Liver/Spleen Scan

Indications:
  • Assessment of anatomy, size, and relative position of liver and spleen.
  • Assessment of hepatomegaly, splenomegaly, splenic infarcts, accesory spleen or splenosis, or situs inversus.
  • Assessment of benign Kupffer cells focal lesions (hemangioma, hamatoma) and hepatocellular focal nodular hyperplasia.
  • confirmation of specific space-occupying lesions - hepatic focal nodule hyperplasia
  • diffuse liver diseases - cirrhosis,hepatitis, and jaundice.

Contraindications:

Study should not be performed after a Barium study. You must wait up to 3 days because attenuation artifacts may occur due to lingering contrast. Also if the patient is pregnant.

Radiopharmaceutical information:
  • Radionuclide: Tc-99m
  • Radiopharmaceutical: Sulfur Colloid (Liver) Pertechnetate (Spleen)
  • Adult dosing: 5mCi (Liver), 25mCi (Spleen)
  • Pediatric dosing: 30-50uCi/kg-Minimum 300uCi (Liver)
  • Method of administration: IV Bolus
  • Method of Localization: Phagocytosis
  • Physical Half-life: 6 hours

Patient Preparation: Inject Tc-99m Sulfur Colloid Intravenously, commence imaging 20 minutes after injection.



Equipment Used:
Type of Camera or Probe: Large-field-of-view Gamma Camera
Collimator used: Parallel Hole, LEHR
Window: 20%

Acquisition Setup:

Dynamic: View(s)
Matrix: 128 X 128
Time/Frame: 1-3 sec/frame for 1 minute
Number of Frames: 60 frames

Statics: View(s)
Matrix: 128 X 128
Total Counts or Duration: 60 seconds or 500kcts - 1 million cts

Whole body: View(s)
Matrix:
Scan Speed:
Start/stop points:

SPECT:
180 or 90 degree configuration
Total Rotation: Single-head 360 (Clockwise) (Dual headed - 180 degrees clockwise)
Starting point:
Matrix:128x128
Time/Azmuiths: 10 sec/step
Number of Azmuiths: 128 steps

Procedure:
.There is no patient preparation prior to this procedure. The patient receives an intravenous injection of Tc-99m SC which will accumulate in the reticuloendothelial cells of the liver and spleen. After 20 minutes the patient will be asked to lie down and start imaging. The camera should be rotated to acquire each view and a marker should be placed approximately on the liver to acquire your marker image. The test is painless and will usually take 30 minutes to be completed.There should be no adverse side effects after the procedure.



Normal Uptake and common varients:
external image ls001ls171.gif
Normal distribution of radiopharmaceutical to liver, spleen and bone marrow with enough image contrast. Uniform uptake and more activity of the radiopharmaceutical is seen in the liver with less uptake and activity in the spleen.

http://gamma.wustl.edu/ls001ls171.gif


Abnormal Uptake and causes:
Insert an image of an abnormal scan. Describe the abnormal uptake, and the cause of the abnormal uptake.

liver.gif
33 year old woman was found to have an abnormal epigastric mass after a routine physical examination; the patient had a Ct examination and then had a liver-spleen procedure to further evaluate the mass. Increased colloid uptake is seen in the left lobe of the liver which corresponds to a 7 cm mass when compared with the CT examination. This image does not have attenuation correction which should result with deeper structures having less activity than is seen when compared with the mass on the left lobe. The woman was diagnosed with focal nodular hyperplasia

Artifacts:
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Superior vena cava obstruction is an artifact that occurs when Tc-99m Sulfur Colloid is injected into the upper extremity of the patient appearing near the quadrate lobe of the liver. This creates an area of increased uptake, or hot spot, at the insertion site of the left umbilical and left portal veins due to blood flow.

Questions asked in Patient History:
When was the last time you had anything to eat or drink?
Have you had any abdominal pain? Where, when, and for how long?
Do you have any history of cancer? What type and when were you diagnosed?
Do you have any problems with the liver? (Cirrhosis, Hepatitis, Injury)
Have you had any recent surgeries? When and what type?
Have you had any recent trauma? What and when?
Are you a diabetic?
Have you been experiencing and nausea or vomiting? When does it occur and for how long?
Do you have a fever? If yes for how long?
Have you had any other related tests? What and when?(CT, ultrasound, X-ray etc.)
Does your patient look jaundice?
Have you had any abnormal blood results? What test and when?
Are you taking any medications? What kinds?
Are you pregnant or breastfeeding? If there is a possibility do a pregnancy test.
How often do you have alcoholic beverages? Also how many within one sitting/day?





References:
Nuclear Medicine Technology: Procedures and Quick reference (2nd edition) -- Pete Shackett