Visualization of metastatic liver disease on technetium-99m bone scintigraphy

To determine the frequency with which liver metastases are visualized on bone scintigraphy, 425 pairs of liver and bone scans, performed within one month of each other, were reviewed. Sixty-three of the 425 liver scans showed metastases. Of these 63, five cases of carcinoma of the colon and six cases of carcinoma of the lung also visualized by Tc-99m MDP scintigraphy. This represented 46% of colon metastases and 15% of lung metastases detected on liver scan. Liver metastases from other primary tumors were not detected on bone scan, but the numbers for these tumors were small. The liver metastases which were detected on bone scan were significantly larger than those which were not. The literature was reviewed and the primary and secondary tumors of liver with uptake of Tc-99m phosphate compounds listed.     

Dynamic positron emission tomography with 13N-ammonia in liver tumors

Dynamic positron emission tomography (PET) of the liver tumor was performed with a whole body multi slice PET device and 13N-ammonia. Sixteen patients with hepatocellular carcinoma (HCC) and seven patients with metastatic liver tumor were studied. In 12 of 16 patients with HCC, in which cases rich tumor vessels and dense tumor stain were proven by hepatic angiography, the tumors showed remarkable uptake of 13N-ammonia from the first scan, whereas the radionuclide accumulation was more gradual in the other part of the liver, and high tumor to liver ratio (T/L ratio) (2.62 +/- 1.09) was observed in the 1st scan, so that the tumor was clearly visualized by high contrast. However, HCC with poor blood supply from the hepatic artery or central necrosis of the tumor were demonstrated as low T/L ratio. In seven cases with metastatic liver tumor, the accumulation of 13N-ammonia was also lower than the normal liver throughout the scan. The results suggested that hepatic arterial blood flow of the liver tumors can be assessed with dynamic PET, which may provide valuable information for the characterization of tumors as well as for the evaluation of the treatment.     

Dynamic positron emission tomography with 13N-ammonia in liver tumors

Dynamic positron emission tomography (PET) of the liver tumor was performed with a whole body multi slice PET device and ¹³N-ammonia. Sixteen patients with hepatocellular carcinoma (HCC) and seven patients with metastatic liver tumor were studied. In 12 of 16 patients with HCC, in which cases rich tumor vessels and dense tumor stain were proven by hepatic angiography, the tumors showed remarkable uptake of ¹³N-ammonia from the first scan, whereas the radionuclide accumulation was more gradual in the other part of the liver, and high tumor to liver ratio (T/L ratio) (2.62±1.09) was observed in the 1st scan, so that the tumor was clearly visualized by high contrast. However, HCC with poor blood supply from the hepatic artery or central necrosis of the tumor were demonstrated as low T/L ratio. In seven cases with metastatic liver tumor, the accumulation of ¹³N-ammonia was also lower than the normal liver throughout the scan. The results suggested that hepatic arterial blood flow of the liver tumors can be assessed with dynamic PET, which may provide valuable information for the characterization of tumors as well as for the evaluation of the treatment.     

Hepatoma visualization with Tc-99m pyridoxylidene glutamate

Tc-99m sulfur colloid is concentrated in Kupffer cells of the liver, whereas the new biliary agents are processed by hepatic parenchymal cells. A case of primary hepatocellular carcinoma, appearing as a defect on sulfur-colloid liver scan and visualized on a biliary scan, is presented. The possible role of biliary scanning in the evaluation of a defect on sulfur-colloid liver scan is discussed.     

In-111 leukocyte scanning and partial functional asplenia in a patient with Sézary syndrome

Functional asplenia is described in the case report of an 80-year-old woman who was admitted with Sézary syndrome. The spleen could not be visualized by a Tc-99m tin colloid (SnC) liver and spleen scan, but was visualized by a Tc-99m sulfur colloid (SC) scan, suggesting a different mechanism in accumulation of SnC and SC in the spleen. In-111 oxine labeled Sézary cells could be found in the spleen, bone marrow, and lymph nodes.     

