Sulfur Colloid Liver-spleen Scan Research Articles

2226 Hot Spot Sign on Tc-99m DISIDA Nuclear Hepatobiliary Scan

INTRODUCTION: Hepatic Focal Nodular Hyperplasia (FNH) can be an unusual cause of abdominal pain. Prior to the advent of readily accessible diagnostic imaging techniques, patients with FNH primarily presented with vague symptoms of abdominal pain, then proceeded to imaging, which led to diagnosis. Today, most cases are found incidentally on imaging, in often asymptomatic patients. Here, we present a patient with significant symptoms in whom an identified FNH was considered inconsequential, but is eventually proven otherwise. CASE DESCRIPTION/METHODS: A previously healthy 31-year-old male presented with a one-month history of persistent postprandial right upper quadrant abdominal pain. Ultrasound showed cholelithiasis. MRI revealed FNH of the anteroinferior subsegment of the liver. Tc-99m DISIDA Cholescintigraphy showed a normal functioning gallbladder, but an abnormal delayed clearance of tracer from a focal area in inferior tip of the liver, corresponding to the FNH seen on MRI, consistent with a “hot spot sign”. Due to suspicion for symptomatic cholelithiasis, he underwent elective cholecystectomy. Symptoms persisted post-op, thus, his pain was thought to be from symptomatic FNH. After subsequent elective FNH resection, symptoms subsided. DISCUSSION: While cholescintigraphy typically evaluates for biliary tree dysfunction, it can also reveal abnormality in hepatic parenchymal tissue. Previously, Tc-99m Sulfur Colloid Liver-Spleen scans were used for diagnosis of FNH. However, the “hot spot sign” on cholescintigraphy has also been described as diagnostic for FNH. This case illustrates that a focal area of delayed tracer washout, or “hot spot”, can also be seen with Tc-99m DISIDA. Although the significance of delayed tracer washout is unclear, this finding suggests liver parenchyma’s inability to effectively clear bile from an FNH. This inability to adequately clear bile, may result in pain. The severity of impaired clearance may even correlate with the severity of symptoms. Although further investigation is necessary, cholescintigraphy may prove a useful tool in functional imaging for differentiating between symptomatic and asymptomatic FNH.

Splenosis: A Benign Phenomenon Mimicking Metastatic Cancer

Splenosis is the benign heterotopic transplantation of splenic tissue that results from traumatic splenic rupture or splenectomy. Many clinicians are unfamiliar with this phenomenon, therefore it is often misdiagnosed and most patients undergo unnecessary invasive diagnostic procedures. We present a rare case of liver and splenic bed splenosis mimicking metastatic cancer. This is the case of a 58-year-old male with medical history of hypertension, migraine, bronchial asthma and nephrolithiasis who presented with diffuse abdominal pain, left flank pain and dark-colored urine for the past two days. He denied fever, chills, hesitancy, dribbling, or any other symptoms. Past medical history notable for splenectomy at age 5 secondary to a motor vehicle accident. Physical exam and laboratory tests were unremarkable except for hematuria on urine analysis. A non-contrast abdominopelvic CT identified a calculus at the ureterovesical junction with associated hydronephrosis. Also revealed evidence of prior splenectomy, a solid exophytic lesion at the right hepatorenal fossa measuring 1.8 cm x 2.3 cm, left upper quadrant lesion near the stomach measuring 1.8 cm x 1.5 cm, and small nodular lesion anterior to the rectum measuring 1.4 cm. Further evaluation included a colonoscopy which was essentially normal. A PET CT showed a bilobulated soft tissue density on the splenic bed and perihepatic soft tissue nodularities most likely representing splenosis. A Tc99m sulfur colloid liver-spleen scan demonstrated localized uptake by soft tissue densities localized on the splenic bed, left pelvic wall and right abdomen just below the right liver lobe compatible with active reticuloendothelial activity as it seen with post-traumatic migratory splenosis. We present a very interesting case of splenosis, which results from the auto-implantation of splenic pulp tissue usually due to trauma or following abdominal surgery. Frequency of splenosis varies according to type of injury, being more common after trauma that following elective surgical removal of the spleen. Spleen implants tend to be multiple as are seen in this patient who had spleen trauma at an early age. These are usually confined to the abdominal cavity; although there are reports of thoracic splenosis. On routine radiological studies, these lesions are usually indistinguishable from other benign or malignant lesions for which radioisotope studies are usually recommended to establish the diagnosis. Although most patients are asymptomatic, abdominal pain due to adhesion, torsion or spontaneous rupture can occur. Splenosis should be considered in all splenectomized patients; especially in presence of unexplained or asymptomatic abdominal mass. Whenever this entity is suspected, diagnosis is feasible through radioisotope scanning, avoiding the need of invasive procedures.

