Liver

• COLLOID LIVER SCINTIGRAPHY indications?

  • reticuloendothelial activity.
  • Differential diagnosis of nodular hyperplasia from other liver tumors
• what Rf is used in colloid liver scintigraphy?

  • 99mTc labelled colloid => rapidly phagocytized by the reticuloendothelial cells of the liver, spleen and bone marrow
  • 99mTc sulfur collide => preferred for liver-spleen imaging
  • 99mTc nanokol
• colloid liver scintigraphy procedure

  • RF iv dose of 100-200 MBq
  • May perform dynamic record first 5min
  • SPECT/CT carried out after 10-15 min in the supine position
  • Record planar projection anterior, posterior and two side entry
  • 360s tomographic reconstruction in three planes
  • Quantification of the record
• indication for blood pool liver scan?

  examines vascularization in cavernous hemiangioma of the liver
• what Rf is used in blood pool liver scan?

  99Tc labelled RBC
• blood pool liver scan procedure?

  • In vitro labelling of RBC
  • Examination in supine position, application of 99mTc-RBC and dynamic record perfusion suspect bearing
  • Static images - the size and designation of the liver
  • After 40-60min SPECT/CT - bearings with increased blood flow in the liver
  • If the findings are inconclusive, repeat the planar and SPECT/CT at the 3rd hour
• indications for hepatic perfusion imaging?

  selective perfusion and shunts,

  used to determine if intra-arterial administration of chemotherapeutic agent is being optimally delivered
• what Rf is used in hepatic perfusion imaging?

  99mTc MAA (albumin aggregate)
• hepatic perfusion imaging procedure?

  RF iv dose 110-220 MBq through the hepatic artery catheter
• what is the principle of hepatobiliary scintigraphy?

  imaging method which evaluates hepatocellular function and checks for obstruction of the biliary system by tracing the production and flow of bile from the liver through the biliary system into the small intestine
• indications for hepatobiliary scintigraphy?

  • Evaluation of typical biliary pain
  • Assessment of gallbladder ejection fraction (GBEF)
  • Investigation of suspected sphincter of Oddi dysfunction (SOD) in patients with postcholecystectomy pain
  • Investigation of congenital anomalies of the biliary system (biliary atresia and choledochal cysts)
  • Imaging post-operative patients (bile leak, hepatico- enterostomy, and biliary fistula)
  • Investigation of suspected cholecystitis (normal ultrasound)
  • Evaluation of liver transplantation (demonstrating function in auxiliary liver)
• what Rf is used in hepatobiliary scintigraphy?

  • 99mTc DISIDA (hepatolite)
  • 99mTc EHIDA (diethylkarbonil iminodiacetic acid)
• how is the patient prepped in hepatobiliary scintigraphy?

  1. Fasting 2-6h before examination
  2. Morphine augmentation is an accepted modification in cases of gallbladder non-visualization
  3. Slow iv administration of sincalide (analogue of cholecystokinin) in order to stimulate gallbladder emptying
• hepatobiliary scintigraphy procedure?

  1. RF iv dose 200-300 MBq
  2. Examination supine, gamma camera in the front projection
  3. Dynamic record for 45 to 60 minutes (an image every 30 or 60sec)
  4. If you receive the gallbladder in 40 min was administered to a patient complaint diet (chocolate) cheaper or more expensive Cholecystokinin.
  5. If by the end examinations displayed activity in the duodenum, accordingly sintigrams
• what are the phases of hepatobiliary scintigraphy?

  1. Vascular phase (0-3 mins)
  2. Hepatic phase (3-15 min)
  3. Biliary phase (15-30 min)
  4. Intestinal phase (30-60 min)
• what is examined in the vascular phase of hepatobiliary scintigraphy?

  blood flow heart, great vessels and capillaries.
• what is examined in the hepatic phase of hepatobiliary scintigraphy?

  uptake of RF by hepatocytes

  liver parenchyma

  intra-hepatic bile ducts.
• what is examined in the biliary phase of hepatobiliary scintigraphy?

  performance of bile water, gallbladder and duodenum
• what is examined in the intestinal phase of hepatobiliary scintigraphy?


