Radioisotope scanning of the liver. What it is? Scintigraphy: general information about the technique

Liver scintigraphy is a functional imaging technique based on the introduction of radioactive isotopes into the body. With the help of special devices, radioactive radiation is recorded and a two-dimensional image of the organ is created. Liver scintigraphy using medicines containing short-lived radioactive isotopes is used when liver diagnostics are necessary.

Examination of the liver is carried out in static and dynamic modes. When the procedure is carried out in a static mode, the functional activity of the cells included in the reticuloendothelial system of the liver is determined. When conducting a survey in a dynamic mode, the state of the hepatobiliary system is determined. When performing an instrumental examination of the reticuloendothelial system of an organ, a colloidal solution based on 99mTc is used, and when examining the hepatobiliary system, chemical compounds are used, based on iminodiacetic acid 99mTc - HIDA.

Scintigraphy is a radioisotope scan of the liver. This method in the study of the liver is used along with such more common methods as ultrasound, CT and angiography of the liver.

Hepatoscintigraphy is a method of imaging the liver using a scintigraphic technique on a gamma camera.

The purpose of this study is to determine the functional activity and quantitative composition of the functioning liver parenchyma tissue when using colloidal radiopharmaceuticals for visualization. The colloid is introduced into the body by intravenous injection with a radio emission activity of 2 MBq/kg. The use of techniques allows you to determine the activity of cells included in the reticuloendothelial system. The mechanism of accumulation of a radioactive pharmaceutical preparation is the process of phagocytosis. Hepatoscintigraphy is carried out 30-60 minutes after drugs with radioactivity enter the internal environment. Hepatoscintigraphy is carried out in three projections - anterior, posterior and lateral, on the right side.

The radioactive drugs used in the liver examination consist of two components. The composition of the medication includes:

vector molecules;
radio markers - isotopes.

The vector molecule is absorbed by the body structure for which it is intended, and the radio tag works as a transmitter in the medication, emitting gamma radiation recorded by a special gamma camera. The volume of the medication used during the examination of the body is such that the radiation generated by the radioactive isotope is sufficient for its registration, but the isotopes do not have a toxic effect on the body.

This laboratory diagnosis of liver diseases allows you to identify serious violations in the early stages of the development of ailments.

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Indications for scintigraphy are:

detection of hepatomegaly and splenomegaly;
detection of hepatitis with a high probability of cirrhosis;
detection of liver cirrhosis;
detection of tumor processes, both primary and secondary;
suspicions of the development of echinococcal and other cysts in the body, as well as an abscess of the liver tissue;
the need to monitor the condition of the liver after surgery;
the presence in the body of lymphogranulomatosis, associated with splenomegaly, to confirm the stage of development of the disease;
the need for a topical diagnosis of a neoplasm of the abdominal cavity adjacent to the liver.

If it is necessary to calculate the parameters of functional ability, an anterior projection is used.

The main parameters determined by planar scintigraphy are:

topography of the liver;
organ shape;
the size;
accumulation and distribution in the liver tissue of a radioactive drug in accordance with the accepted gradation.

The normal distribution of the colloidal drug in the liver tissue is uniform. One of the most important parameters of scintigraphy is the fixation of the radiopreparation in the liver-spleen system. In the normal state, this parameter is 95% -5%. An increase in this indicator in the spleen indicates the development of liver failure in the body and the appearance of signs of portal hypertension.

Radioisotope methods for examining the liver are contraindicated during the period of childbearing and breastfeeding, as well as in severe general condition.

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The introduction of a radioactive drug is carried out by intravenous injection. After that, the health worker takes pictures in different projections of the liver. The resulting images of the organ resemble x-rays, based on the results, the physician makes a conclusion about the state of the organ.

In order to identify possible pathologies of the organ, a radiopharmaceutical is injected into the liver in small doses. The drug has the ability to accumulate, and with the help of special equipment, an assessment is made of the distribution of a radioactive isotope in the tissue of an organ.

The procedure for examining the functioning of the liver tissue is painless. The subject does not experience discomfort and discomfort. During the examination, a low radiation load on the body is used, and the drug used for this purpose is very quickly excreted from the body.

The entire examination cycle is carried out in the outpatient clinic. Before the procedure, the patient is required to empty the bladder. The technique used has practically no contraindications and side effects.

The purpose of the survey is:

assessment of the functioning of the liver tissue;
determination of the location and size of the organ;
determination of the degree of traumatization of the organ after injury;
monitoring the process of recovery of the organ after surgery.

After the introduction of a radioisotope preparation, an examination is carried out using a gamma camera.

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After the appearance of such a method as ultrasound examination of the liver, isotope examination of the liver has lost its importance due to the fact that it has low sensitivity and special specificity in detecting pathologies in the functioning of the organ. At the present stage of development of medicine, this method of examination is used to identify certain ailments of the biliary system.

Conducting an examination using a sulfur colloid, which is designated as technetium-99, is based on the phagocytosis of the radiomaterial by the phagocyte system. Hepatitis and fibrosis of the liver tissue contribute to the development of dysfunction of the phagocyte system, which leads to excessive retention of radioisotope material.

Another pathological change that has a specific scintigraphic picture is nodular hyperplasia, in which there is an increased capture of a radioactive drug.

Due to the absence of phagocyte cells, a focal accumulation defect appears among hepatocellular carcinoma cells during the scanning process using sulfur in combination with technetium. More informative is the research method using gallium-67, which accumulates more actively in cells than in the parenchyma. The disadvantage of using this radioactive marker is the occurrence of a similar picture in the development of lymphomas, liver abscesses and the spread of metastases.

One of the most significant drawbacks of the diagnostic technique is obtaining a large number of positive results in the development of tumors in the body that have extrahepatic localization. In addition, a large number of positive results are caused by erroneous interpretation due to the peculiarities of the size and location of the liver.

To visually determine the functionality of the liver, scintigraphy is used. Liver scintigraphy is prescribed as a diagnostic method for detecting hepatitis, cirrhosis, tumor and cystic formations. The method is based on the introduction of specific radioisotopes into the body. On special devices, the radiation emitted by substances is recorded, which is converted into a 2D image of the gland. The method is indicated for control after an operation or treatment of an organ.

Scintigraphy is a "nuclear" hardware study of the state of the liver.