Functional Hyposplenism in Pediatric Chronic Graft-Versus-Host Disease

AbstractAbstract 4493 Introduction:Functional hyposplenism is a well-recognized complication of chronic graft versus host disease (cGVHD). Whether the hyposplenism in cGVHD is transient and if there is any association between the severity of cGVHD and degree of hyposplenism are not well understood. The pitted red cell count has been shown to be a simple and reliable biomarker of splenic function that correlates well to other tests such as quantitative Howell-Jolly bodies and 99mTc sulfur-colloid liver-spleen scans. It measures the ability of the splenic red pulp to pinch off intracellular vesicles, or pits, from red blood cells as they pass through narrow adjustable slits in an endothelial lining. Methods:We hypothesized that functional hyposplenism correlates with the severity of cGVHD in pediatric BMT patients. We performed a single-center, retrospective review of pediatric allogeneic bone marrow transplant (BMT) patients who had more then one pit count performed post-BMT and clinical diagnosis of cGVHD based on NIH consensus criteria. Results:We identified 9 pediatric BMT recipients (3 males, 6 females; average age at BMT = 9.6 years) that met our criteria. Indications for BMT were AML (2), ALL (1), biphenotypic acute leukemia (1), CML (2) and thalassemia (3). All 9 had functional hyposplenism with active cGVHD as determined by a pit count > 2%. We identified two distinct groups. In 7 of the 9 BMT recipients, there was a return to normal splenic function that lagged between 12 and 18 months after clinical improvement/resolution of cGVHD symptoms and successful weaning of immunosuppressive therapy. In the other 2 patients there was no correlation between abnormal pit count and cGVHD symptoms. Conclusions:Our single-centre retrospective cohort study provides evidence that the functional hyposplenism associated with cGVHD is not permanent but improvement in cGVHD symptoms and successful weaning of immunosuppressive therapy should not be used as indicators of return to normal splenic function and reasons to stop Penicillin prophylaxis. We propose that all patients post-BMT should have serial pit counts performed, as resolution of cGVHD clinical symptoms does not ensure normal splenic function. Disclosures:No relevant conflicts of interest to declare.

Can Infant US Predict Clinical Function in Sickle Cell Anemia?

