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

Yıl 2023, Sayı: 19, 98 - 109, 29.04.2023
https://doi.org/10.38079/igusabder.1035135

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.

Kaynakça

  • Duron JJ, Keilani K, Jost JL. Giant cavernous hepatic hemangiomas in adults: Enucleation under selective blood inflow control. Am Surg. 1995;61:1019-22.
  • Vilgrain V, Boulos L, Vullierme MP, A Denys, B Terris, Menu Y. Imaging of atypical hemangiomas of the liver with pathologic correlation. Radiographics. 2000;20(2):379-97.
  • Rodríguez-Peláez M, Menéndez De Llano R, Varela M. Benign liver tumors. Gastroenterol Hepatol. 2010;33(5):391-7.
  • Tsai CC, Yen TC, Tzen KY. The value of Tc-99m red blood cell SPECT in differentiating giant cavernous hemangioma of the liver from other liver solid masses. Clin Nucl Med. 2002;27:578-81.
  • Royal HD, Brown ML, Drum DE, Nagle CE, Sylvester JM, Ziessman HA. Procedure guideline for hepatic and splenic imaging. Society of Nuclear Medicine. J Nucl Med. 1998;39:1114–1116.
  • Sánchez-Aguilar M, Rodriguez-Muñoz F, Santaella-Guardiola Y. Characterization of hemangioma by nuclear medicine techniques. Gastroenterol Hepatol. 2018;41(5):325-327.
  • Ziessman HA, Silverman PM, Patterson J, et al. Improved detection of small cavernous hemangiomas of the liver with high-resolution three-headed SPECT. J Nucl Med. 1991;32:2086–2091.
  • Schillaci O, Danieli R, Manni C, Capoccetti F, Simonetti G. Technetium-99m-labelled red blood cell imaging in the diagnosis of hepatic haemangiomas: The role of SPECT/CT with a hybrid camera. Eur J Nucl Med Mol Imaging. 2004;31:1011-1015.
  • Hutton BF, Braun M, Thurfjell L, Dennys YHL. Image registration: an essential tool for nuclear medicine. Eur J Nucl Med Mol Imaging. 2002;29:559–577.
  • Ishak KG, Robin L. Benign tumors of liver. Med. Clin.North Am. 1975;59: 995-1013.
  • Jang HJ, Choi BI, Kim TK. Atypical small heman-giomas of the liver: “Bright dot” sign at two-phase spiral CT. Radiolgy. 1998;208:543-548.
  • Toro A, Mahfouz AE, Ardiri A, Malaguarnera M, Malaguarnera G, Loria F. What is changing in indications and treatment of hepatic hemangiomas. A review. Ann Hepatol. 2014;13(4):327-339.
  • Yılmaz Ö, Okçu N. Karaciğer hemanjiomları. Güncel Gastroenteroloji. 2006;10(2):194-198.
  • Gedaly R, James J, Pomposelli, Lewis WD, Jenkins RL. Cavernous Hemangioma of the liver anatomic resection vs enucleation. Arch Surg. 1999;134:407.
  • Masui T, Katayama M, Nakagawara M. Exophytic giant cavernous hemangioma of the liver with growing tendency. Radiat Med. 2005;23:121-124.
  • Wu XF, Bai XM, Yang W, et al. Differentiation of atypical hepatic hemangioma from liver metastases: Diagnostic performance of a novel type of color contrast enhanced ultrasound. World J Gastroenterol. 2020;26(9):960-972.
  • Leslie DF, Johnson CD, Johnson CM, Ilstrup DM, Harmsen WS. Distinction between cavernoushemangiomas of the liver and hepatic metastases on CT: Value of contrast enhancement patterns. AJR. 1995;164:625-629.
  • Soyer P, Dufresne AC, Somveille E. Differentiation between hepatic cavernous hemangioma and malignant tumor with T2-weighted MRI: Comparison of fast spin-echo and breathhold fast spin-echo pulse sequences. Clin Imaging. 1998;22:200-210.
  • Heiken JP, Liver. In: Lee JKT, Stanley RJ, Heiken JP. Computed Body Tomography with MRI Correlation 3rd ed. Philadelphia: Lippincott-Raven 1998:701-777.
  • León-Asuero-Moreno I, Calvo-Morón MC, Garcia-Gomez FJ, Sabatel-Hernández G, Castro-Montaño J. Differential diagnosis of a hepatic mass by 99mTc-labelled red cells and octreotide scintigraphy. Cir Esp (Engl Ed). 2019;97(6):355-357.
  • Birnbaum BA, Weinreb JC, Megibow AJ, et al. Definitive diagnosis of hepatic hemangiomas: MR imaging versus Tc-99mlabeled red blood cell SPECT. Radiology. 1990;176:95–101.
  • Nakaizumi A, Iishi H, Yamamoto R. Diagnosis of hepatic cavernous hemangioma by fine needle aspiration biopsy under ultrasonic guidance. Gastrointest Radiol. 1990;15:39-42.
  • Bocher M, Balan A, Krausz Y, et al. Gamma camera-mounted anatomical X-ray tomography: Technology, system characteristics and first images. Eur J Nucl Med. 2000;27:619–627.
  • Zheng JG, Yao ZM, Shu CY, Zhang Y, Zhang X. Role of SPECT/CT in diagnosis of hepatic hemangiomas. World J Gastroenterol. 2005;11(34):5336-5341.
  • Roy SG, Karunanithi S, Agarwal KK, Bal C, Kumar R. Importance of SPECT/CT in detecting multiple hemangiomas on 99mTc-labeled RBC blood pool scintigraphy. Clin Nucl Med. 2015;40(4):345-6. doi:10.1097/RLU.0000000000000663.
  • Djekidel M, Michalski M.J Hybrid Imaging with SPECT-CT and SPECT-MR in hepatic splenosis. Nucl Med Technol. 2021;6:jnmt.121.263013. doi:10.2967/jnmt.121.263013.

