Atypical appearance of an hepatic hemangioma with technetium-99m red blood cell scintigraphy

Three-phase 99mTc red blood cell scintigraphy is an established technique for distinguishing hemangiomas from other focal liver lesions. The most widely recognized feature is the perfusion to blood-pool "mismatch" characterized by decreased or normal arterial perfusion, with lesion activity which progressively increases over 1-2 hr. Although increased arterial vascularity of hemangiomas has been described, such cases either involved small portions of the lesion only or occurred in lesions not conclusively proven to be hemangiomas. We report a case of an angiography proven hemangioma with increased arterial vascularity involving a significant portion of the lesion as well as intense early blood-pool activity similar to that seen on delayed imaging. This case emphasizes the diverse appearance of hepatic hemangiomas using 99mTc blood cell scintigraphy.