Tl-201 chloride SPECT imaging of hepatocellular carcinoma.
OBJECTIVE
Tl-201 chloride has been used to image viable tumors in various sites of the body. There has been limited use of Tl-201 below the diaphragm because of normal uptake in the liver, spleen, kidneys, and intestines. The use of sequential Tl-201 and Tc-99m sulfur colloid in the detection and characterization of suspected hepatocellular carcinoma (HCC) was prospectively evaluated.


METHODS
Four patients with indeterminate liver nodules on radiologic imaging studies were studied with sequential Tl-201 and sulfur colloid liver scans on a triple-headed gamma camera with planar and SPECT acquisition. All patients had subsequent pathologic correlation.


RESULTS
There were three focal nodular HCC lesions and one case of multicentric HCC, size varying between 1.9 cm and greater than 4.0 cm (multicentric HCC). In all lesions, Tl-201 SPECT images showed abnormal increased uptake at sites of HCC, which corresponded to areas of photopenia on sulfur colloid. Computed tomography detected a lesion in two of four patients, whereas US was positive in all patients. However, US was specific for tumor in only one patient and CT was not specific in any patient.


CONCLUSIONS
We believe that in patients with suspected HCC, Tl-201 SPECT imaging will have an important role in the detection and characterization of HCC, especially in the cirrhotic patient. Planar Tl-201 hepatic images will usually be normal, except in large lesions, and high-resolution SPECT technique is essential in successful liver tumor imaging.
Kempf
J S
JS
Nuclear Medicine Section, Robert Wood Johnson University Hospital, New Brunswick, NJ 08903-2601, USA.
Hudak
R
R
Abdel-Dayem
H M
HM
Freiman
H
H
Cheung
Y
Y
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D002648:Child; D015902:Gamma Cameras; D006801:Humans; D007422:Intestines / Q000000981:diagnostic imaging; D007668:Kidney / Q000000981:diagnostic imaging; D008099:Liver / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D013154:Spleen / Q000000981:diagnostic imaging; D013671:Technetium Tc 99m Sulfur Colloid; D013793:Thallium; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation / Q000379:methods; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; C027549:thallium chloride; D013671:Technetium Tc 99m Sulfur Colloid; D013793:Thallium