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Title: Specific diagnosis of hepatocellular carcinoma by delayed hepatobiliary imaging

Abstract

For assessment of the value of delayed hepatobiliary imaging with technetium 99m (/sup 99m/Tc)-(Sn)-N-pyridoxyl-5-methyltryptophan (/sup 99m/Tc-PMT) for specific diagnosis of hepatocellular carcinoma, 88 patients with various malignant and benign liver diseases (49 with hepatocellular carcinoma, 4 with cholangiocellular carcinoma, 10 with metastatic liver carcinoma, 2 with liver cysts, 2 with liver hemangioma, 1 with liver abscess, 2 with intrahepatic lithiasis, 12 with liver cirrhosis, and 6 with chronic hepatitis) were studied. In 20 (41%) of the 49 patients with hepatocellular carcinoma, greater uptake of /sup 99m/Tc-PMT by the tumor than by the surrounding liver tissue was seen in delayed hepatobiliary images, whereas in eight patients (16%), equilibrated uptake was seen. No increased uptake of the radioisotope by hepatic lesions was seen in 21 patients with localized liver diseases other than hepatoma. Moreover, in 18 patients with diffuse liver diseases, no focal accumulation of the radioisotope was seen in delayed /sup 99m/Tc-PMT images. In addition, of 28 patients with hepatocellular carcinoma in whom the serum alpha-fetoprotein level showed little or no increase, 12 showed increased uptake of /sup 99m/Tc-PMT by the tumor. In assessing delayed /sup 99m/Tc-PMT images, however, it was necessary to consider following complications: accumulation of tracer in obstructedmore » and dilated biliary trees; retention of radioactivity in nonneoplastic liver tissues; difficulties in evaluating /sup 99m/Tc-PMT uptake by small hepatic tumors; overlapping of radioactivity in the gut and gallbladder in delayed /sup 99m/Tc-PMT images of tumors. This study indicates that delayed /sup 99m/Tc-PMT images can be useful in the diagnosis of hepatocellular carcinoma.« less

Authors:
; ; ; ; ; ; ; ; ;
Publication Date:
Research Org.:
Center for Adult Diseases, Osaka, Japan
OSTI Identifier:
5844318
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cancer (Philadelphia); (United States); Journal Volume: 2
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BILIARY TRACT; RADIOISOTOPE SCANNING; CARCINOMAS; DIAGNOSIS; LIVER; IMAGES; PATIENTS; PYRIDOXAL; TECHNETIUM 99; TRYPTOPHAN; UPTAKE; ALDEHYDES; AMINO ACIDS; AROMATICS; AZAARENES; AZINES; AZOLES; BETA DECAY RADIOISOTOPES; BETA-MINUS DECAY RADIOISOTOPES; BODY; CARBOXYLIC ACIDS; COUNTING TECHNIQUES; DIGESTIVE SYSTEM; DISEASES; GLANDS; HETEROCYCLIC ACIDS; HETEROCYCLIC COMPOUNDS; HOURS LIVING RADIOISOTOPES; INDOLES; INTERMEDIATE MASS NUCLEI; ISOMERIC TRANSITION ISOTOPES; ISOTOPES; NEOPLASMS; NUCLEI; ODD-EVEN NUCLEI; ORGANIC ACIDS; ORGANIC COMPOUNDS; ORGANIC NITROGEN COMPOUNDS; ORGANIC OXYGEN COMPOUNDS; ORGANS; PYRIDINES; PYRROLES; RADIOISOTOPES; TECHNETIUM ISOTOPES; YEARS LIVING RADIOISOTOPES; 550601* - Medicine- Unsealed Radionuclides in Diagnostics