The scintigraphic technique involves scanning the liver using radioisotope irradiation of the gland tissues. The technique is used along with more popular methods: ultrasound, CT, MRI, liver angiography. There are two types of research:

static liver scintigraphy, which involves the assessment of functional cellular activity in the liver macrophage system using a colloidal solution with 99mTc;
dynamic mode designed to detect disorders in the bile-forming and biliary systems using iminodiacetic acid 99mTc (HIDA).

Hepatoscintigraphy, regardless of the technique used, is carried out on special equipment - in a gamma camera. Tasks of the diagnostic procedure:

detection of deviations in the functional activity of cells;
determination of quantitative violations in the composition of the parenchyma.

A radioactive colloid emits radiation at 2 MBq/kg. The substance accumulates in the liver according to the principle of phagocytosis. According to the rules of scintigraphy, the study is carried out after half an hour from the moment the drugs enter the liver. Hepatoscintigraphy is carried out in three projections - in front, behind, on the right side. The composition of radioactive preparations includes:

vector blood molecules - for the purposeful introduction of drugs into the liver;
isotope radio markers - for transmission of radiation to the registration gamma camera.

The amount of radio substance is selected so that the emitted radiation is sufficient to visualize the state of the liver, but not enough to have a toxic effect on the body of the subject. Scintigraphic imaging of the gland is based on the property of the organ to extract labeled antigens from the blood. For this, technetium (99) isotope-labeled erythrocytes are used - blood cells.

A feature of laboratory diagnostics is the possibility of early detection of serious disorders in the liver.

Under normal conditions, the colloid is distributed evenly. No less important is the parameter of fixing the radio substance in the "liver-spleen" system, which should be equal to - "95% -5%". If there is an excess in terms of the spleen, they talk about hepatic dysfunction with signs of portal vein hypertension. Scintigraphy allows you to determine such violations in the liver:

Scintigraphy is performed with suspicion of inflammation, neoplasms, mutations, liver injury.

damage to hepatomegaly, splenomegaly;
inflammation against the background of hepatitis with a high risk of developing cirrhosis;
cirrhosis;
primary and secondary tumor formations;
defeat of echinococcal and other types of cysts;
abscess;
lymphogranulomatosis.

Indications for diagnosis by this method is the need for:

determining the degree of tumor germination from the peritoneum to the liver;
control of the state of the gland in the postoperative period.

During scintigraphy, the following parameters are determined:

topography;
shape and size;
the degree of absorption and distribution of the isotope in tissues, according to gradation standards.

Specific preparatory procedures before manipulation are not required. The main thing is to empty the bladder. With a planned dynamic scintigraphy, the patient should have 2 raw eggs to create conditions for the outflow of bile after eating on an empty stomach. Bring with you analyzes of previous examinations (X-ray, CT scan), an outpatient card, doctors' conclusions.

In the manipulation room, the patient is injected intravenously with a radiotracer. Some time is given for the accumulation of the isotope in the liver tissues, usually it takes 15-30 minutes. After a specified period of time, the patient is placed on the treatment table for scanning using a gamma camera. The procedure is non-invasive, painless, does not require rehabilitation, passes without complications.

Features of this diagnostic method is the intravenous administration of a specific radiomarker based on 99mTc in order to determine the activity of macrophages. The procedure is carried out 30-60 minutes after the introduction of the radiopharmaceutical. Position - lying on your back. The gamma camera captures and fixes the emitted radiation by labeled erythrocytes with the isotope Tc (99) without significant impact on the patient's body. Pictures are taken within half an hour. The results are processed in 15-30 minutes and immediately issued to the patient.

When performing this manipulation, the patient is injected intravenously with the radioisotope 99mTc with iminodiacetic acid in erythrocytes. The patient is placed on his back under the gamma camera. Scanning begins immediately to capture the changes that occur as the substance passes through. Pictures are taken within 60 minutes. Of these, the first half an hour the examination is carried out on an empty stomach, and the remaining time - after eating in the form of 2 eggs, with the help of which a choleretic effect is achieved. Results are issued after 15-30 minutes. A delayed examination may be required, involving an additional scan in an hour.

The data obtained during scanning is processed on a computer in several stages. The result is a general picture of the functioning of the liver and its dependent organs (gall bladder with ducts, spleen). Stages:

Visual evaluation of the obtained images. The doctor identifies suspicious areas.
Plotting "time-activity" to assess the quality and rate of distribution of the isotope throughout the body.
Mathematical calculation. Curves are constructed taking into account the working capacity of the liver.

In case of deviation from the norm, the doctor diagnoses a specific pathology:

Liver failure is detected by the accumulation of the isotope in the liver in an amount less than 95%, and in the spleen - more than 5%. In this case, the isotope is evenly distributed.
Tumor processes of any nature and an abscess are characterized by the presence of "cold" areas with low radiation. The liver is enlarged and unclear contours of the neoplasm and the gland itself are visualized.
Cirrhosis, portal hypertension are detected with a strong accumulation of the isotope in the bone marrow. The last stages are characterized by a sharp decrease in the volume of the gland, deformation of the edges.
Chronic inflammation (hepatitis of various etiologies), fatty hepatic degeneration manifests itself in the form of an enlarged volume of the gland with unclear edges or affected lobules. In this case, in the inflamed area there will be less contrast. Less often, a significant accumulation of matter in the spleen can be visualized.

Non-invasiveness, painlessness, minimal risk of developing allergies during the procedure allows scintigraphy to be applied to all patients. Exception:

pregnant women;
breastfeeding mothers;
overweight patients.

Complications rarely occur in the form of:

short-term jump in blood pressure;
isotope allergies;
increased urge to urinate.

The positive aspects of scintigraphy are numerous:

the possibility of conducting repeatedly (weekly examination of the liver is allowed), since the radiation doses are insignificant;
full display of the function of the gland;
obtaining a quantitative assessment of the degree of damage;
lack of preparation;
high information content with the possibility of making an accurate diagnosis;
non-invasiveness, painlessness;
lack of a rehabilitation period;
minimal risk of complications and adverse reactions.

Negative features:

insufficiently high clarity of the obtained images (inferior to CT and MRI) against the background of the dependence of the image quality on the degree of accumulation of the isotope in the tissues;
duration (may take several hours to complete distribution of the isotope through the bloodstream and tissues).

This remedy with a natural composition will help the liver even in the most severe cases ...

