Karaciğer Hemanjiomu Tanısında Tc-99m İşaretli Eritrosit Sintigrafisinin SPECT/BT ile Değerlendirilmesi

Öz

Amaç: Günümüzde görüntüleme yöntemlerindeki gelişmeyle birlikte karaciğer hemanjiomlarının saptanması da artmıştır. Genellikle asemptomatik olan karaciğer hemanjiomlarının, karaciğerin diğer primer ve metastatik malign tümörlerinden ayırıcı tanısının konulması gerekmektedir. Özellikle boyutu küçük olan ve ana vasküler yapılara yakın olan lezyonların tanısını koymak önemlidir. Bu tip lezyonlar Tc-99m işaretli eritrosit sintigrafisi ile doğru olarak tanımlanabilir. Bu çalışmanın amacı karaciğer hemanjiomlarının Tc-99m işaretli eritrosit sintigrafisinin SPECT/BT ile değerlendirilmesi ve tanıya olan katkısını araştırmaktır. Yöntem: Hemanjiom ön tanısı ile kliniğimize gönderilen 36 olgudaki 40 lezyon retrospektif olarak değerlendirildi. Modifiye in vivo yöntemle Tc-99m işaretli eritrosit sintigrafisi yapılan 36 hasta SPECT/BT ile görüntülendi. Hastalar 12-24 aylık klinik bulgu ve diğer görüntüleme yöntemleri (USG, BT ve MRG) ile takip edildi. Yapılan takiplerle lezyonların boyut ve morfolojisinde değişiklikler değerlendirilerek tanıları doğrulandı. Bulgular: SPECT/BT ile görüntülemede 36 olgunun 29’unda aktivite artışı saptandı ve bu olguların hepsi gerçek pozitif olarak değerlendirildi. 7 olguda aktivite tutulumu olmadı. 2 olgu kist hidatik, 4 olgu metastaz (1 kolon kanseri, 3 meme kanseri) olarak belirlendi. 1 olgu ise yanlış negatif olarak saptandı. Bu olguda lezyon boyutu 1 cm idi. Tc-99m işaretli eritrosit sintigrafisi-SPECT/BT ile sensitivite:%100; spesifite: %96,7; pozitif prediktif değer: %100; negatif prediktif değer: % 85,7 ve toplam tanı değeri: %97,3 olarak belirlendi. Ayrıca SPECT/BT’de 9 (%25) olguda lezyonlar ana vasküler yapılara yakın yerleşimli idi. Lezyonların 1’i kalbe, 3’ü vena kava inferiora, 5’i ise büyük hepatik damarlara yakın yerleşimli idi. BT sayesinde radyoaktivite akümülasyonunun olduğu odağın doğru anatomik lokalizasyonu yapılarak hastalara hemanjiom tanısı kondu. Sonuç: Tc-99m işaretli eritrosit sintigrafisi SPECT/BT sayesinde karaciğer hemanjiomlarının tespitinde sensitivitesi, spesifitesi ve doğruluğu yüksek olan, fonksiyonel ve anatomik görüntülemenin bir arada yapılmasına sağlayan noninvaziv bir görüntüleme yöntemidir.

Anahtar Kelimeler

• Radyonuklit görüntüleme
• hemanjiom
• karaciğer
• tek foton emisyon bilgisayarlı tomografi

Evaluation of Tc-99m Labeled Erythrocyte Scintigraphy with SPECT/CT in the Diagnosis of Hepatic Hemangioma

Öz

Aim: With recent developments in imaging technology, there has been an increase in the diagnosis of hepatic hemangiomas. The differential diagnosis of hepatic hemangiomas, which are generally asymptomatic, from other primary and metastatic malignant tumors of the liver should be determined. It is especially important to diagnose lesions of small size and close to the main vascular structures. This type of lesions can be accurately identified with Tc 99m labelled erythrocyte scintigraphy. However, there are controversial results in small lesions (<1cm) and those close to major vascular structures. The aim of this study is to assess hepatic hemangiomas with Tc-99m RBC SPECT/CT and to investigate its contributions to the evaluation and diagnosis. The aim of this study is to evaluate Tc-99m-labeled erythrocyte scintigraphy of hepatic hemangiomas with SPECT/CT and to investigate its contribution to the diagnosis. Methods: 36 patients (40 lesions) with clinical suspicion of hemangiomas referred to our clinic were assessed retrospectively. Out of 36 patients who had injections of Tc-99m RBC with the modified in vivo method, 36 patients were scanned with SPECT/CT. The patients were followed up for 12-24 months clinically and other imaging modalities (USG, CT or MRI) and their diagnoses were confirmed. Results: In 29 out of 36 patients increased activity is seen in SPECT/CT, and all of these were considered as true positive. Activity uptake was not determined in 7 patients. Two patients were determined as cyst hydatid, four patients as metastasis (1 colon cancer,3 breast cancers). 1 patient was defined as a false negative. The size of lesion in this case was 1 cm. The sensitivity and specificity of Tc 99m-RBC SPECT/CT were 100 % and 96.7% respectively. The positive predictive value was 100 %, the negative predictive value: 85.7 % and the total diagnosis value was determined as 97.3 %. SPECT/CT detected lesions located close to major vascular structures (1 close to the heart, 3 to the vena cava inferior 5 to major hepatic veins) in 9 patients (25%). The lesions were diagnosed as hemangioma with CT, which detected detailed anatomical localization of the focus with radioactivity accumulation. Conclusion: Tc 99m-labelled RBC SPECT/CT is a noninvasive hybrid imaging method with high sensitivity, specificity, and accuracy in the detection of hepatic hemangiomas which enables to use of functional and anatomic imaging together.

Anahtar Kelimeler

• Radionuclide imaging
• hemangioma
• liver
• single photon emission computed tomography computed tomography

Kaynakça

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