J Nucl Med. 2007; 48 (Supplement 2):277P
General Clinical Specialties: Gastroenterology
Gastroenterology Posters |
Liver-spleen scintigraphy revisited
Dwight Achong1 and
Martin Zloty1
1 Nuclear Medicine Service (115), James A. Haley Veterans' Hospital, Tampa, Florida
1248
Objectives: With the increasing use of ultrasound, MRI and CT for anatomic evaluation of the liver and spleen, functional imaging with Tc-99m sulfur colloid (SC) has become an underappreciated (and possibly underutilized) study. The ordering practices and imaging results of liver-spleen (LS) scintigraphy at a busy VA Medical Center were reviewed and analyzed. Methods: Over an 8 month period, 160 LS scans (153 men and 7 women, age range 29-87 yrs, mean 65 yrs) were ordered by just 3 services: Hematology/Oncology (77%), Primary Care/Medicine (17%), Gastroenterology (6%). The vast majority, 140/160 (88%), were done specifically for evaluation of hematologic abnormalities (e.g., pancytopenia, thrombocytopenia, anemia, CLL, polycythemia, leukocytosis). Other indications included (?) splenosis, (?) splenomegaly, (?) focal nodular hyperplasia (FNH), (?) underlying hepatic disease. Standard imaging protocol utilized 6 mCi SC and planar imaging of the abdomen/pelvis in anterior, posterior, oblique and lateral projections. SPECT imaging (n=10) was reserved for evaluation of liver or intra-abdominal soft tissue masses. Scans were routinely assessed for liver pliability on inspiration/expiration, homogeneity of SC uptake in liver, spleen and bone marrow, presence/absence and severity of SC shift to spleen/bone marrow, and organ size, and correlated with available ultrasound/CT and pertinent blood work. Results: 52/160 (33%) scans were normal. Abnormal findings included: SC shift only to the spleen, 46/160 (29%); SC shift only to bone marrow, 2/160 (1%); SC shift to both spleen and bone marrow, 38/160 (24%); decreased liver pliability 12/160, (8%); hepatomegaly, 42/160 (26%); splenomegaly, 45/160 (28%); heterogeneous SC uptake throughout the liver (suggesting the presence of hepatic disease such as cirrhosis), 13/160 (8%). 52/160 (33%) scans had more than one abnormal finding. Overall, 97/140 (69%) studies ordered for hematologic indications had at least one abnormality. For non-hematologic indications, splenosis was confirmed in 7/8 cases and 0/1 FNH. Conclusions: At our institution, there continues to be a role for functional LS scintigraphy, a simple and easily performed study. It is particularly useful in the work-up of hematologic abnormalities; e.g., the presence of SC shift to the spleen would support "hypersplenism" as an etiology of thrombocytopenia or pancytopenia.