To identify pathological changes localized in the liver and biliary tract, various diagnostic methods are used. One of them is liver scintigraphy. This instrumental method allows assessing the dynamic performance of the hepatobiliary system and identifying the causes that led to functional disorders.

In some pathological conditions associated with functional disorders of the hepatobiliary system, the patient is prescribed hepatoscintigraphy. What is it and how is the examination carried out? The procedure is a method of hardware research, which allows you to visualize pathologically altered structures of the organs under study.

Carrying out scintigraphy - radionuclide study of the liver

The principle of the study is to determine the radiation emitted by special radioactive markers embedded in the liver and adjacent organs. Radioactive isotopes introduced into the body emit certain waves, which are recorded by special equipment.

The radiation is transformed into a visual two-dimensional image. As the isotopes move through the structures, several images are taken, on the basis of which the state of the organs and tissues under study is diagnosed.

As an active substance for hepatoscintigraphy, special radiopharmaceuticals (RP) are used, which contain radioactive isotopes. In the diagnosis of the liver, colloid preparations labeled with radioactive isotopes (198Au, 99mTs-phyton, 113In-kainol, 99mTs-HIDA TSK-15, 99mTechnetium) are used.

The drug is absorbed by phagocytic cells of the liver. The conclusion about the state of the liver is derived from the nature of the dynamics of the distribution of the radio indicator in the process of absorption-excretory activity of the hepatobiliary system.

The amount of the drug is selected individually, which allows for a safe examination and eliminates the risk of radioactive tissue damage.

To convert radionuclide radiation into a visual two-dimensional image, special equipment is used. This is a computerized gamma camera that registers the waves emitted by the injected radiopharmaceutical and converts them into a visual image.

Cleansing the liver will help rejuvenate the body in a few days and give an additional 15 years of life ...

A snapshot that captures a visual display of the position of the radio indicator is called a hepatogram.

Liver scintigraphy is performed in two ways:

Static way. The result of the study is a series of two-dimensional images obtained in a scintillation chamber. They allow you to assess the state of the parenchyma and identify areas in which there is a violation of functionality.
dynamic way. It consists in building a dynamic curve, which consists of a series of static images. They make it possible to evaluate the dynamics of the passage of radioactive isotopes through the liver and biliary tract, and determine the degree of impairment of the absorption-excretory functions.

Static scintigraphy displays qualitative indicators - the size and contours of the liver, gallbladder and spleen, their position in the abdominal cavity and shape.

The dynamic form of scanning allows you to evaluate quantitative indicators that show the state of polygonal cells, blood flow velocity, concentration and excretory motility, as well as the degree of bile duct patency.

Radioisotope scanning of the liver and biliary tract is a highly accurate method that can replace most biochemical tests.

A dynamic study allows diagnosing even minimal functional abnormalities of parenchyma cells in a short time, differentiating the type of hepatic pathology and determining a further prognosis.

Assign a study when there are the following indications:

steatohepatosis;
fibrosis;
hepatitis of various etiologies;
cirrhosis;
portal hypertension;
violation of the functions of the gallbladder and biliary tract;
inflammatory processes of the hepatobiliary tract;
tumor formations in the liver and adjacent organs.

The method of hepatoscintigraphic scanning is also used in the postoperative period. It helps to give an objective assessment of the state of the organs that have undergone surgical intervention.

Such a diagnostic method of examination is not prescribed if there is reason to assume pregnancy, in order to exclude a potential threat to the fetus. Also, the procedure is contraindicated in patients with acute liver failure and hepatic encephalopathy. For other categories, scintigraphy of the hepatobiliary system is safe.

Radioisotopes are not capable of harming the body, since they are administered in strictly controlled doses. Side effects of radiopharmaceuticals can manifest themselves in the form of allergic reactions with individual intolerance to the components of the drug.

The diagnostic technique does not require special preliminary preparation. The day before the procedure, doctors recommend that you stop taking medications that stimulate the secretion of bile. Immediately before the examination, you need to go to the toilet, because the procedure cannot be interrupted. Diagnose on an empty stomach.

Before the start of the diagnostic complex, a radiopharmaceutical is administered intravenously to the patient(contrast agent). The study begins immediately after the introduction of the active radioisotope substance. The patient is placed on a couch, directly under the gamma camera.

Scanning of the liver is carried out in three planes:

in the anterior upper part of the right hypochondrium;
in lateral projection;
in the upper part of the right hypochondrium, from the back.

The machine takes a series of pictures as the isotopes move through the organ. After the first 20 minutes, the patient needs to eat choleretic food. To do this, use a boiled egg or sour cream.

The study is carried out non-invasively, so the rehabilitation period is not required.

Radionuclide diagnostics allows you to detect any pathological changes in the liver, gallbladder, bile ducts and spleen. They are visualized on the hepatogram, which is deciphered by the specialist who performed the diagnosis.

In healthy tissues, the drug is distributed evenly. Focal or diffuse changes localized in the hepatobiliary system make it difficult for the radiotracer to be absorbed and excreted, which is displayed on the pictures.

Visual quality indicators observed in hepatitis or fatty degeneration of the liver determine an increase in the size of the organ, degenerative changes in the parenchyma, which confirms the decrease in image contrast.

Cirrhosis is diagnosed by a visual picture, indicating a change in the size and deformation of the organ. With this pathology, liver images have reduced contrast, and an increased concentration of the drug is observed in the spleen.

Portal hypertension, accompanied by severe circulatory disorders, or tumor formations are determined by the presence of diffuse changes with a characteristic impairment of radiopharmaceutical absorption.

Differentiate the nature and severity of the pathology help dynamic curves obtained with the dynamic method of research.

Scintigraphy is a modern diagnostic method that doubles the diagnostic efficiency compared to other instrumental, invasive or laboratory examination methods. Unfortunately, this diagnostic method is inaccessible, since the equipment is available only in some large regional clinics.

STABILIN is a special suspension used to regulate metabolic processes and restore the regeneration and functions of liver cells…

The liver performs important functions in the human body. It takes part in the process of digestion, in metabolism, cleanses the blood of toxic compounds, synthesizes protein, forms bile, glycogen. It is the largest gland.

Violation of the work of the body leads to a negative effect on the body. The state of health worsens, pains and discomfort of an abdominal cavity appear, there is a decrease in immunity. To diagnose liver problems and diseases, a functional research method is used - scintigraphy.