肝脏淋巴管扩张水肿的CT诊断与分析

目的:探讨和分析慢性肝病患者肝内淋巴管扩张水肿的CT表现及原因。方法:对68例慢性肝病患者行上腹部平扫和增强扫描,观察肝脏血管周围的影像表现。结果:18例患者在肝内血管周围有阳性改变。血管轴位像上表现为血管周围稍低密度影;血管的非轴位像上表现为沿血管两侧走行的线条状稍低密度影,血管周围阳性改变与肝功能损害程度有相关性。结论:肝内淋巴管扩张水肿在上腹部CT平扫和增强扫描图像上有其相应的影像学表现,它反映出肝内病变已引起肝内液体循环障碍。     

Ovarian carcinoma imaged by 99mTc-pyrophosphate: case report.

An ovarian carcinoma which avidly accumulated 99mTc-pyrophosphate was imaged during a bone scan. The primary tumor and its implants over the liver surface were both visualized. Although imaging of such an ovarian malignancy has not been previously reported, it offers a potential method for assessing neoplastic size and spread.     

Incarcerated primary anterior liver hernia: A case report

The anterior liver hernia is a very rare entity that mainly occurs within an incisional hernia. Primary anterior liver hernia, in the absence of a previous abdominal incision, is extremely rare. The diagnosis is suspected in patients with epigastric bulging. The confirmation requires imaging studies such as computed tomography scan (CT scan). We report the case of an incarcerated primary ventral liver hernia, in an 83-year-old man who presented with a sudden epigastric swelling. A contrast-enhanced CT scan confirmed the diagnosis of incarcerated epigastric hernia with liver and epiploic content. Risk factors were thought to be the increased intra-abdominal pressure related to benign prostate hyperplasia, as well as the old age of the patient. The surgical conservative management was successful.     

肝转移瘤高场MRI诊断

目的:探讨高场MRI在肝转移瘤(HMs)中的检出、诊断与鉴别诊断价值。方法:收集经临床、影像证实的HMs 43例,所有病例均进行高场MRI平扫和动脉期、门脉期、延迟期扫描,其中23例尚做螺旋CT平扫、动脉期、门脉期扫描,分析记录HMs螺旋CT、高场MRI平扫及多期增强扫描特征。结果:共计174枚瘤灶在MRI平扫上呈长T2长T1信号,动脉期122枚瘤灶不强化,门脉期174枚瘤灶均呈环状强化,延迟期108枚瘤灶呈向心性充填;23例79枚瘤灶螺旋CT平扫均呈低密度,动脉期49枚瘤灶不强化,30枚呈环状强化,门脉期73枚呈环状强化,4枚呈向心性充填;43例HMs高场MRI均准确诊断,螺旋CT漏检2例,误诊7例。结论:高场MRI对HMs的检出、诊断与鉴别诊断具重要价值,可作为HMs的首选检查方法。     

Disparate hepatic imaging with technetium-99m sulfur colloid and disofenin in Wilson's disease

A 10-yr-old boy presented with fulminant hepatic failure. Technetium-99m sulfur colloid images showed absent reticuloendothelial function in the liver. A [99mTc]-disofenin hepatobiliary scan visualized liver parenchyma and biliary excretion. Disparate appearance of the liver may be seen in other hepatic diseases, but should be remembered as a possible pattern in Wilson's disease.     

Analysis of liver scanning in a general hospital.

The specificity and sensitivity of liver scanning in a general referral population of 125 patients was studied. All patients had a liver biopsy prior to the scan or not more than 10 days later. The results of this study were compared with one earlier and one ongoing study in the same laboratory. The differences in accuracy are mostly attributable to the difference in the populations studied. It is apparent that the multiple-view scintillation camera technique is not superior to the rectilinear two-view scans for studying the liver.     

PET显像联合CT增强扫描对肝脏原发性肿瘤的诊断价值

目的:探讨18F-FDGPET联合CT增强扫描在肝脏原发性肿瘤诊断中的临床价值。方法:选取经穿刺活检组织检查或手术病理检查证实的肝脏原发性肿瘤16例,先行全身18F-FDGPET显像后再行肝脏CT三期增强扫描,将所得结论与病理结果进行对比评价。结果:18F-FDGPET联合CT增强扫描诊断肝脏原发性肿瘤的阳性率为93.7%,单PET显像阳性率为62.5%,单CT增强扫描阳性率为81.2%。结论:PET显像联合CT增强扫描较单独PET显像或CT增强扫描对肝脏原发性肿瘤诊断的敏感性及准确性均有明显的提高,因此PET显像联合CT增强扫描在肝脏原发性肿瘤的诊断中有较高的临床价值。     

Large focal defect on liver/spleen scan caused by fatty liver and masquerading as neoplasm.