  • shows the activity in the intestine.
  • decreased activity in biliary vessels and the liver.
• what types of radiotherapy are used to treat hepatocellular carcinomas?

  1. external beam radiotherapy
  2. percutaneous thermal ablation
  3. selective internal radiation therapy
• how is external beam radiotherapy used to treat liver tumours?

  Stereotactic irradiation (radiosurgery) of colorectal carcinoma metastasis (total dose 36 Gy) + follow up after 2months
• how is percutaneous thermal ablation used to treat liver tumours?


  A procedure that uses an energy source (either heat, cold, or chemical) to destroy cancerous tissue in a target organ
• how is selective internal radiation therapy used to treat liver tumours?


  intra-arterial application of small particles (Yttrium 90) which do EMBOLISATION of capillaries in tumors.
• what Rf is used in selective internal radiation therapy (SIRT)?

  Yttrium 90

  • beta emitter,
  • t1/2 = 64.2h
  • 2.5mm penetration
• indications for liver tumour scintigraphy + radiotherapy?

  • primary hepatocellular carcinoma
  • Unresectable hepatocellular carcinoma with/without portal vein thrombosis
  • Liver metastasis
  • Liver metastasis of colon cancer
• contraindications of liver tumour scintigraphy + radiotherapy?

  • Pretreated SHUNT demonstrating potential for >30Gy radiation exposure, that cannot be corrected by interventional radiation embolization
  • Excessive Tumor burden with limited hepatic reserve
  • Elevated bilirubin >2 mg/dl in absence of a reversible cause
• complications of liver tumour scintigraphy + radiotherapy?

  • Radiation Pneumonitis
  • Hepatic Dysfunction
• what is the patient follow-up after liver tumour scintigraphy + radiotherapy?

  • Post-procedure SPECT/CT performed to assess dose of Y-90 to target lesion
  • Patients are observed for 2-6h
  • Lab values are evaluated 4-6 weeks after the procedure
  • Triple phase CT or MRI done after 4-6 weeks
  • Pharmacotherapy: PPI for 7-10 days are given to prevent gastritis
• what is the patient follow-up after liver tumour scintigraphy + radiotherapy?

  • 35-47% response rate,
  • median survival of 15-24months,
  • safe with treatment with portal vein thrombosis and combination with chemotherapy
• What is hemangioma?

  Hemangioma is a benign (noncancerous) tumor made up of blood vessels.
• what Rf is used in hemangiomas?

  99mTc-Erythrocytes; dose = 550 MBq IV
• what is the principle of 99mTc-Erythrocytes use in hemangiomas?

  99mTc activity remains in the blood for as long as the RF decays (4h).
• what is biliary atresia?

  Biliary atresia is a childhood disease of the liver in which one or more bile ducts are narrowed, blocked or absent
• what Rf is used for biliary atresia?

  99Tc-EHIDA (diethylkarbonil iminodiacetic acid)

  99mTc-DISIDA (Hepatolite)
• what imaging is used in biliary atresia?

  hepatobiliary scintigraphy
• what Rf is used in hepatopulmonary shunt?

  99mTc-MAA (albumin aggregate)
• what treatment is used in hepatopulmonary shunt?

  Selective Internal Radiation Therapy (SIRT)
• How can we diagnose hemangioma of the liver?

  • imaging test, such as an ultrasound, SPECT/CT, or MRI scan.
  • Liver blood pool imaging with Radiopharmaceutical 99mTc-ERY
• What is Cholescintigraphy?

  Cholescintigraphy is a test to evaluate the health and function of the gall bladder and biliary system.
• what is the principle of cholescintigraphy?

  If there is obstruction the RF will not empty as usual into the duodenum, but it will be stacked at the point of the obstruction.