When intravenous Au198 or rose bengal-I131 is removed from the blood by normal liver tissue, tumors will be demonstrated as defects on the liver scan pattern only if their presence sufficiently affects the counting rate of the scintillation counter. The liver is a solid organ which resembles an irregular hemisphere, having been so molded by surrounding structures that at least half its bulk is curved laterally along the right side of the patient in contact with the ribs. In one-plane scanning of a supine patient, the recorded image emphasizes the left side of the liver. Unfortunately, tumor identification is made difficult in this region by easy confusion with normally occurring liver defects such as the gallbladder fossa, the hilus, and the fissure for the round ligament, all of which can be consistently demonstrated on the photorecording. Nor are defects in the more homogeneous large right lobe demonstrated well, for, as the probe traverses it, the curvature of the liver mass results in an increasing displacement of the surface from the detector and the lobe is actually viewed on edge with maximum thickness. As a consequence, small tumors in the posterior right lobe are masked by the thick intervening layer of liver tissue and may escape detection. To a certain extent, this difficulty might be avoided by making multiple planar scans in anterior, oblique, and lateral views, but this would be time-consuming, would re-quire repeated dosage if rose bengal-I131 were to be used, and each recording would show only a limited region of the liver to advantage. In seeking to refine this study, it became apparent that rotational scanning might be employed to advantage. If, instead of scanning in one plane, the detector were to traverse the upper abdomen in semicircular path, with the probe focused continuously on the anterior border of the vertebral column, the collimator would be held as close as possible to the liver surface at all times and a more uniform thickness of liver tissue would be examined throughout the scan (Fig. 1). The maximum volume of the liver would thus be brought within the range of effective scanning. Experimental studies with a realistic liver phantom have confirmed the validity of this hypothesis. What would be a deeply placed lesion from a frontal planar view now becomes a shallow lesion as the detector rotates laterally. Tumors of the right lobe are scanned with greater effectiveness, increasing the probability of their detection, and yet the left lobe is surveyed just as adequately as with planar scanning (Figs. 2 and 3). A panoramic image of both liver lobes is presented on a single recording. Preliminary investigations suggest that rotational scanning may be a definite improvement of the liver survey technic meriting further development.
Read full abstract