Research Article| November 01 2011 Can Infant US Predict Clinical Function in Sickle Cell Anemia? AAP Grand Rounds (2011) 26 (5): 57. https://doi.org/10.1542/gr.26-5-57 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Can Infant US Predict Clinical Function in Sickle Cell Anemia?. AAP Grand Rounds November 2011; 26 (5): 57. https://doi.org/10.1542/gr.26-5-57 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: sickle cell anemia, spleen, kidney, gallbladder Source: McCarville MB, Luo Z, Huang X, et al. Abdominal ultrasound with scintigraphic and clinical correlates in infants with sickle cell anemia: baseline data from the BABY HUG trial. AJR. 2011; 196(6): 1399– 1404; doi: https://doi.org/10.2214/AJR.10.4664Google Scholar Investigators from multiple United States centers sought to determine if ultrasound (US) findings in/of the spleen, kidneys, and gallbladder/biliary tree among infants with sickle cell anemia (SCA) correlate with clinical, nuclear medicine (NM), and/or laboratory findings. Infants in this study were participating in the multi-institutional BABY HUG study, a randomized placebo-controlled phase 3 trial of hydroxyurea among infants with SCA. (See AAP Grand Rounds, August 2011;26:16.) US studies of 203 infants (116 females) between ages 7.5 and 18 months (mean 12.9 months) from 14 institutions were reviewed by one experienced pediatric radiologist. The following were considered abnormal: indistinct renal corticomedullary differentiation; gallbladder thickness greater than 3 mm after 6 hours NPO; and common bile duct greater than 2 mm. Splenic function was assessed by Technetium 99m sulfur colloid liver spleen scans, pitted RBC count, and flow cytometry for Howell-Jolly bodies. Spleen scans were reported as radiotracer uptake equal to the liver, less than that of the liver, or no splenic uptake. Renal glomerular filtration rates (GFR) were evaluated by DTPA (Technetium 99m diethylenetriaminepentaacetic acid). Liver function was assessed by serum alanine aminotransferase (ALT) levels. SCA patients had greater spleen volumes than hematologically normal children. However, spleen volume did not predict NM function. Lesser uptake was associated with some increase in spleen volume, perhaps due to increased congestion causing decreased function prior to inevitable splenic autoinfarction. There was no correlation between volumes and percentages of pitted RBCs or Howell-Jolly bodies. As expected, sonographic spleen volumes correlated with spleen palpation. Two hundred and one patients had adequate renal US images; 4% had renal abnormalities. Three percent had increased renal echogenicity or absent corticomedullary differentiation. Both kidneys were significantly larger in the studied cohort compared with charts for normal children. Kidney sizes correlated positively with GFR, and the cohorts’ GFRs were statistically greater than published values for normal children. Two hundred patients had adequate biliary tree imaging. Abnormalities included multiple gallstones (1 child), sludge (6), thickened gallbladder wall (1), and dilated common duct (2). Only two patients had abnormal ALT levels: a child with a dilated duct and a child with sludge. There was no overall correlation between serum chemistries (ALT or bilirubin) and gallbladder findings, although the patient with gallstones had a markedly elevated total bilirubin. The authors conclude that among infants with SCA, sonographic spleen volume does not reflect function, although increased kidney volume correlates with increased GFR, consistent with hyperfiltration. They also note that clinically silent gallbladder disease in SCA begins in infancy. Dr Cohen has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Transcranial Doppler US1 has been used... You do not currently have access to this content.

Abdominal ultrasound with scintigraphic and clinical correlates in infants with sickle cell anemia: baseline data from the BABY HUG trial.

The purpose of this study is to perform and evaluate baseline abdominal ultrasound in infants with sickle cell anemia who participated in the BABY HUG multiinstitutional randomized placebo-controlled trial of hydroxyurea therapy and to examine the potential relationships among ultrasound results and clinical, nuclear medicine, and laboratory data. After local institutional review board approval and with informed guardian consent, 116 girls and 87 boys (age range, 7.5-18 months) with sickle cell anemia underwent standardized abdominal sonography at 14 institutions. Imaging was centrally reviewed by one radiologist who assessed and measured the spleen, kidneys, gallbladder, and common bile duct. Baseline physical assessment of spleen size, serum alanine aminotransferase and bilirubin levels, (99m)Tc sulfur colloid liver-spleen scans, and (99m)Tc diethylenetriaminepentaacetic acid clearance glomerular filtration rates (GFRs) were obtained. Analysis of variance and the Student test were performed to compare sonographic findings to published results in healthy children and to clinical and laboratory findings. The mean (± SD) spleen volume (108 ± 47 mL) was significantly greater than published normal control values (30 ± 14 mL; p < 0.0001). There was no correlation between spleen volume and function assessed by liver-spleen scan. The mean GFR (125 ± 34 mL/min/1.73 m(2)) was elevated compared with control GFRs (92 ± 18 mL/min/1.73 m(2)). Renal volumes (right kidney, 29 ± 8 mL; left kidney, 31 ± 9 mL) were significantly greater than control volumes (right kidney, 27 ± 3 mL; left kidney, 27 ± 3 mL; p < 0.0001) and were positively correlated with GFR (p = 0.0009). Five percent of patients had sonographic biliary abnormalities (sludge, n = 6; dilated common bile duct, n = 2; and cholelithiasis and thickened gallbladder wall, n = 1 each). There was no correlation between biliary sonographic findings and laboratory results. In infants with sickle cell anemia, sonographic spleen volume does not reflect function, but increased renal volume correlates with GFR and is consistent with hyperfiltration. Sonographic biliary abnormalities can occur early in life, while remaining clinically silent.

