The evaluation of 'Tree-like' defects on the liver scintigram

Total 3347 liver scintigram which had been performed for 2 years, Apr. 1979 to Apr. 1981 were reviewed retrospectively and 293 of them revealed 'tree-like' defects extending from porta hepatis to the periphery. For obtaining correlation of such defects with hepatobiliary disorders and the clinical significance of them, we studied 61 cases which were confirmed by PTC, ERCP and/or surgery, and we established 3 subjective grades according to size of the defects seen on the ant. scintiscan. After analysis of these scintigraphic findings and the relation to the clinical findings, the results obtained were as follows: 1. The appearance of 'tree-like' defects on the liver scan is suggested characteristic of obstructive lesion in biliary system. 2. The hepatobiliary disorders with more severe biliary obstruction showed more distinct defects on the liver scan. 3. 'Tree-like' defects could be seen in the patient with cholecystitis or clonorchiasis. 4. The long duration of jaundice and higher level of serum bilirubin and alkaline phosphatase are, the large and more distinct defects could be seen on the liver scan. Based on the results of this study, it is concluded that tree-like defects of porta hepatis on the liver scan might be an important finding strongly suggesting obstructive hepatobiliary disorders even though scintigram using 99mTC sulfur-colloid has been considered as a diagnostic method for hepatic parenchymal disorders such as liver cirrhosis and space-occupying lesion. Colloid scintigram is also thought as a noninvasive useful diagnostic method in differential diagnosis of lcteric patients. Futhermore, when 'tree-like defect' on the liver scan is shown, invasive procedure such as PTC, PTCD, ERCP and ERCD should be done on these patients to determine the nature of the lesion and to give adequate treatment