Liver scintigraphy is a modern, informative method for diagnosing pathologies of internal organs. The instrumental method is based on obtaining a series of images using special equipment. The patient is injected with a contrast agent. A radioactive isotope emits radiation, a radiologist takes pictures of the organ in a two-dimensional projection. Contrast is displayed as a bright tint on the screen. Diagnostics determines the structure of the tissue, the state of the work of the organ, reveals anomalies in development. Scintigraphy examines the gallbladder, bile ducts.

When scanning, both the liver and spleen are examined at once. The spleen is an unpaired organ of the abdominal cavity that performs the functions of filtration, hematopoiesis, and is involved in the metabolism in the body.

There are two types of scintigraphy:

Static. Examines violations in the functioning of the liver. It is carried out in a horizontal position. A radioactive isotope is injected intravenously. The time for uniform distribution of the substance is 60 minutes. The duration of the procedure takes half an hour, pictures of the organ are taken. The result of the study is ready in 20 minutes, the obtained images are processed and analyzed on site by a radiologist. The method does not have a negative effect on the body.
Dynamic. The method collects additional information, quantitative characteristics and features of the liver, bile duct. This method determines the rate of accumulation and withdrawal of the contrast agent. The patient is placed on the couch. Scanning is performed by a gamma camera. The procedure is performed on an empty stomach, lasts 60 minutes. The result is ready on the day of the examination.

Diagnosis by scintigraphy is the distribution of the contrast agent. The images track the rate of accumulation of the isotope and excretion of the substance from the body.

Scanning the liver using a radioactive isotope is a painless method that does not affect the body. The dosage of the injected contrast agent is minimal, it is quickly excreted from the body. Low radiation exposure can allow visualization of internal organs without harm to health.

If pathological processes in the liver are detected during ultrasound, CT, an additional medical examination is prescribed to confirm or refute the diagnosis. When is a liver scintigraphy indicated?

An increase in the size of the gland;
With chronic hepatitis;
With helminthic invasion;
Suspicion of tumor processes (detection of a malignant, benign tumor);
With cystic lesions of the organ;
Cirrhosis of the liver;
With purulent processes (abscess);
Suspicion of metastases in the gland;
Hemangioma of the liver;
For examination in preparation for surgery or organ transplantation;
Allows you to monitor the dynamics of the development of the disease;
Reveals rupture of the spleen;
Fatty degeneration of the gland;
Control of internal organs after surgery;
In case of injuries and bruises of the organ, the condition is assessed.

The method refers to radiation diagnostics, but due to the fact that exposure during the study is minimal, it does not affect human health. Examination allows timely detection of the disease and eliminate the consequences.

Before performing a scintigraphy with labeled erythrocytes, the patient must provide:

Referral for examination;
A card with a medical history, extracts from previous tests;
If there are results of an MRI, CT scan;
The result of ultrasound of the liver, the conclusion of specialists;
Blood test for bilirubin level.

Before scintigraphy, a consultation with a doctor is required. Warn him if there is an allergy to medications, about recent surgical interventions in the abdominal cavity, about health problems at the time of the examination. It is necessary to report the time of the last CT scan, fluorography. If additional preparation is needed, the doctor should inform the patient. Usually the study is not carried out on an empty stomach. After the procedure, there are no restrictions.

Scintigraphy is a paid procedure. There are discounts for certain categories of people. Check the price with your doctor.

Scintigraphy procedure

What does the test result show?

The survey methodology is highly informative. The liver of a healthy person in the picture looks like a triangle. On the scintigram, the right and left lobes of the gland are clearly visible. After analyzing the data obtained, the specialist can evaluate and identify:

The functional state of the body;
Anatomical features of the structure of the gland;
Pathological processes;
Foci of lesions, neoplasms;
The hepatobiliary system (liver, spleen) is being studied;
The nature of tumor processes;
Abnormal change in the shape and size of the organ;
condition of the bile ducts.

Deviations from the norm are determined:

With an increase in the size of the gland, with uneven outlines, a diagnosis of hepatitis or fatty degeneration is made. Inflamed areas have a weak staining.
If there is an uneven accumulation of a radioactive isotope in the area of the bone marrow, then this indicates the presence of cirrhosis. In severe stages of the disease, a decrease in the volume of the liver and fuzzy edges of the gland are characteristic.
If the accumulation of the contrast agent is less than 95% with a uniform distribution, then this indicates liver failure.

Tumor neoplasms are displayed on the pictures, their contours can be recognized, the gland is enlarged in volume.

An experienced radiologist immediately reads information from the images, makes a diagnosis. If necessary, appoints an additional medical examination, tests.

Liver images are analyzed by a specialist. A radiologist performs computer processing of images, a visual assessment is made for the presence of pathologies, the state of the organ. The doctor studies the graphs of the activity of the distribution of the contrast agent, the withdrawal time. The analysis is carried out on several images. On the basis of frames, a conclusion is made about the functionality of the organ, the structure of tissues.

The diagnostic method is advanced due to the simplicity of preparation and the accuracy of the study of internal organs. Advantages of the method:

The ability to quickly and accurately diagnose the disease, the results are ready immediately after the examination.
Detection of pathologies even at an early stage of development reveals minor deviations from the norm, anomalies in development.
Painless examination. During the scan, the patient does not experience discomfort.
It reveals a malfunction of the organ, neoplasms earlier than an x-ray.
You can periodically scan the internal organs in order to monitor the dynamics of the disease, control the recovery period after surgery. The dosage of irradiation is small, does not harm health.
Allows you to visualize the required organ as a whole, evaluate the functioning, identify malfunctions.
Determines inflammatory processes, the severity of the disease.
Diagnosis does not require surgery.
After scintigraphy, no recovery period and restrictions are required.

The disadvantages of scintigraphy include:

The image is not as clear as with magnetic resonance imaging (MRI);
duration of the procedure;
Not all medical facilities are equipped with special equipment for scanning;
In rare cases, there are side effects or an allergic reaction to a radioactive isotope that is used to scan the internal organs;
Scintigraphy is a paid procedure.

The method is safe for human health, there are no absolute prohibitions on the procedure, except for individual intolerance to the components that make up the contrast agent, allergic reactions. There are relative limitations under which it is recommended to reschedule the examination:

Pregnancy;
The period of breastfeeding;
If there were ultrasound or CT scans on the day of the examination;
Fainting, fever;
Hypertensive disease;
Severe condition of the patient.