Citation Formats

Hasegawa, Y., Nakano, S., Ibuka, K., Hashizume, T., Noguchi, A., Sasaki, Y., Imaoka, S., Fujita, M., Kawamoto, S., and Kasugai, H.. Specific diagnosis of hepatocellular carcinoma by delayed hepatobiliary imaging. United States: N. p., 1986. Web. doi:10.1002/1097-0142(19860115)57:2<230::AID-CNCR2820570208>3.0.CO;2-W.
Hasegawa, Y., Nakano, S., Ibuka, K., Hashizume, T., Noguchi, A., Sasaki, Y., Imaoka, S., Fujita, M., Kawamoto, S., & Kasugai, H.. Specific diagnosis of hepatocellular carcinoma by delayed hepatobiliary imaging. United States. doi:10.1002/1097-0142(19860115)57:2<230::AID-CNCR2820570208>3.0.CO;2-W.
Hasegawa, Y., Nakano, S., Ibuka, K., Hashizume, T., Noguchi, A., Sasaki, Y., Imaoka, S., Fujita, M., Kawamoto, S., and Kasugai, H.. 1986. "Specific diagnosis of hepatocellular carcinoma by delayed hepatobiliary imaging". United States. doi:10.1002/1097-0142(19860115)57:2<230::AID-CNCR2820570208>3.0.CO;2-W.
@article{osti_5844318,
title = {Specific diagnosis of hepatocellular carcinoma by delayed hepatobiliary imaging},
author = {Hasegawa, Y. and Nakano, S. and Ibuka, K. and Hashizume, T. and Noguchi, A. and Sasaki, Y. and Imaoka, S. and Fujita, M. and Kawamoto, S. and Kasugai, H.},
abstractNote = {For assessment of the value of delayed hepatobiliary imaging with technetium 99m (/sup 99m/Tc)-(Sn)-N-pyridoxyl-5-methyltryptophan (/sup 99m/Tc-PMT) for specific diagnosis of hepatocellular carcinoma, 88 patients with various malignant and benign liver diseases (49 with hepatocellular carcinoma, 4 with cholangiocellular carcinoma, 10 with metastatic liver carcinoma, 2 with liver cysts, 2 with liver hemangioma, 1 with liver abscess, 2 with intrahepatic lithiasis, 12 with liver cirrhosis, and 6 with chronic hepatitis) were studied. In 20 (41%) of the 49 patients with hepatocellular carcinoma, greater uptake of /sup 99m/Tc-PMT by the tumor than by the surrounding liver tissue was seen in delayed hepatobiliary images, whereas in eight patients (16%), equilibrated uptake was seen. No increased uptake of the radioisotope by hepatic lesions was seen in 21 patients with localized liver diseases other than hepatoma. Moreover, in 18 patients with diffuse liver diseases, no focal accumulation of the radioisotope was seen in delayed /sup 99m/Tc-PMT images. In addition, of 28 patients with hepatocellular carcinoma in whom the serum alpha-fetoprotein level showed little or no increase, 12 showed increased uptake of /sup 99m/Tc-PMT by the tumor. In assessing delayed /sup 99m/Tc-PMT images, however, it was necessary to consider following complications: accumulation of tracer in obstructed and dilated biliary trees; retention of radioactivity in nonneoplastic liver tissues; difficulties in evaluating /sup 99m/Tc-PMT uptake by small hepatic tumors; overlapping of radioactivity in the gut and gallbladder in delayed /sup 99m/Tc-PMT images of tumors. This study indicates that delayed /sup 99m/Tc-PMT images can be useful in the diagnosis of hepatocellular carcinoma.},
doi = {10.1002/1097-0142(19860115)57:2<230::AID-CNCR2820570208>3.0.CO;2-W},
journal = {Cancer (Philadelphia); (United States)},
number = ,
volume = 2,
place = {United States},
year = 1986,
month = 1
}
  • The present investigation was aimed to assess the usefulness of biliary agents scintigraphy in the diagnosis of hepatocellular carcinoma (HCC) and to ascertain the relationship between the uptake of these agents and the degree of HCC differentiation. Forty-four patients with this hepatic cancer were included in the study. Liver scans were performed 20 min and 3 hr after the administration of 99mTc diisopropyliminodiacetic acid (DISIDA). DISIDA scintigraphy could not be assessed in six cases. In 16 (42%) out of the remaining 38 patients, the tumor exhibited equal or greater radioactivity uptake than the surrounding liver. In six out of thesemore » 16 patients, tumor uptake was apparent in the early and delayed hepatic scans, while in the other ten