Nuclear medicine hybrid imaging (SPECT/CT) in distinguishing the presence of a hepatic hemangioma – single center study
Abstract
Introduction
Hepatic hemangioma (HH) is the most common benign liver tumor, and the second most frequent tumor in the liver after hepatic metastasis. Clinicians often encounter а diagnostic dilemma of whether the detected hepatic lesion/mass is а benign or malignant tumor. The SPECT/CT hybrid technique will be beneficial for the investigation of this type of HH since it can precisely identify the hepatic lesions. It is possible to avoid other more invasive procedures like biopsy by using the non-invasive and highly specific technique of scintigraphy with marked red cells using 99mTc via SPECT.
The aim of this study was to reevaluate the sensitivity and specificity of the nuclear medicine method for confirmation or exclusion of benign hemangioma of the liver based on a series of cases at our department and briefly review of the literature.
Materials and methods: We retrospectively analyzed 107 patients, 62 females (57.94%) and 45 males (42,05%) with mean age 50.05±11.92 years, referred to the Nuclear Medicine Department for 99mTc-RBC scintigraphy of the liver to conclude or exclude the presence of HH, in the period 2019 to 2020.
Results Hepatic scintigraphy located the hemangiomas mostly in the right hepatic lobe. The size of the lesion varied from to 6-140 mm (46.04 ± 27.1); 13 hemangiomas were described as giant.
SPECT-CT confirmed HH in 1 patient that was negative on ultrasound, besides 30/87 (34,48%) patients who were described as positive on US and turned out to be negative on the scintigraphic method. In 53 (60,92%) patients, positive matching of the US images and hybrid SPECT/CT imaging for HH was found.
Most of the patients had benign referral diagnosis, while 12 of them had confirmed malignant diagnosis in whom (n=8, 66,67%) were confirmed free of hepatic metastasis and SPECT-CT detected HH, while in 4 patients who were described as positive for HH on the CT scan, the scintigraphic method excluded HH and further evaluation of the hepatic lesion was needed.
Conclusion
Hepatic hemangiomas require a careful diagnosis to differentiate from other focal hepatic lesions, co-occurring diagnoses are also possible. Differentiating between HH and hepatic metastatic disease is a typical clinical difficulty when the problem is present in staging or monitoring patients with oncological disease.
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