Labeled RBC scintigraphy is a popular method for detecting liver problems. The method allows you to evaluate the functioning, condition of the tissues of the gland and spleen.

Scintigraphy is a modern diagnostic method that allows you to obtain information about violations of the functions of the liver and its system as a whole. It is based on the introduction of a radioactive pharmaceutical preparation (RPM) labeled with certain isotopes that emit radiation in the amount of 2 MBq / kg. For example, technetium (99mTc). This diagnostic method is prescribed for control after a long-term treatment or surgery. The procedure allows you to assess the size and shape of the body, as well as its structure.

Scintigraphy is a modern diagnostic method that allows you to obtain information about violations of the functions of the liver and its system as a whole

What is liver scintigraphy

Radioisotope scanning of the liver is used as a method to detect inflammatory processes, cirrhotic deformity, neoplastic formations and benign inclusions. The purpose of the diagnostic procedure is not only to determine deviations in the functional activity of cells, but also to quantify disturbances in the composition of the organ tissue.

Since the scintigraphic study belongs to the group of radiation methods, in order to maintain a balance between diagnostic efficiency and toxic effects, the volume of the administered drug is assessed individually. Before scanning inside, a special preparation is administered, which consists of two components:

a vector blood molecule that allows the drug to be delivered to the liver tissue;
isotope radio marker designed to transmit radiation to the recording part of the gamma camera.

Half an hour after the administration of the drug, the patient is placed in a specialized apparatus, the so-called gamma chamber, in which the radiation emitted by the radiopharmaceutical is further converted. As a result, a map is obtained, on which areas with increased or pathological accumulation of the previously administered radiopharmaceutical are marked.

According to modern data, in order to obtain the most effective and complete information about the organ, it is recommended to use three methods of radiation diagnostics in parallel, therefore, together with scintigraphy, ultrasound, computed tomography, magnetic resonance imaging and angiographic studies are carried out.

Hepatoscintigraphy is carried out in three mutually perpendicular projections - frontal, dorsal and right lateral.

There are two types of radioisotope study of the liver:

There are two types of radioisotope study of the liver

Both types of studies are carried out on an outpatient basis. The procedure does not cause pain or discomfort.

This procedure is prescribed to confirm or refute the diagnoses of the liver and its system:

with chronic hepatitis with a risk of developing cirrhosis;
cirrhosis of the liver;
the formation of primary or secondary metastases and tumors;
enlargement of the spleen or liver;
damage to hepatomegaly or splenomegaly;
cyst or abscess lesion;
suspicion of echinococcosis;
fatty hepatosis of the liver;
the presence of lymphogranulomatosis.

This type of examination is mandatory if there is a suspicion of germination of metastases from the abdominal cavity to the liver, as well as to monitor the condition of the gland after a recent operation.

Such advantages of scintigraphy as painlessness and non-invasiveness create a minimal risk for the development of allergic reactions and other complications. That's why this method of examination can be applied to almost all patients. The exception is:

pregnancy;
lactation period;
individual intolerance to radiotracer
patients in critical condition.

The dynamic view of the study is prohibited with a recent endoscopic or radiopaque diagnosis. In this case, a break of at least two weeks is required between these procedures. Without special indications, it is not carried out to children.

In rare cases, the procedure can cause a short-term jump in blood pressure and frequent urge to urinate.

Scan results are processed by a radiologist using a computer

Preparation and holding

No special preparation is required before the procedure. The main and mandatory requirement is to go to the toilet before the procedure. Since the diagnosis can take a large amount of time, during which you can not move. When diagnosing a dynamic view, the patient needs to take two raw chicken eggs with him to create normal conditions for the outflow of bile after eating them on an empty stomach.

Mothers are advised to stop breastfeeding for two days after scintigraphy

It is also required to bring with you the results of previous studies.(X-ray, CT scan, ultrasound, etc.), an outpatient card and a doctor's report. This is required so that the specialist can establish the allowable dose of the radioactive drug for administration.

Pregnant and lactating women, before the procedure, you need to warn a specialist about this. In addition, mothers are advised to stop breastfeeding for two days after the scintigraphy. Since radioactive substances can enter the body of the baby along with breast milk.

Already in the office, the patient is injected intravenously with the so-called radioactive indicator and waits for a while for the accumulation of radioactive isotopes in iron. Depending on the human body, this takes from 20 to 30 minutes. After the isotopes have accumulated, the patient is placed on a special table and scanned using a gamma camera. As a rule, several shots are taken, which take from 30 to 60 minutes.

After the procedure, the person will not need any rehabilitation, since scintigraphy is non-invasive and completely painless.

The scan results are processed by a radiologist using a computer in several stages:

Visual assessment and designation of suspicious areas.
Construction of a graph according to the "time-activity" type, which makes it possible to determine the rate of spread of a radioactive substance throughout an organ.
Mathematical processing of the graph.

As a result, specialists get a complete picture of the functioning of the liver and its tissues (gall bladder with bile ducts, spleen, etc.).

Scintigraphy: general information about the technique
Indications for liver scintigraphy
Method of examination of the body
Liver disease detected by scintigraphy

Scintigraphy: general information about the technique

Scintigraphy is a radioisotope scan of the liver. This method in the study of the liver is used along with such more common methods as ultrasound, CT and angiography of the liver.

Hepatoscintigraphy is a method of imaging the liver using a scintigraphic technique on a gamma camera.

The radioactive drugs used in the liver examination consist of two components. The composition of the medication includes:

vector molecules;
radio markers are isotopes.

This laboratory diagnosis of liver diseases allows you to identify serious violations in the early stages of the development of ailments.

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Indications for liver scintigraphy

Indications for scintigraphy are:

detection of hepatomegaly and splenomegaly;
detection of hepatitis with a high probability of cirrhosis;
detection of liver cirrhosis;
detection of tumor processes, both primary and secondary;
suspicions of the development of echinococcal and other cysts in the body, as well as an abscess of the liver tissue;
the need to monitor the condition of the liver after surgery;
the presence in the body of lymphogranulomatosis, associated with splenomegaly, to confirm the stage of development of the disease;
the need for a topical diagnosis of a neoplasm of the abdominal cavity adjacent to the liver.

If it is necessary to calculate the parameters of functional ability, an anterior projection is used.

The main parameters determined by planar scintigraphy are:

topography of the liver;
organ shape;
the size;
accumulation and distribution in the liver tissue of a radioactive drug in accordance with the accepted gradation.

