간혈관신티그램의 정상성과 간암 및 간농양에서의 변화

Hepatoscintiangiography of Normal Liver and Its Alteration in Hepatomas and Liver Abscess

This study was performed to establish normal hepatoscintiangiographic(HSA) pattern of hepatic blood flow and to investigate dynamic differential HSA findings of primary and metastatic carcinomas and abscess of the liver. HSA was carried out after intravenous bolus injection of 10 mCi of Tc-99m-phytate by obtaining sequential anterior images of 1-second exposure for 16 seconds. Observations included (1) baseline study of normal hepatic blood flow pattern by correlating with contrast angiogram, (2) time sequence phasing of normal HSA, and (3) analysis of altered patterns in primary and metastatic carcinomas and abscesses of the liver. Materials consisted of 20 normal subjects, 28 primary hepatocellular carcinomas, 16 metastatic carcinomas and 7 liver abscesses. Results were: (1) Normal HSA demonstrated 3 distinct phases of arterialization(AP), of arterial hepatogram(AHP), and of portal venous hepatogram(PVHP). The means of each phase were 5.3, 6.3 and 8.3 seconds, respectively. Portal vein could be seen in all but one of 20 normal subjects. (2) Pattern changes in diseases groups were early start of AP in carcinomas and very early start of AP in abscesses. AP became prolonged in all disease group. (3) Distinction between AHP was sharp in metastasis and abscesses but un sharp in primary hepatoma. Cold area or areas became vascularized in primary hepatoma but not in abscess. Cold areas of metastasis were inhomogeneously vascularized in late AP and throughout AHP and became relatively vascular as PVHP began. The cold area of abscess showed rim enhancement during AH and APH. These differences in HSA pattern were very useful in differential diagnosis of the diseases studied.