Hepatic scintiangiography using gamma camera system: diagnosis of hepatomas and liver abscess

The purpose of this investigation is to distinguish hepatomas from the liver abscess by scintiangiography using Anger camera system. Ninety-five patients were imaged by Gamma camera system in St. Mary's Hospital, Catholic Medical College between May 1979 and January 1980 and their medical records were reviewed in detail. Of a total of 95 patients 38 patients were proved by histology. The patients were placed supine under Gamma camera detector head to view the anterior projection of the liver and spleen. Following an intravenous bolus injection of 10 mCi Tc-99m-phytate in volume of 3 ∼ 4ml, rapid sequential imaging 1 second duration was obtained for 16 and 30 seconds, and recorded 16 to 30 images in one film. The 4 ∼ 5 scintigraphic images obtained from the time of the first appearance of radioactivity in the abdominal aorta until its disappearance from the abdominal aorta were classified as the arterial phase of the study. In normal arterial phase, there is little or no radioactivity in the hepatic bed, compared to the lungs, heart and right kidney. When a radioactivity (early arterial staining) is depicted in the hepatic bed in the arterial phase of the scintiangiography, neoplastic condition is highly suggested. Hepatoma (47 cases) and metastasis (4 cases) show that extremely high concentration of radioactivity (early arterial staining) was noted in arterial phase in 44 cases and equivocal in 7 cases. A total of early arterial staining is concerted into the cold area in the static liver imaging. This early arterial staining is thought to be due definitely to neovascularization and feeding arteries of tumors. Liver abscess (4 cases) shows that appearance of radioactivity in the hepatic scintiangiogram as a whole was normal, except for reactive rim of hyperemia in arterial and early venous phases, but the area identified on the static liver imaging as a cold area. The hepatic scintiangiography plus static liver imaging using gamma camera system is very new diagnostic technique and proved effective in diagnosing hepatoma, metastasis and liver abscess. These findings are able to use as an aid in differential diagnosis of space-occupying lesions of the liver. We suggest that this test is therefore absolutely useful in differentiating abscess of cyst from neoplastic condition of the liver