Radioisotope methods for examining the liver are contraindicated during the period of childbearing and breastfeeding, as well as in severe general condition.

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Method of examination of the body

The purpose of the survey is:

assessment of the functioning of the liver tissue;
determination of the location and size of the organ;
determination of the degree of traumatization of the organ after injury;
monitoring the process of recovery of the organ after surgery.

After the introduction of a radioisotope preparation, an examination is carried out using a gamma camera.

Liver scintigraphy has become widespread as a highly effective method for diagnosing diseases of the hepatobiliary system in the USA, Europe and a number of other countries. To date, in Russia, the study is quite rare. This is due to several factors: unavailability of radiopharmaceuticals, lack of equipment, biased attitude of the population towards radionuclide research methods after the Chernobyl accident (even despite the fact that the radiation exposure with this method is two times less than with computed tomography of the same anatomical area). If in the West the procedure is often performed on an outpatient basis (in polyclinics), then in Russia this is the lot of large medical centers and research institutes.

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What is a liver scintigraphy?

Liver scintigraphy is a radionuclide method for studying the functional and morphological state of the organs of the hepatopancreobiliary system (liver, pancreas, gallbladder are anatomically and functionally closely related, therefore they are combined into a single system).

The procedure is based on the use of radiopharmaceuticals (RP), which are administered in small amounts intravenously immediately before the study. Radiopharmaceutical is a radioactive isotope or its combination with an organic or inorganic substance approved for diagnostic purposes. Each radiopreparation has its own tissue specificity, i.e., different radioisotopes are distributed differently in different organs. The radiologist selects radiopharmaceuticals that accumulate well in the liver tissue. The choice is regulated in clinical protocols intended for specialists, but it is also necessary to proceed from the positions of the availability of a particular drug in the institution. The most commonly used radioactive isotope of technetium (99mTc or 99mTc-HIDA). These substances do not affect normal vital processes - they are used in negligible amounts and are quickly excreted from the body.

On a special device - a gamma camera - several pictures are taken at intervals of several minutes as the drug moves through the body. The RFP plays the role of an indicator, the gamma camera captures the radiation and translates it into a color image. Thus, the speed, the nature of the movement, the features of the accumulation and excretion of a substance from the organ are recorded. In parallel, you can evaluate the work of the gallbladder, bile ducts and pancreas. Based on the images obtained, one can judge the state of tissues, the vascular system, and the presence of pathological formations.

Liver scintigraphy is completely painless, harmless and highly sensitive. Together with the data of the examination of the patient, laboratory and other instrumental studies, the doctor concludes in favor of a particular diagnosis.

Echogenicity of the liver is increased what is it

Kinds

In the tissue organization of the liver, their own cells are isolated - hepatocytes, toxic-immune cells - stellate reticuloendotheliocytes. With the accumulation of a substance in hepatocytes, the technique is called hepatobiliscintigraphy, it is also dynamic; in stellate cells hepatoscintigraphy, she is static . In both cases, two-dimensional images are obtained in two projections, but the objectives of the study are somewhat different.

Comparative table of types of scintigraphy:

Liver CT

Single photon emission computed tomography of the liver (SPECT)

SPECT is often referred to as a type of scintigraphy. In fact, this is computed tomography, supplemented by the ability to study the features of the accumulation of radiopharmaceuticals in scintigraphy. Allows you to evaluate the functional activity of the liver in layers in three mutually perpendicular projections. At the output, the computer produces a 3D image of the organ with all the features of the distribution of the radioisotope in the tissue.

Procedure

From the introduction of the drug to the completion of the study, 1.5-2 hours pass. How to go through the procedure:

1. RFP is administered intravenously.
2. A study on a gamma camera is carried out 0.5–1 hour after the introduction of the radiopreparation.
3. The patient lies down on the table.
4. The table with the patient is fed into the frame of the gamma camera.
5. Obtaining one picture or a series of pictures of the liver at regular intervals (bp, 1 minute).

General indications and contraindications

Like any other instrumental study, liver scintigraphy has its own indications and contraindications. The appointment is not indicated prophylactically for screening (routine annual examination).

Indications

Consultation with a specialist is required for the appointment of a study. The reason for the appointment of scintigraphy may be the diagnosis of the following conditions:

an increase in the size of the liver and spleen (hepatomegaly and splenomegaly);
degeneration of healthy liver tissue into fatty (fatty hepatosis);
chronic hepatitis of any origin (viral, alcoholic);
cystic lesion;
neoplasms (benign and malignant, including metastases);
liver failure;
liver abscesses;
preparation for the operation;
control of chemotherapeutic treatment of oncological patients.

Test principle. The study is based on the phagocytic capture by reticuloendothelial cells (RES) of the liver, spleen and red bone marrow of colloidal particles introduced into the bloodstream. The rate and degree of capture of colloids by RES cells of the liver and spleen does not depend on the functional state of hepatocytes, but is determined by the state of the hepatic blood flow and the presence of pathologically altered areas in these organs. Colloidal preparations 198 Au, 99m Ts - phyton or 113 In - kainol do not participate in metabolic processes and therefore are not excreted from the body, remaining in the RES cells until complete decay.

The study is carried out in 3 projections: anterior straight, right lateral, posterior straight. Indications: hepatomegaly or splenomegaly, the need to identify or exclude a primary tumor or metastatic lesions of the liver, suspicion of the presence of an echinococcal or other cyst, liver abscess, dynamic monitoring of the state of the liver after surgical interventions for abscesses or liver injuries, chronic hepatitis, cirrhosis, thrombophlebitis of the veins of the spleen, lymphogranulomatosis with splenomegaly to clarify the stage of the disease, differential topical diagnosis of an abdominal tumor adjacent to the liver, relaxation of the right dome of the diaphragm, autoimmune hemolytic anemia, etc.

Contraindications - possible or established pregnancy. Radiopharmaceuticals: colloid preparations labeled with 99m Tc-99m, 113m In, 198 Au. The best results are obtained when using colloidal radiopharmaceuticals labeled with 99m Technetium. In recent years, hepatoscintigraphy has been performed using Technephyt-99m Ts, which is prepared directly in the laboratory from 99m Ts-pertechnetate and a set of reagents. Equipment. To perform the study, a scintillation gamma camera is required, connected to a system for collecting and processing information. Patient preparation - not required. Methodology. The drug is administered intravenously. The study begins in 15 - 30 minutes and is performed in at least 3 projections: anterior, posterior and right lateral. During the examination, the patient must not move relative to the detector. Research result - a series of images (scintigrams). When analyzing information, the position of the liver, its shape and size, the contour of the image, the level of accumulation and the nature of the distribution of radiopharmaceuticals, the degree of capture of the drug by the spleen and red bone marrow are evaluated.

