Clinical Aspects of Pulmonary Radioactivity Observed in Radiocolloid Liver Scintigraphy

간 스캔에서 관찰되는 폐 방사능에 관한 임상적 고찰

  • So, Young (Departments of Nuclear Medicine, Chungnam National University Hospital) ;
  • Lee, Kang-Wook (Departments of Internal Medicine, Chungnam National University Hospital) ;
  • Lee, Heon-Young (Departments of Internal Medicine, Chungnam National University Hospital) ;
  • Lee, Won-Woo (Department of Nuclear Medicine, Asan Medical Center)
  • 소영 (충남대학교병원 핵의학과) ;
  • 이강욱 (충남대학교병원 내과) ;
  • 이헌영 (충남대학교병원 내과) ;
  • 이원우 (서울아산병원 핵의학과)
  • Published : 2002.06.30

Abstract

Purpose: We studied clinical aspects and courses of patients with pulmonary radioactivity on liver scintigraphy and speculated the mechanism of pulmonary uptake of radiocolloids. Materials and Methods: Forty-nine patients with pulmonary radioactivity were classified into 5 disease groups-liver disease, infection, cancer, ischemic necrosis of liver, etc.- and their presence or absence of chronic liver disease (CLD), Child-Pugh class, serum levels of AST and ALT, results of follow-up liver scintigraphy and clinical course were checked. Results: Of total 49 patients 25 had CLD; there were 23 liver disease patients, 16 infection patients, 7 advanced cancer patients, 2 ischemic necrosis of liver patients, and 1 hemolytic anemia patient. Reversible rise of serum levels of AST and ALT was observed in all patients with liver disease and ischemic necrosis of liver; on one-way ANOVA, these rise were statistically significant (p<0.01). Serum level of ALT of liver disease group patients without CLD was significantly higher than that of infection group patients without CLD (p<0.05). Among 17 patients who underwent follow-up liver scintigraphy, 13 showed no pulmonary radioactivity. Total 12 patients died during follow-up and most of them were terminal cancer patients or CLD patients of Child-Pugh class C. Conclusion: Pulmonary radioactivity of radiocolloid liver scintigraphy could be attributed to the mobilization of reticuloendothelial system (RES) cells by the activation of RES cells in severe infection and terminal cancer, and also by the extensive liver destruction in liver diseases.

목적: 방사성교질 간 스캔에서 폐 방사능이 관찰된 환자들의 임상적 소견을 바탕으로 간 스캔에서 폐 방사능이 관찰되는 질환의 종류를 알아보고 각 질환에 따른 폐 방사능 섭취 기전 및 환자 임상 경과를 알아보았다. 대상 및 방법: 대상 환자 총49명의 의무 기록 조사를 통하여 Tc-99m tin colloid 간 스캔에서 폐 방사능이 관찰될 당시의 주 진단명을 기준으로 대상 환자를 간 질환, 감염성 질환, 암, 허혈성 간 괴사, 기타 등 다섯 가지 질환군으로 분류하고, 각 질환군 환자들의 만성 간 질환 여부, Child-Pugh 등급, 혈청 AST, ALT수치, 추적 간 스캔 결과 및 임상 경과를 알아보았다. 결과: 총 49명중 25명에서 만성 간 질환이 있었고, 질환군별 환자수는 간 질환 23명, 감염성 질환 16명, 암 7명, 허혈성 간 괴사 2명, 기타 1명이었다. 혈청 AST, ALT 수치는 간 질환군과 허혈성 간 괴사 군 환자 모두에서 가역적 상승을 보였고, 이는 통계적으로 유의하였다(p<0.01, one-way ANOVA). 혈청 ALT 수치는 만성 간 질환이 없는 간 질환군에서 감염성 질환군에 비하여 유의하게 높았다(p<0.05). 추적 간 스캔검사가 시행된 총 17명 중 13명에서 추적 간 스캔에서 폐 방사능이 관찰되지 않았으나, 암 2명, 간과 신장의 다낭성 질환과 간 경변이 있는 독성 간염 1명 그리고 간 결핵 1명에서 추적 간 스캔에서 폐 방사능이 관찰되었다. 사망 환자는 총 12명으로 사인은 만성 간 질환 악화에 의한 간 부전 6명, 말기암 5명, 감염성 심내막염에 합병된 뇌출혈 1명이었다. 결론: 간 스캔에서 폐 방사능은 망상내피계 세포가 자극되는 심한 감염증 및 말기 암, 그리고 광범위한 간의 염증 또는 괴사를 동반하는 급, 만성 간 질환 및 허혈성 간 질환 등에서 관찰되는 것으로 판단된다.

