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Improved Evaluation of Technetium-99m-Red Blood Cell SPECT in Hemangioma of the Liver

Albert-Ludwigs-Universität, Radiologische Universitätsklinik, Abteilung Nuklearmedizin and Abteilung Röntgendiagnostik,, Freiburg, F.R.G.

Correspondence: For correspondence or reprints, contact: Thomas Krause, MD, Radiologische Universitätsklinik, Abteilung Nuklearmedizin, Hugstetter Strasse 55, 7800 Freiburg, FAG.

ABSTRACT

This paper reports the results of a prospective study carried out to evaluate a new reading method of tomographic ^99mTc red bloodcell (RBC) imaging in liver hemangiomas. For this purpose, assessment of planar imaging and conventional, static ^99mTc-RBC SPECT presentation (x-ray type film) (Method 1) was compared to a dynamic three-view display of SPECT slices (Method 2) in 21 patients with 56 hemangliomas and 18 patients with malignant liver lesions. Of the 56 hemangiomas, 47 were diagnosed by US, 6 by CT and 56 by MRI. Twenty-nine (52%) hemangiomas were detected by planar scintigraphy and 38 (68%) by SPECT Method 1, whereas 53 (95%) were visualized by SPECT Method 2. Comparing Methods 1 and 2 in hemangiomas 1.0 cm, 1.1–2.0 cm and 2.1–3.0 cm in diameter, Method 2 improved sensitivity from 18% to 82%, 50% to 93% and 82% to 100%, respectively. The smallest hemangioma detected with Method 2 was 0.5 cm in diameter; with Method 1, 0.9 cm; and with planar imaging,1.0 cm. As assessed by evaluation of the metastases and carcinomas, the specificity for hemangioma was 100%, independent of the method applied, resulting in a positive predictive value of 100%. This study suggests that evaluation of dynamically displayed ^99mTc-RBC SPECT studies is superior to conventional reading of static display and comparable to MRI in liver hemangioma 1 cm. Therefore, this approach is suggested as an alternative to MRI for confirming the diagnosis of liver hemangioma 1 cm if planar imaging is negative. This option is available with most modern computer software systems and saves additional disbursement.