Liver scanning in surgical practice

Abstract

SUMMARYLiver scanning is a simple, safe investigation which can be of value in several clinical situations commonly encountered in surgical practice :-I. The differential diagnosis of upper abdominal masses.2. The differential diagnosis of hepatomegaly. 3. The differential diagnosis of jaundice. 4. The detection of right subphrenic abscess. 5. The detection of focal intrahepatic lesions, and the screening of patients with malignant disease.6. The response of hepatic metastases to therapy. In the detection of focal intrahepatic lesions an overall accuracy of about 90 per cent was achieved in our series of 185 scans. Clinical findings were suggestive in 57 per cent and liver-function tests in 48 per cent of the patients. 1965).The present study using a Picker V Magnascanner (Fig. I) was undertaken in an attempt to assess the accuracy of the technique, to compare this accuracy with that of clinical findings and liverfunction tests, and to determine the applications of the technique in surgical practice.'THE investigation of hepatic disease lacks a simple, safe test to demonstrate structural hepatic lesions. Clinical findings and biochemical tests of liver function are inexact because of the enormous functional reserve of the liver, multiple spaceoccupying lesions being compatible with little or no derangement of liver-function tests. Selective hepatic arteriography is difficult to perform and is associated with a significant morbidity.Although liver scanning was first successfully demonstrated by Friedell, MacIntyre, and Regal in America in 1957, little has appeared in the British literature on the subject. A previous paper from this unit, before the use of the Magnascanner, presented a small series in which derangements in hepatic structure were demonstrated by an external scintillation technique (Torrance, Isbister, and Mitchell,