The image of the liver normally has a triangular shape in the anterior and posterior projection, in the lateral rounded one. The upper border of the liver is convex, located at the level of the 5th rib, the lower one - along the edge of the costal arch. The size of the liver image on the scan exactly corresponds to the size of the organ according to Kurlov, the measurement scale on the scintigram is 1:2 or 1:5. The lateral edge of the liver is smooth. The lower border of the liver may be flat or change the notch at the border of the right and left lobes (the gallbladder bed). The intensity of the image of the liver (contrast) is typical: the maximum intensity falls on the center of the right lobe with a gradual decrease in contrast to the periphery; in the left lobe, the image intensity is 30% less than in the right. The nature of the distribution of radiopharmaceuticals in the liver is diffusely uniform in all departments. In the spleen, the inclusion of the drug in the anterior projection is usually not observed (except for splenomegaly), and only in the posterior projection can the image of the spleen appear.

With a volumetric process in the liver (tumor, metastases, abscess, cyst), the characteristic features are: deformation of the organ, sometimes enlarged sizes and fuzzy contours, focal uneven distribution of the nuclide with the presence of "cold" zones, a symptom of a shift of normally functioning tissue up, down, to the side. In the massive right lobe, it is possible to identify foci of destruction of the liver tissue with a size of at least 3 cm, in the left - over 2 cm.

In patients with chronic hepatitis, fatty degeneration of the liver, an increase in the organ and a decrease in the contrast of one of the lobes, as well as the fuzziness of the boundaries of the liver, sometimes a moderate increase in the inclusion of radiopharmaceuticals in the spleen, is determined.

In cirrhosis, which occurs with the syndrome of portal hypertension and enlargement of the spleen, there is a decrease in the size and deformation of the contours of the liver with reduced contrast and a significant accumulation of the nucleide in the spleen, red bone marrow (spine, pelvic bones)

In the case of severe circulatory disorders with pronounced congestive changes in the liver, the image of the entire organ was significantly enlarged with a clear diffusely uneven distribution of the drug.

Liver scintigraphy is completely painless, harmless and highly sensitive. Together with the data of the examination of the patient, laboratory and other instrumental studies, the doctor concludes in favor of a particular diagnosis.

02 Views

04 Procedure

From the introduction of the drug to the completion of the study, 1.5-2 hours pass. How to go through the procedure:

1. RFP is administered intravenously.
2. A study on a gamma camera is carried out 0.5–1 hour after the introduction of the radiopreparation.
3. The patient lies down on the table.
4. The table with the patient is fed into the frame of the gamma camera.
5. Obtaining one picture or a series of pictures of the liver at regular intervals (bp, 1 minute).

05 General indications and contraindications

Like any other instrumental study, liver scintigraphy has its own indications and contraindications. The appointment is not indicated prophylactically for screening (routine annual examination).

06 Readings

Consultation with a specialist is required for the appointment of a study. The reason for the appointment of scintigraphy may be the diagnosis of the following conditions:

an increase in the size of the liver and spleen (hepatomegaly and splenomegaly);
degeneration of healthy liver tissue into fatty (fatty hepatosis);
chronic hepatitis of any origin (viral, alcoholic);
portal hypertension;
cystic lesion;
neoplasms (benign and malignant, including metastases);
liver failure;
liver abscesses;
preparation for the operation;
control of chemotherapeutic treatment of oncological patients.

07 Contraindications

There are no strict contraindications for the study, but there are conditions in which it is undesirable:

pregnancy;
the period of breastfeeding (if necessary, you should refrain from breastfeeding the baby during the day);
severe condition of the patient;
allergic to radiopharmaceuticals (it is possible to choose another drug).

08 Conclusion

Scintigraphy is a painless, high-precision and practically harmless procedure. In our country, this study has not received wide distribution due to the lack of equipment for testing and the prejudiced opinion of the population regarding the radiopharmaceuticals used. Being the most accurate study, in contrast to similar diagnostics, scintigraphy shows high results. The passage of this diagnostic method helps patients to detect even latent forms of diseases in a timely manner.

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general information

The essence of the technique is that the patient is injected with a special preparation consisting of two parts: a marker and a vector. In this case, the vector particle is absorbed by the body, and the role of the informant is played by a radioactive label, which makes it possible to transmit information about the state, activity of cells and the dynamics of the development of the hepatobiliary system. This is done due to the fact that the label produces gamma rays that are recorded by the gamma camera.

The process of the procedure

Training

The patient should be informed of the need to stop taking drugs that accumulate and persist for a long time in the tissues, and other drugs that can cause distortion of the results in the opinion of the attending physician.

Liver scintigraphy procedure

To begin with, a specialist introduces radioactive substances into the human body, which, together with pharmacological preparations, enter the liver with blood. The information obtained by means of particles of substances is recorded and processed by a computer, which makes it possible to evaluate the following characteristics of an organ:

the size;
the form;
location.

The radioactive substances used for this study are absolutely safe, as they have the ability to decay and be excreted from the body.

rehabilitation period

The study does not include a rehabilitation period.

Indications and contraindications

inflammatory processes in the body;
metabolic diseases;
cholecystitis;
biliary dyskinesia;
assessment of the patient's condition after a surgical operation on the hepatobiliary system.

Contraindications

The method is the safest of all methods of examination of this kind and has only two contraindications:

the presence of an allergy to a substance-indicator;
pregnancy.

The service for those patients who are breastfeeding is acceptable, but in this case, you can start feeding the baby 24 hours after the examination.

Complications

Complications may be of the following nature:

temporary increase or decrease in blood pressure;
allergic reaction to radioactive substances;
frequent urge to urinate.

Who conducts and where?

The service can be carried out in special medical diagnostic centers, private clinics and public hospitals. After receiving the result, the information is transmitted to the attending gastroenterologist, who directs the further actions of the medical staff. You can find out more information on the medical portal medbooking.com.

medbooking.com

Indications

The scintigraphy procedure is performed if the following liver pathologies are suspected:

fatty hepatosis;
echinococcosis;
chronic hepatitis;
liver failure;
portal hypertension;
abscess;
cirrhosis;
splenomegaly;
benign and malignant neoplasms in the body.