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

Yıl 2023, Sayı: 19, 98 - 109, 29.04.2023
https://doi.org/10.38079/igusabder.1035135

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.

Kaynakça

  • Duron JJ, Keilani K, Jost JL. Giant cavernous hepatic hemangiomas in adults: Enucleation under selective blood inflow control. Am Surg. 1995;61:1019-22.
  • Vilgrain V, Boulos L, Vullierme MP, A Denys, B Terris, Menu Y. Imaging of atypical hemangiomas of the liver with pathologic correlation. Radiographics. 2000;20(2):379-97.
  • Rodríguez-Peláez M, Menéndez De Llano R, Varela M. Benign liver tumors. Gastroenterol Hepatol. 2010;33(5):391-7.
  • Tsai CC, Yen TC, Tzen KY. The value of Tc-99m red blood cell SPECT in differentiating giant cavernous hemangioma of the liver from other liver solid masses. Clin Nucl Med. 2002;27:578-81.
  • Royal HD, Brown ML, Drum DE, Nagle CE, Sylvester JM, Ziessman HA. Procedure guideline for hepatic and splenic imaging. Society of Nuclear Medicine. J Nucl Med. 1998;39:1114–1116.
  • Sánchez-Aguilar M, Rodriguez-Muñoz F, Santaella-Guardiola Y. Characterization of hemangioma by nuclear medicine techniques. Gastroenterol Hepatol. 2018;41(5):325-327.
  • Ziessman HA, Silverman PM, Patterson J, et al. Improved detection of small cavernous hemangiomas of the liver with high-resolution three-headed SPECT. J Nucl Med. 1991;32:2086–2091.
  • Schillaci O, Danieli R, Manni C, Capoccetti F, Simonetti G. Technetium-99m-labelled red blood cell imaging in the diagnosis of hepatic haemangiomas: The role of SPECT/CT with a hybrid camera. Eur J Nucl Med Mol Imaging. 2004;31:1011-1015.
  • Hutton BF, Braun M, Thurfjell L, Dennys YHL. Image registration: an essential tool for nuclear medicine. Eur J Nucl Med Mol Imaging. 2002;29:559–577.
  • Ishak KG, Robin L. Benign tumors of liver. Med. Clin.North Am. 1975;59: 995-1013.
  • Jang HJ, Choi BI, Kim TK. Atypical small heman-giomas of the liver: “Bright dot” sign at two-phase spiral CT. Radiolgy. 1998;208:543-548.
  • Toro A, Mahfouz AE, Ardiri A, Malaguarnera M, Malaguarnera G, Loria F. What is changing in indications and treatment of hepatic hemangiomas. A review. Ann Hepatol. 2014;13(4):327-339.
  • Yılmaz Ö, Okçu N. Karaciğer hemanjiomları. Güncel Gastroenteroloji. 2006;10(2):194-198.
  • Gedaly R, James J, Pomposelli, Lewis WD, Jenkins RL. Cavernous Hemangioma of the liver anatomic resection vs enucleation. Arch Surg. 1999;134:407.
  • Masui T, Katayama M, Nakagawara M. Exophytic giant cavernous hemangioma of the liver with growing tendency. Radiat Med. 2005;23:121-124.
  • Wu XF, Bai XM, Yang W, et al. Differentiation of atypical hepatic hemangioma from liver metastases: Diagnostic performance of a novel type of color contrast enhanced ultrasound. World J Gastroenterol. 2020;26(9):960-972.