subjects radioactivity uptake by the HCC could only be detected in the 3-hr delayed scans. In the remaining 22 patients, HCC appeared as a cold area. Tumor location by this technique did not differ from that observed by 99mTc-sulfur colloid scan or ultrasound. DISIDA uptake was significantly related to tumor differentiation: 70% of those well differentiated tumors exhibited DISIDA uptake, whereas it was found in only 30% of those moderately differentiated and in none of those poorly differentiated (p less than 0.05). These results show that DISIDA scintigraphy can be useful in the diagnosis of HCC. Since its sensitivity is related to the degree of tumor differentiation, it may be indicated when aspiration cytology is unable to distinguish between well differentiated HCC and reactive changes due to hepatic cirrhosis.« less
  • The accuracy of scintigraphy in diagnosing hepatocellular carcinoma (HCC) at Boston City Hospital between January 1, 1978 and September 30, 1983 is retrospectively reviewed. A combined protocol using technetium-99m sulfur colloid (TsSC), gallium (Ga), and scintiangiography (STA) was employed in order to enhance diagnostic specificity. There were 14 cases of HCC, of which 10 were proven histologically. The others were diagnosed clinically and angiographically. With one exception, all patients who had triple tracer scintigraphy showed a specific pattern of findings: (1) cold defects with TcSC; (2) Ga-avid foci, and (3) increased vascular supply from hepatic arteries. One false-positive study andmore » one false-negative study were originally reported, although in both cases, strict adherence to the three criteria above would have avoided diagnostic error. These results indicate that triple tracer scintigraphy may be an effective diagnostic test for HCC. The relative efficacy of scintigraphy, ultrasonography, and computerized tomography in diagnosing HCC is also discussed.« less
  • A case of hepatocellular carcinoma demonstrating increased Tc-99m DISIDA concentration on both dynamic and static scans of the liver is presented.
  • Concentration of Tc-99m(Sn)-N-pyridoxyl-5-methyltryptophan (Tc-99m PMT), a biliary agent, in hepatic tumors was studied with delayed hepatobiliary imaging in 23 patients with histologically verified hepatocellular carcinomas. All 23 showed filling defects on liver images obtained with Tc-99m tin colloid. In the images taken 5 hr after Tc-99m PMT injection, ten cases showed increased uptake in the carcinoma, six nearly normal uptake, and seven decreased uptake. In those showing the increased uptake of Tc-99m PMT in the tumor, the ratio of the radioactivity in the lesion to that in the adjacent liver parenchyma (T/L ratio) increased progressively with time for 5 hrmore » after injection. These results indicate that delayed Tc-99m PMT images, obtained 5 hr after injection, are useful in assessment of uptake of the radioactivity by hepatocellular carcinoma.« less
  • A retrospective review was made of all radionuclide hepatobiliary studies performed in a major trauma center over a 27-month period and correlated with the patients' clinical course. In a population of 42 patients (27 of whom were on total parenteral nutrition (TPN)) who had severe intercurrent illness (primarily trauma), and an additional 18 patients who had hepatocellular dysfunction, hepatobiliary imaging confirmed a patent cystic duct in 43 of 60 patients (72%). Of 17 patients who had nonvisualization of the gallbladder, four had surgically proved acute cholecystitis. The presence of gallstones, wall thickening, or sludge on sonograms did not correlate withmore » cystic duct patency, and was not specific for acute cholecystitis. Though gallbladder function is compromised in the population with severe intercurrent disease, radionuclide hepatobiliary imaging is still valuable; it can confirm a patent systic duct in at least 72% of patients if routine imaging is continued for up to 24 hours.« less