• Royal HD, Brown ML, Drum DE, Nagle CE, Sylvester JM, Ziessman HA. Procedure guideline for hepatic and splenic imaging, 3.0. Reston (VA): Society of Nuclear Medicine; 2003 Jul 20. 5 p. [10 references]

This is the current release of the guideline.

This guideline updates a previous version: Society of Nuclear Medicine. Procedure guideline for hepatic and splenic imaging, 2.0. Reston (VA): Society of Nuclear Medicine; 1999 Feb. 16 p. (Society of Nuclear Medicine procedure guidelines; no. 2.0).

Background Information and Definitions

1. Liver-spleen imaging is performed after the injection of a ^99mTc-labeled colloid that has been rapidly phagocytized by the reticuloendothelial cells of the liver, spleen, and bone marrow.
2. Liver blood pool imaging is performed after the injection of ^99mTc-labeled red blood cells for the detection of cavernous hemangiomas of the liver.
3. Hepatic perfusion studies are performed following the injection of ^99mTc-macroaggregated albumin (MAA) through a hepatic artery catheter to determine that intra-arterially administered agents are delivered optimally.
4. Splenic imaging is performed after the injection of ^99mTc-labeled heat-damaged red blood cells. Damaged red blood cells are selectively taken up by functioning splenic tissue.

Common Indications

1. Liver-Spleen Imaging

   This study can be used for determining the size and shape of the liver and spleen as well as for detecting functional abnormalities of the reticuloendothelial cells of these organs. Specifically, these studies are occasionally performed:

   1. For suspected focal nodular hyperplasia of the liver. These lesions often have normal or increased uptake on sulfur colloid imaging.
   2. To assess the function of the reticuloendothelial system in patients with suspected liver disease. The decision to perform a liver biopsy or to continue treatment with a hepatotoxic agent may be influenced by the severity of liver disease that is seen on liver-spleen imaging.

2. Liver Blood Pool Imaging

   This test is highly specific for cavernous hemangiomas of the liver. The sensitivity for detecting large lesions of the liver (>2 to 3 cm) is also high. Hemangiomas as small as 0.5 cm may be detected with single-positron emission computed tomography (SPECT) using a multihead camera.

3. Hepatic Perfusion Imaging

   This study is useful for demonstrating that hepatic artery catheters used to infuse chemotherapeutic or therapeutic radiolabeled microsphere agents are positioned optimally to perfuse liver tumors and to avoid perfusion of normal extrahepatic tissues (e.g., stomach).

4. Splenic Imaging

   This study is used for detecting functional splenic tissue. This study is often performed:

   1. In children to rule out congenital asplenia or polysplenia
   2. In adults whose thrombocytopenia has been treated previously with splenectomy
   3. For characterizing an incidentally noted mass as functional splenic tissue

Procedure

The detailed procedure recommendations in the guideline address the following areas: patient preparation; information pertinent to performing the procedure (i.e., important data that the physician should have about the patient at the time the exam is performed and interpreted); precautions; information regarding the radiopharmaceutical (i.e., ranges of administered activity, organ receiving the largest radiation dose, effective dose), image acquisition; interventions; processing; interpretation/reporting; quality control, and sources of error.

None provided

The type of evidence supporting the recommendations is not specifically stated.

• Royal HD, Brown ML, Drum DE, Nagle CE, Sylvester JM, Ziessman HA. Procedure guideline for hepatic and splenic imaging, 3.0. Reston (VA): Society of Nuclear Medicine; 2003 Jul 20. 5 p. [10 references]

Not applicable: The guideline was not adapted from another source.

1999 Feb (revised 2003 Jul 20)

Society of Nuclear Medicine, Inc - Medical Specialty Society

Society of Nuclear Medicine (SNM)

Task Force

Authors: Henry D. Royal, MD (Mallinckrodt Institute of Radiology, St. Louis, MO); Manuel L. Brown, MD (Henry Ford Hospital, Detroit, MI); David E. Drum, MD (West Roxbury Veterans Administration, Boston, MA); Conrad E. Nagle, MD (William Beaumont Hospital, Troy, MI); James M. Sylvester, MD (Our Lady of the Lake Medical Center, Baton Rouge, LA); and Harvey A. Ziessman, MD (Georgetown University Hospital, Washington, DC)

Not stated

This is the current release of the guideline.

This guideline updates a previous version: Society of Nuclear Medicine. Procedure guideline for hepatic and splenic imaging, 2.0. Reston (VA): Society of Nuclear Medicine; 1999 Feb. 16 p. (Society of Nuclear Medicine procedure guidelines; no. 2.0).

None available

This summary was completed by ECRI on July 20, 1999. It was verified by the guideline developer as of August 5, 1999. This NGC summary was updated by ECRI on April 14, 2005.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.