Are hepatic scans overused?

Abstract

Liver scans are used in the evaluation of hepatomegaly, abnormal liver chemistries, fever of unknown origin, suspected hepatic abscess, and cirrhosis. Except in the case of hepatic abscess, where the scan is of proven diagnostic accuracy in 80 to 95 percent of cases, the reliability of the scan in these situations has not been examined critically. It has not been established whether the scan provides useful new data in these settings or merely duplicates information obtained by more conventional methods. Extensive anecdotal experience suggests that a normal liver scan in these situations cannot exonerate the liver as a site of disease, and an abnormal scan provides little or no information on the nature of the disease process. That the liver scan can be used routinely to obviate biopsy or other more invasive procedures in these difficult clinical problems is highly unlikely. There is no question that in selected cases the liver scan may be helpful in indicating the presence of hepatic disease and its location. When used wisely the scan may contribute to the evaluation and management of many clinical problems. The reliability of the technique, however, is limited and its routine application as a screening test for metastatic malignancymore » or other hepatic disorders is unwarranted.« less