title: The hot spot hepatobiliary scan in focal nodular hyperplasia.
abstract: A prospective study was performed on 14 patients with histologically proven focal nodular hyperplasia (FNH) using a hepatobiliary scan with trimethylbromoimino-diacetic acid (TBIDA) and a colloid scan with rhenium sulfur colloids. TBIDA uptake was relatively normal in the region of the tumor, but during the clearance phase 23/25 of the tumors were detected by a hot spot of radioactivity. Depending on the relative contrast achieved between the tumor and normal liver, this hot spot appeared early or later, but was always present at 60 min. In three tumors, a "doughnut" pattern was observed within the hot spot due to a central defect. Hypervascularization was observed during the perfusion phase in 76% of the tumoral sites and normal colloid uptake in only 64%. The detectability of FNH appears greater with TBIDA (92%) than with CT or MRI (84%). The high prevalence of hot spots may be due to careful technological conditions when obtaining hepatobiliary scans. Late images, overexposed films, multiple views and stimulation of gallbladder excretion increased tumor detectability. The hot spot sign may be a useful tool when combined with the results of other imaging modalities in the diagnosis of FNH. The peculiar pathology of FNH with fibrosis, hyperplastic hepatocytes and cholangiolar proliferation might explain this scintigraphic appearance.
authors.affiliation: Department of Nuclear Medicine, Hôpital Henri Mondor, Université Paris XII-Val de Marne, Créteil, France.
authors.forename: H
authors.initials: H
authors.lastname: Boulahdour
authors.forename: D
authors.initials: D
authors.lastname: Cherqui
authors.forename: F
authors.initials: F
authors.lastname: Charlotte
authors.forename: A
authors.initials: A
authors.lastname: Rahmouni
authors.forename: D
authors.initials: D
authors.lastname: Dhumeaux
authors.forename: E S
authors.initials: ES
authors.lastname: Zafrani
authors.forename: M
authors.initials: M
authors.lastname: Meignan
mesh_terms: D000328:Adult; D000814:Aniline Compounds; D001659:Biliary Tract / Q000000981:diagnostic imaging*; D005260:Female; D005998:Glycine; D006801:Humans; D007098:Imino Acids; D008099:Liver / Q000000981:diagnostic imaging; D008107:Liver Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012211:Rhenium; D012680:Sensitivity and Specificity; D013671:Technetium Tc 99m Sulfur Colloid; D014057:Tomography, X-Ray Computed
chemical_list: D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; C030406:technetium Tc rhenium-sulfur colloid; D013671:Technetium Tc 99m Sulfur Colloid; D012211:Rhenium; C034837:technetium Tc 99m mebrofenin; D005998:Glycine