title: Intrahepatic, extramedullary hematopoiesis mimicking hemangioma on technetium-99m red blood cell SPECT examination.
abstract: Cavernous hemangiomas are the most common lesion of the liver. Because of the risk of hemorrhage inherent in percutaneous biopsy of such lesions, noninterventional modalities (such as CT, ultrasound, MRI and Technetium-99m red blood cell imaging) have been utilized for differentiating them from other lesions. The sensitivities and specificities of these techniques vary greatly. Technetium-99m red blood cell imaging with planar and SPECT imaging has been shown to have an overall sensitivity of 89%, a specificity of 100%, and an overall accuracy of 92%. Despite its high accuracy, rare false positives have been reported with Technetium-99m red blood cell imaging with SPECT. Review of the literature indicates four cases of hepatocellular carcinoma, one case of hepatic angiosarcoma, and one case of hepatic metastases from colorectal carcinoma as having an appearance identical to hemangioma with this modality. We present an additional false positive of a focal region of intrahepatic extramedullary hematopoiesis in a patient with Gaucher's disease as having an appearance on Technetium-99m red blood cell imaging with SPECT identical to that of hemangioma.
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: E P
authors.initials: EP
authors.lastname: Tamm
authors.forename: L S
authors.initials: LS
authors.lastname: Rabushka
authors.forename: E K
authors.initials: EK
authors.lastname: Fishman
authors.forename: R H
authors.initials: RH
authors.lastname: Hruban
authors.forename: A M
authors.initials: AM
authors.lastname: Diehl
authors.forename: A
authors.initials: A
authors.lastname: Klein
mesh_terms: D000818:Animals; D001706:Biopsy; D006224:Cricetinae; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D005260:Female; D005776:Gaucher Disease / Q000175:diagnosis*; D006392:Hemangioma, Cavernous / Q000000981:diagnostic imaging*; D006411:Hematopoiesis, Extramedullary; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008099:Liver / Q000098:blood supply* / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D013670:Sodium Pertechnetate Tc 99m; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D013670:Sodium Pertechnetate Tc 99m