more positive in anterior and posterior views in comparison to lesion smaller than 25 mm. Conclusion: 1-Tc99m-RBC scan in anterior and posterior views may increase sensitivity for detection of lesions and by the way decrease need t oliver SPECT. For lesion smaller than 25 mm liver SPECT is recommended. If the number of lesions in sonography and CT are not compatible with lesions in planar scan then SPECT can help to find the lesions that was not seen in planar scan. Right lobe lesions were better seen in posterior view but left lobe lesions were better seen anterior view and lesions between to lobes were better seen in SPECT