  • Leslie DF, Johnson CD, Johnson CM, Ilstrup DM, Harmsen WS. Distinction between cavernoushemangiomas of the liver and hepatic metastases on CT: Value of contrast enhancement patterns. AJR. 1995;164:625-629.
  • Soyer P, Dufresne AC, Somveille E. Differentiation between hepatic cavernous hemangioma and malignant tumor with T2-weighted MRI: Comparison of fast spin-echo and breathhold fast spin-echo pulse sequences. Clin Imaging. 1998;22:200-210.
  • Heiken JP, Liver. In: Lee JKT, Stanley RJ, Heiken JP. Computed Body Tomography with MRI Correlation 3rd ed. Philadelphia: Lippincott-Raven 1998:701-777.
  • León-Asuero-Moreno I, Calvo-Morón MC, Garcia-Gomez FJ, Sabatel-Hernández G, Castro-Montaño J. Differential diagnosis of a hepatic mass by 99mTc-labelled red cells and octreotide scintigraphy. Cir Esp (Engl Ed). 2019;97(6):355-357.
  • Birnbaum BA, Weinreb JC, Megibow AJ, et al. Definitive diagnosis of hepatic hemangiomas: MR imaging versus Tc-99mlabeled red blood cell SPECT. Radiology. 1990;176:95–101.
  • Nakaizumi A, Iishi H, Yamamoto R. Diagnosis of hepatic cavernous hemangioma by fine needle aspiration biopsy under ultrasonic guidance. Gastrointest Radiol. 1990;15:39-42.
  • Bocher M, Balan A, Krausz Y, et al. Gamma camera-mounted anatomical X-ray tomography: Technology, system characteristics and first images. Eur J Nucl Med. 2000;27:619–627.
  • Zheng JG, Yao ZM, Shu CY, Zhang Y, Zhang X. Role of SPECT/CT in diagnosis of hepatic hemangiomas. World J Gastroenterol. 2005;11(34):5336-5341.
  • Roy SG, Karunanithi S, Agarwal KK, Bal C, Kumar R. Importance of SPECT/CT in detecting multiple hemangiomas on 99mTc-labeled RBC blood pool scintigraphy. Clin Nucl Med. 2015;40(4):345-6. doi:10.1097/RLU.0000000000000663.
  • Djekidel M, Michalski M.J Hybrid Imaging with SPECT-CT and SPECT-MR in hepatic splenosis. Nucl Med Technol. 2021;6:jnmt.121.263013. doi:10.2967/jnmt.121.263013.
Toplam 26 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Makaleler
Yazarlar

Hatice Sümeyye Yavuz Bu kişi benim 0000-0003-4532-0342

Müge Öner Tamam 0000-0002-3793-0178

Halim Ozcevik 0000-0001-7201-9868

Ahmet Yavuz 0000-0003-1885-9430

Mehmet Mülazımoğlu 0000-0002-7107-0386

Erken Görünüm Tarihi 29 Nisan 2023
Yayımlanma Tarihi 29 Nisan 2023
Kabul Tarihi 21 Aralık 2022
Yayımlandığı Sayı Yıl 2023 Sayı: 19

Kaynak Göster

JAMA Yavuz HS, Öner Tamam M, Ozcevik H, Yavuz A, Mülazımoğlu M. Karaciğer Hemanjiomu Tanısında Tc-99m İşaretli Eritrosit Sintigrafisinin SPECT/BT ile Değerlendirilmesi. IGUSABDER. 2023;:98–109.

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