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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,
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,
Instances of false positive technetium-99m hepatic scintiscans resulting from objects in a right jacket pocket, the interposition of an arm between the liver and the detector, the presence of deeply indented rib margins, and the presence of kidney shadows on the posterior scan are presented. Such false positive scans are caused by the easily shielded 140 kev gamma photon of technetium-99m. The problem may be accentuated by the tomographic effect of the various focused rectilinear scanners currently in use. By anticipating these problems and by promptly repeating scans following corrective measures, misinterpretation of the technetium-99m hepatic scintiscan may be avoided.
Liver scans, biopsies, and function studies were reviewed in 63 cancer patients and correlated with autopsy material to determine the value of the liver scan in such patients. The scan is abnormal in 96% of patients with autopsy-confirmed hepatic disease, but the scan pattern is of little assistance in differentiating tumor from nontumor pathology. Liver function studies are equally nonspecific and even less sensitive than the scan. Percutaneous biopsy, while diagnostic when positive, is insensitive, showing false-negative results in up to 40% of cases. The liver scan, as the most sensitive indicator of liver disease, may be most valuable when normal, reflecting a better prognosis and aiding in the determination of treatment. When the liver scan is abnormal, more specific tests must be employed. A method of approach is suggested. Whang et al., 1965). It is difficult t o compare these studies for several reasons: the use of different radiopharmaceuticals, improvements in techniques and in the experience of the nuclear medicine physician, the failure in older studies t o obtain The mentioning of trade names or manufacturers does not constitute approval of or endorsement by the U.S. Government.
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