Keywords

References

  1. Steinbach HL. Pulmonary accumulation of99mtechnetium sulfur colloid during liver scanning.Tex Med 1972;68:137-8.
  2. Keyes Jr JW, Wilson GA, Quinones JD. Anevaluation of lung uptake of colloid during liverimaging. J Nucl Med 1973;14:687-9l.
  3. Gillespie PJ, Alexander JL, Edelstyn GA. Highconcentration of 99mTc-sulfur colloid foundduring routine liver scan in lungs of patient withadvanced breast cancer. J Nucl Med 1973;14:711-712.
  4. Turner JW, Syed IB, Hanc RP. Lung uptake of9~c-sulfur colloid during liver scanning. J NuclMed 1974;15:462-4.
  5. Imarisio JI. Liver scan showing intense lunguptake in neoplasia and infection. J Nucl Med1975;16:188-90.
  6. Ziessman HA. Lung uptake of 99mTc_sulfurcolloid in faIciparum malaria: case report. J NuclMed 1976;17:794-6.
  7. Klingensmith III WC, Ryerson TW. Lunguptake of 99mTc-sulfur colloid. J Nucl Med1973;14:201-4.
  8. Klingensmith III WC, Ryerson TW, Corman JL.Lung uptake of 99~c-sulfur colloid in organtransplantation. J Nucl Med 1973;14: 757-9.
  9. Jacobson AF, Teefty SA, Higano CA, BiancoJA. Increased lung uptake of 99Tcm-sulphurcolloid as an early indicator of the developmentof hepatic veno-occlusive disease in bone marrowtransplant. Nucl Med Commun 1993;14:706-1l.
  10. Klingensmith III WC, Yang SL, Wagner HL.Lung uptake of 99mTc_sulfur colloid in liver andspleen imaging. J Nucl Med 1978;19:31-5.
  11. Kaplan WD, Drum DE, Lokich rr. The effect ofcancer chemotherapeutic agents on the liverspleenscan. J Nucl Med 1980;21:84-7.
  12. Klingensmith III WC, Tsan M, Wagner HL.Factors affecting the uptake of 99mTc_sulfurcolloid by the lung and kidney. J Nucl Med1976;17:681-4.
  13. Mikhael MA, Evens RG. Migration andembolization of macrophages to the 1ung-apossible mechanism for colloid uptake in thelung during liver scanning. J Nucl Med 1975;16:22-7.
  14. Koblik PD, Hornof WJ, Yen C-K, Fisher PE,Komtebedde J. Use of technetium-99m sulfurcolloid to evaluate changes in reticuloendothelialfunction in dogs with experimentallyinduced chronic biliary cirrhosis and portosysternicshunting. Am J Vet Res 1995;56:688-93.
  15. Koblik PD, Homof WJ. Technetium 99m sulfurcolloid scintigraphy to evaluate reticuloendothelialsystem function in dogs with portasystemicshungs. J Vet Int Med 1995;9:374-80.
  16. Winter PF, Perl LJ, Johnson PM. Lung uptake ofcolloid during liver-spleen scanning: a normalfinding in children. Nuklearmedizin 1976;15:294-6.
  17. Cohen MB. Reducing particle size in 99mTcsulfur colloid preparations. J Nucl Med 1970;11:767-8.
  18. Park CH, Mansfield CM. The recognition andinterpretation of extrahepatic uptake of 99mTcsulfur colloid in liver scanning. J Natl MedAssoc 1973;65:104-7.
  19. Bobinet RD, Sevrin R, Zurbriggen MT, SpolterL, Cohen MB. Lung uptake of 99~C_Su1furconoid in patient exhibiting presence of A13+ inplasma. J Nucl Med 1974;15:1220-2.
  20. Harper PV, Lathrop KA, Gottschalk A.Pharmacodynamics of some teclmetium-99mpreparations. In; Anderws GA, Kniseley RM,Wagner HN, editors. Radioactive pharmaceuticals.Symposium series 6, CONF-651111, OakRidge: USAEC; 1966. p. 335-358.