Focal fatty infiltration of the liver may be mistaken for metastatic disease, primary tumor or other space-occupying lesions on CT or ultrasound. Usually, a 99mTc-sulfur colloid scan is sensitive in documenting the presence of Kupffer's cell in such a process. We present a case that was suggestive of focal fatty infiltrate on a CT scan, nondiagnostic on ultrasound, and seen as a large focal defect on the 99mTc-sulfur colloid liver/spleen scan. A 133Xe inhalation study, however, did show uptake in the area of fatty infiltration. A needle biopsy confirmed the diagnosis.     

MRI一站式综合扫描对活体肝移植的应用价值

 目的 研究MRI一站式综合扫描对活体肝移植的应用价值.方法 选择活体肝移植的患者及供体各20名.进行MRI扫描,包括3.0T磁共振采用常规血管四期增强扫描.磁共振平扫采用flash序列及TSE序列扫描.血管增强后选择与平扫相同的T,vibe压脂序列进行扫描.依据个体需要,在注射后40-120 min之间进行延迟扫描.以手术所见为参考标准,比较MRI平扫与一站式MRI综合扫描(MRI平扫+MRCP+血管增强+肝实质增强+延迟)对病灶检出的敏感度,评估其诊断价值.结果 MRI平扫对供体/受体血管变异、胆道变异和癌变的检出敏感性分别为40.0%、72.22%、75.0%.而一站式MRI扫描对病灶检出的敏感性都为100.0%,两种方法对后两种病变的敏感性比较差异有统计学意义(P<0.05).结论 在活体肝移植中一站式MRI综合扫描检查具有重要价值.     

Scintigraphic elvaluation of liver metastases from thyroid carcinoma.

Thirty-one patients with carcinoma of the thyroid were evaluated using 131-I scan of the torso including the area of the liver. Focal areas of 131I uptake were found in the liver in two patients with follicular thyroid carcinoma. Both patients showed associated abnormalities on 99m-Tc-sulfur colloid liver scans. The remaining 29 patients showed either no uptake or a normal diffuse pattern of 131-I uptake in liver. Careful evaluation of the liver is recommended on the radioiodine body scan for metastases in patients with thyroid carcinoma.     

Gd-EOB-DTPA对多b值肝脏DWI中表观弥散系数值的影响

目的 通过行肝脏多b值弥散加权成像（DWI）,观察注射钆塞酸二钠（Gd-EOB-DTPA）前、后不同时相表观弥散系数（ADC）值的变化,探讨增强后行DWI的可行性。方法 收集行Gd-EOB-DTPA肝脏增强的受检者126例,其中,例行体检的健康志愿者30名,肝脏病变患者96例（原发性肝癌25例、转移性肝癌20例、肝血管瘤28例、肝囊肿23例）,均经临床或病理证实。在Philips Achieva 1.5T双梯度超导MR成像系统上,行同相与正反相T1加权像闭气轴位平扫及轴位呼吸门控DWI。通过肘静脉向受检者注射0.025 mmol/kg Gd-EOB-DTPA,行动脉期、静脉期、3 min期、10 min期、20 min期、30 min期闭气轴位T1加权高分辨率各向同性容积激发序列（THRIVE）扫描,在5 min期,行轴位T2加权像脂肪抑制呼吸门控扫描,在15 min期,行轴位呼吸门控DWI后,接着行冠状位T2加权闭气扫描,在25 min期,行轴位呼吸门控DWI。平扫期、15 min期、25 min期的DWI参数完全一致,为单次激发自旋回波-平面回波成像（SE-EPI）序列,b值依次取0、50、300、600 s/mm2,扫描时间196 s。在EWS工作站上,通过ADC分析函数生成平扫期、15 min期、25 min期在b=50、300、600 s/mm2时的ADC图,测出正常肝脏、原发性肝癌、转移性肝癌、肝血管瘤、肝囊肿的ADC值,对同一b值下同一疾病在平扫期、15 min期及25 min期的ADC值进行t检验,分析是否存在统计学差异。结果 同一b值下同一疾病的ADC值在平扫期时最大,随着Gd-EOB-DTPA的注入,ADC值开始下降,然后上升,到了25 min期,ADC值与平扫期时基本一致,15 min期的ADC值最低,平扫期、15 min期、25 min期的ADC值差异无统计学意义（t=0.25~1.29,P均>0.05）。同一疾病同一时相的DWI中,随着b值的增加,ADC值不断下降,b值越小,ADC值越大。结论 静脉注射Gd-EOB-DTPA后,肝脏ADC值下降十分有限,增强后行DWI是可行的。     