Biomarkers of splenic function in infants with sickle cell anemia: baseline data from the BABY HUG Trial

AbstractWe evaluated spleen function in 193 children with sickle cell anemia 8 to 18 months of age by 99mTc sulfur-colloid liver-spleen scan and correlated results with clinical and laboratory parameters, including 2 splenic biomarkers: pitted cell counts (PIT) and quantitative Howell-Jolly bodies (HJB) enumerated by flow cytometry. Loss of splenic function began before 12 months of age in 86% of infants in association with lower total or fetal hemoglobin and higher white blood cell or reticulocyte counts, reinforcing the need for early diagnosis and diligent preventive care. PIT and HJB correlated well with each other and liver-spleen scan results. Previously described biomarker threshold values did define patients with abnormal splenic function, but our data suggest that normal spleen function is better predicted by PIT of ≤ 1.2% or HJB ≤ 55/106 red blood cells and absent function by PIT ≥ 4.5% or HJB ≥ 665/106. HJB is methodologically advantageous compared with PIT, but both are valid biomarkers of splenic function. This trial was registered at www.clinicaltrials.gov as #NCT00006400.

Importance of Tc-99m Sulfur Colloid Liver???Spleen Scans Performed Before Indium-111 Labeled Leukocyte Imaging for Localization of Abdominal Infection

The localization of intraabdominal abscesses is a difficult imaging problem in nuclear medicine, especially when the location of the abscess is in the area of the liver and spleen. The need for performing Tc-99m sulfur colloid liver-spleen scans before injecting indium-111 leukocytes for improved lesion detection and characterization versus performing In-111 leukocyte scans alone has been questioned in the literature We present 3 patients with intraabdominal abscesses in the liver-spleen area, in which liver-spleen scans were performed before In-111 leukocyte scans. The findings of all were correlated with computed tomography and interventional procedures. In all patients, the Tc-99m liver-spleen scan helped for accurate recognition of the location of the abscess, correlated with computed tomography findings, and were helpful for intervention and exclusion of the other sources of infection. Data from these 3 patients reinforces the need for Tc-99m sulfur colloid liver-spleen scans before performing In-111 WBC scans for better localization and interventional treatment of intraabdominal abscesses.

Autotransplantation of spleen tissue in children with mansonic schistosomiasis who underwent splenectomy: Evaluation of splenic residual functions

Autotransplantation of spleen tissue is an attempt for maintenance of splenic functions when splenectomy is indicated in children. It minimizes the risks of overwhelming postsplenectomy infection and it has been done in children with severe portal hypertension due to hepatosplenic mansonic schistosomiasis that underwent splenectomy. The purposes of this investigation were to study the morphology of the residual splenic tissue; to evaluate the residual filtration function of this splenosis; and to assess the immune response to polyvalent pneumococcal vaccine of these patients. Twenty-three children with portal hypertension from mansonic schistosomiasis who underwent splenectomy, ligature of the left gastric vein, autotransplantation of spleen tissue into an omental pouch were evaluated for residual splenic parenchyma and functions. Tc-99m sulfur colloid liver-spleen scans were used for detection of splenic nodules. The search for Howell Jolly bodies were used for assessing the filtration function and Enzyme-linked immunosorbent assay was used for measuring the relative rise in titter of specific pneumococcal antibodies. Splenosis was evident in all children; however, in two there were less than five splenic nodules in the greater omentum, which was considered insufficient. Howell-Jolly bodies were found in the peripheral blood only in these two patients with less evident splenosis. The immune response was adequate in 15 patients; it was intermediate in 4 patients and inadequate in 4 patients. Autotransplantation of spleen tissue into an omental pouch is efficient in maintaining the filtration splenic function in more than 90% of the cases and the immune response to pneumococcal vaccination in approximately 65% of the children.

Review of hepatic imaging and a problem-oriented approach to liver masses

We believe that imaging of the liver is complicated. The sporadic appearance of incidental benign lesions and variability in scanning techniques, equipment and artifacts add difficulties to the evaluation of liver masses. Therefore we emphasize the need to define the problem for which the patient is being imaged. This information helps in choosing the procedure of choice and the technique needed to give the most expedient, accurate answer. This will also help apply the lowest risk and most cost-efficient care. Imaging algorithms vary depending on the suspected pathological conditions. Dynamic bolus-enhanced CT is the modality of choice in most situations. Tc99m sulfur-colloid liver-spleen scans are helpful in patients with suspected FNH, and Tc99m-tagged-RBC-SPECT scans are recommended to confirm cavernous hemangiomas. Cysts are easily confirmed by US. Although MRI is competitive with CT, it has not become a primary modality because of cost, availability, patient selection and variability of scanner capabilities among the many manufacturers and models. It is hard to predict what future development of imaging techniques will bring. Many feel that significant advances have plateaued. Time and money will more likely be concentrated on improving image resolution, speed of scanning and ability to transfer this information to sites outside of the radiology department. In addition to faster scanning, we expect to soon have available safe intravenous and enteric contrast agents for MRI. Certainly this will lead to a new round of investigations to compare MRI with CT scanning.

Uptake of Technetium-99m Sulfur Colloid by a Breast Carcinoma

A preoperative Tc-99m sulfur colloid liver spleen scan in a patient with a breast carcinoma showed intense activity within the breast lesion. The mechanism of this uptake is postulated to be secondary to tumor invasion of blood vessels producing narrowing of the lumen and trapping of the colloid particles.

Colloid Shift in Technetium-99m Sulfur Colloid Liver-Spleen Scans of Trauma Patients

To assess the radiosulfur colloid distribution in the liver-spleen scans of trauma patients, 73 trauma patients (age: 4-74 years, mean: 32 years) who had Tc-99m sulfur colloid liver-spleen scans for trauma workup were studied and compared with the liver-spleen scans of 87 control patients (age: 2-64 years, mean: 36 years). Radiocolloid distribution was visually assessed by two physicians independently, and the areas of the greatest density in the liver and spleen on the posterior view that included both organs were compared. The scans were grouped into three grades: Grade I, liver density greater than spleen density; Grade II, both organs showing equal density; and Grade III, splenic density greater than liver density (colloid shift). Forty-three of the trauma patients (59%) were in Grade III, 22 (30%) in Grade I, and 2 (11%) in Grade II. The control group had 12 (14%) patients in Grade III, 54 (62%) in Grade I, and 21 (24%) in Grade II. When the young adults and children of the trauma patients (age: 4-20 years, mean: 14 years) were looked at separately, 17 of 20 (85%) showed colloid shift (Grade III). It is concluded that there is a significantly higher incidence of colloid shift in trauma patients compared to control patients (P less than .01).

Hepatic infarcts: new observations by CT and sonography.

Until recently hepatic infarcts were rarely diagnosed before autopsy and were nearly always fatal. Four cases of hepatic infarcts, three of them nonfatal, were diagnosed and followed by CT (three cases), sonography (two cases), arteriography (two cases), and sulfur colloid liver-spleen scan (one case). In three patients with multiple subsegmental hepatic infarcts, most of the lesions were round or oval and centrally located. Only a minority of the lesions were wedge-shaped and peripheral. The early lesion appears hypoechoic on sonography, and CT shows a poorly demarcated low-density region. Later, lesions become confluent with more distinct margins. Bile lakes are a late sequela of large infarcts. Gas formation within sterile infarcts is newly described in two cases. Hepatic infarcts have a variable appearance on CT and sonography and are not reliably distinguished from other lesions such as abscess or necrotic neoplasm.

Imaging studies and the prognostic value of serum calcitonin in staging small-cell lung cancer.

The controversial prognostic significance of serum calcitonin in small-cell lung cancer (SCC) prompted this retrospective study relating serum levels to (1) stage of disease [limited disease (LD) vs. extensive disease (ED)], (2) imaging studies of metastases to bone, liver, and brain, and (3) survival. Of the 127 previously untreated patients with SCC presenting from 1979 to 1984, calcitonin levels could be compared to the stage of the disease in 69 patients (25 LD and 44 ED) and to various staging procedures including 99mTc methylene diphosphonate bone scans (63 patients), 99mTc sulfur colloid liver-spleen scans (64 patients), computed tomography of the head (63 patients) and serum calcium (61 patients). 71% (49/69) of patients had elevated calcitonin of whom 65% (32/49) had ED. 29% (20/69) had normal levels of whom 60% (12/20) had ED. 40% (18/45) of patients with raised calcitonin had liver metastases. 100% (19/19) with normal calcitonin had no liver involvement. Two patients with hypercalcemia and increased calcitonin had extensive bony metastases. The survival experiences of patients with normal and elevated serum calcitonin levels were analyzed. No significant differences were found within each stage or in the group overall. The positive correlation of serum calcitonin to liver metastases was statistically significant. No such relationship could be demonstrated with stage of disease, bone metastases, brain metastases, or survival.