Prominent gaseous distension of bowel causing false-positive technetium-99m sulfur colloid liver scintigram

A Tc-99m sulfur colloid liver scan carried out shortly after a prolonged upper gastrointestinal endoscopy demonstrated two concave indentations along the inferior border of the liver and increased space between the left lobe of the liver and the spleen. These abnormalities, simulating compression by an extrinsic mass, were caused by air introduced endoscopically into the gastrointestinal tract. Eight days later, a repeat radiocolloid scan was normal. There should be awareness that gaseous distension of the bowel and stomach may result in a false-positive radiocolloid liver scan. Correlation with abdominal radiographs may avert such misinterpretation.     

Hepatic abscess in liver transplantation. Accurate diagnosis and treatment

Serial HIDA scanning was performed on a patient following liver transplantation. During the patient's course he developed biliary obstruction that manifested as a photopenic region in the liver, on the HIDA scan which filled in on the delayed views. The patient subsequently developed a region in the superior portion of the right lobe of the liver that did not fill in with activity on delayed views. The patient was experiencing low-grade fevers and was clinically believed to have either an abscess or an episode of rejection. A gallium scan was performed revealing a photopenic defect in the same region as the HIDA. Because of the clinical suspicion of abscess, a percutaneous transhepatic drainage study was performed, revealing a large abscess cavity in the suspect area within the liver. Following the drainage the patient did well. This case illustrates the usefulness of serial HIDA scanning in patients who have received liver transplants. It also is important to note that the gallium scan was negative in this hepatic abscess. In the authors' opinions, the finding of an intrahepatic fluid collection in a septic patient that does not fill with activity on the HIDA study, should be considered the source of the infection, until proven otherwise, and should be drained regardless of the findings of other studies.     

药物性肝损害的多层螺旋CT影像表现

目的 探讨药物性肝损伤的MSCT表现.方法 回顾性分析2008年5月至2010年1月间经临床及病理证实的40例药物性肝损伤患者的MSCT影像及临床资料,总结其影像表现特征.结果 药物性肝损伤的MSCT影像表现主要有3种类型.(1)弥漫性肝脏损害2例:平扫肝脏密度均匀性减低,增强扫描肝实质轻度均匀强化.病理表现为肝细胞脂肪变性;混合炎性细胞浸润,点状坏死,毛细胆管淤胆.(2)灶性肝脏损害6例:肝内大片或多发小片状坏死灶5例.平扫肝脏密度不均匀,病变区为低密度改变;增强后病变区强化,特别是静脉期与平扫图像比较呈反转表现.另1例病程20 d的移植肝显示肝内弥漫的结节样再生.CT平扫可见肝内弥漫分布的稍高密度结节灶,增强后动脉期病灶强化,静脉期及延迟期近似于肝实质密度.5例患者病理表现为肝细胞片状及桥接坏死,大量混合炎性细胞浸润;1例重度淤胆,假小叶形成,肝细胞羽毛变性.(3)肝硬化表现2例:平扫肝脏表面呈结节状,肝叶比例失调,肝裂增宽.增强后肝脏强化一致,同时伴有脾大、腹水、侧支循环.病理为纤维组织增生,点状坏死和毛细胆管淤胆.结论 药物性肝损伤的MSCT影像表现具有一定的特征性,对临床诊断具有重要的参考价值.     

Thallium-201 for myocardial imaging: appearance of the normal heart.

Thallium-201 myocardial perfusion images were obtained from 13 healthy adults after tracer administration both at rest and at maximal stress. On the rest-injected scan, tracer was seen in left ventricular myocardium, liver, and spleen. In two subjects with resting tachycardia, the right ventricular myocardium was slightly visualized after tracer injection at rest. When tracer was administered at stress, the left ventricular activity was more nearly homogeneous and the left ventricle was better defined on the scan. The left-ventricle-to-lung-background activity ratio increased from 2.4 at rest to 3.4 at stress. The right ventricular myocardium was seen on the stress-injected scan. Phantom studies, performed to define the optimum position for visualization of lesions, showed that small lesions were best defined when seen either en face or in tangent. Scans should be performed at stress whenever possible and multiple views are essential.