Diffuse thoracoabdominal radioactivity seen in bone imaging.

Diffusely increased radioactivity in the thoracoabdominal region (lower thorax and/or upper abdomen) occasionally has been observed when performing Tc-99m phosphonate bone studies. To assess the significance of activity in this finding, 1100 bone scintigrams were reviewed and the clinical data and other diagnostic imaging procedures were evaluated in these cases. With the exclusion of Tc-99m sulfur colloid liver-spleen scans 18 patients were found to have mild but diffuse increased radioactivity in the thoracoabdominal region either on the right or left. Clinical findings in these cases with abnormal uptakes were pleural effusions (six cases), hepatic colonic metastases (six cases), splenic metastases from bronchogenic carcinoma (one case), abdominal and peritoneal colonic metastases (one case), a massive metastatic squamous cell carcinoma (from lung) in the right lower chest (one case), and defective radiopharmaceuticals (three cases). Since the defective radiopharmaceuticals contained 5% of hydrolyzed reduced Tc-99m colloid by thin-layer chromatography, each of three patients received approximately 740 mu Ci of Tc-99m sulfur colloid. Factors to be considered in the interpretation of diffuse thoraco-abdominal activity from a bone agent should include splenic or hepatic metastases, a Tc-99m sulfur colloid splenic or hepatic metastases, a Tc-99m sulfur colloid study within the previous 24 hours, pleural effusion, faulty radiopharmaceuticals, and abdominal and peritoneal colonic metastases.

Radiographic characteristics of benign liver tumors: Focal nodular hyperplasia and hepatic adenoma

The imaging characteristics of focal nodular hyperplasia are varied. Unenhanced computed tomography reveals the attenuation of these lesions, in general, to be slightly less than that of normal liver; after contrast enhancement, their attenuation is equal to (isodense) or greater than (hyperdense) that of normal liver. This, of course, depends on the rate at which the contrast material is injected and the timing of scans after its injection. Central scar, a helpful finding when present, was not noted as a common finding at the time of computed tomography or ultrasound examination. Ultrasound examinations, in general, showed these lesions to be homogeneous, isoechoic or hypoechoic tumors. The angiographic findings revealed them, in general to be more vascular than the normal liver with an intense, homogeneous capillary stain. Hypovascular focal nodular hyperplasia does occur, but rarely. The blood supply to these tumors was most commonly from peripheral vessels, in contrast to previous reports of a central blood supply being more common. The technetium-99m sulfur colloid liver-spleen scan is often the key to the diagnosis of focal nodular hyperplasia. The majority of these tumors at the time of liver-spleen scanning will be seen as areas of normal or increased uptake; this is a reliable clue to the diagnosis of focal nodular hyperplasia. lf the radionuclide scan is not diagnostic, however, the combined findings of CT, ultrasound and angiography often are. Hepatic adenomas also clearly have a varied imaging presentation. The angiographic findings show these tumors to be hypervascular with small areas of hypovascularity within them. Blood is supplied to the adenomas by peripheral vessels in most cases, and there is no intense capillary stain. Computed tomography shows hepatic adenomas, in general, to be hypodense in the absence of contrast enhancement. Yet on contrast enhanced scans, they are complex lesions with multiple ranges of attenuation located within them. Acute hemorrhage can be seen in approximately half the unenhanced CT scans. By sonography, hepatic adenomas, in general, display intrinsic areas that are isoechoic, hyperechoic, and hypoechoic; and they are invariably nonhomogeneous lesions. These tumors appear as focal defects in all cases on technetium-99m sulfur colloid liver-spleen scans.

Radioisotope Spleen Scan in Patients With Splenic Injury

The technetium Tc 99m sulfur colloid liver-spleen scan is a valuable aid in diagnosis and treatment of patients with splenic injury. After reviewing the charts of 47 patients who were ill as a result of splenic trauma, we came to the following conclusions: (1) the scan identified the injury, accurately mapped its extent, and indicated the presence or absence of associated liver injuries; (2) the scans were useful in following the extent and rate of healing of the splenic injury; (3) the scan is an indirect measurement of of return of splenic fuction; (4) the procedure can be performed in a reasonable time frame with no serious morbidity; and (5) the indications, contraindications, and timing of scans are now reasonably well established.