Survey Options

Liver scintigraphy can be performed in static or dynamic modes. Each of the methods of research is carried out according to a certain scheme:

Each version of the study is carried out on an outpatient basis. There is no pain or discomfort during the procedure.

Contraindications

The scintigraphy procedure is completely safe, since the radiation dose received during this study is much less than when performing the usual x-ray examination. In addition, the radioactive drug used during the procedure is quickly excreted from the body without any side effects.

In this regard, there are practically no contraindications to this procedure. However, there are still some limitations.

This study cannot be carried out if the patient has an individual intolerance to the indicator, as well as women during pregnancy (at any time).

In addition, mothers are advised not to breastfeed for the first 2 days after the procedure, as radioactive substances can be excreted in breast milk. Also, this type of examination is not carried out in a serious condition of the patient.

It is unacceptable to conduct dynamic scintigraphy after performing endoscopic and radiopaque examination.

In this case, you should take a break for 2 weeks.

Preparation for the procedure

The procedure does not require any preparation. If dynamic scintigraphy is to be performed, the patient should have 2 raw chicken eggs with him (they have a choleretic effect).

Also, the patient must bring with him the results of examinations that were carried out earlier (X-ray examination, computed tomography), outpatient cards, expert opinions and other medical documentation.

Before the study, the patient must empty the bladder.

Processing scan results

After performing the dynamic scintigraphy procedure, the specialist processes the results:

visually evaluates and marks the area of interest;
builds a graph according to the "time-activity" type, which allows you to evaluate the distribution of the radiotracer in the liver;
performs mathematical processing of graphic data.

Subject to all the above conditions, it is possible to quantify the functional state of the liver and its tissues.

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Research options:

Dynamic hepatobillioscintigraphy (dynamic scintigraphy of the liver and bile ducts)

Preparation for the study:
Static scintigraphy: no preparation required.
Dynamic scintigraphy of the liver and bile ducts: on an empty stomach (fasting for 4 hours or more before the study), it is necessary to have a choleretic product with you (for example, a banana, liquid fat cream, 2 egg yolks). In the evening before the study, a light dinner.

Indications:
1. Static scintigraphy of the liver:

Determining the amount of functioning tissue
Differential diagnosis of chronic hepatitis and liver cirrhosis.
Diagnosis of focal lesions of the liver.
Acute poisoning, blood diseases.
Dynamic monitoring of changes in the state of the liver during treatment or progression of the disease.

2. Dynamic hepatobillioscintigraphy:

Determination of the bile-forming function of the liver.
Inflammatory and metabolic diseases of the liver and gallbladder.
Identification of dyskinesia of the gallbladder (determination of the motor function of the gallbladder).
Differential diagnosis of mechanical and parenchymal jaundice (determination of bile outflow disorders and the level of obstruction of the common bile duct).
The presence of signs of gastrointestinal reflux of bile, suspicion of a spill of bile.
Treatment quality control.
Malformations of the biliary system.

Contraindications: with caution during pregnancy and lactation.

Research features:
Static liver scintigraphy: a short-term study that is comfortable for the patient. It is carried out 40-45 minutes after the introduction of the radiopharmaceutical. The conclusion is issued on the day of the study.
Dynamic hepatobillioscintigraphy: a long-term study, the patient lies on the gamma camera for about 1.5 hours. In the middle of the procedure, the bile flow is stimulated by taking a choleretic breakfast (banana, heavy cream, egg yolks). The study is carried out immediately after the injection. The conclusion is issued on the day of the study.

Used radiopharmaceuticals (RP) are administered intravenously:
Static liver scintigraphy
– Technefit, Ts99m: phytate complexes. The drug is absorbed by Kupffer cells, accumulates in the liver parenchyma.
Dynamic hepatobillioscintigraphy
– Bromesis, Tc99m: derivatives of immidoacetic acid. The drug is absorbed by the polygonal cells of the liver, as part of the bile is excreted into the intestine, where it is not reabsorbed. The gallbladder, intra- and extrahepatic bile ducts are visualized

Normal static scintigram of the liver in the anterior, lateral and posterior projections:

Dynamic hepatobillioscintigraphy:

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xda.su Scintigraphy Liver and spleen scintigraphy

Scintigraphy- a modern method of radiation diagnostics, which is used to assess the functioning of various organs and tissues.

Scintigraphy- a method of functional imaging, which consists in introducing radioactive isotopes into the body and obtaining an image by determining the radiation emitted by them.

A scintigraphy is a procedure performed on a gamma-ray tomograph - a diagnostic radiological device - after the injection of a small amount of a radioactive substance.

SCINTIGRAPHY OF THE LIVER AND SPLEEN is a functional imaging technique that is used to visually evaluate the liver and spleen.

Liver- This is an unpaired organ of the abdominal cavity, the largest gland in the human body.

The liver performs a variety of functions:

In the liver, the toxic substances that enter it with blood from the gastrointestinal tract are neutralized.

In the liver, the most important protein substances of the blood are synthesized, glycogen and bile are formed.

The liver is involved in lymph formation, plays an essential role in metabolism.

Spleen It is an unpaired parenchymal organ of the abdominal cavity. It performs immune, filtration and hematopoietic functions, takes part in metabolism.

Liver and spleen scintigraphy is done in motionless and dynamic modes.

In a stationary state, the functional activity of the cells of the reticuloendothelial system of the liver is assessed.

In the dynamic state, the state of the hepatobiliary system is assessed.

Drugs used in spleen and liver scintigraphy

For the study of the reticuloendothelial system of the liver - colloidal solutions.

For studies of a hepatobiliary compound based on mezide and imidodiacetic acid.

Indications for scintigraphy of the liver and spleen

Allows you to determine the size and position of the liver and spleen.

Allows you to assess the functional state of the parenchyma.

Allows you to identify focal changes in the parenchyma (cysts, abscesses, neoplasms, heart attacks).

Allows you to identify diffuse changes in the parenchyma (liver cirrhosis, chronic hepatitis).

It is used to diagnose a ruptured spleen.

Contraindications for scintigraphy of the liver and spleen

Spleen-liver scintigraphy is contraindicated in the presence of an allergy to an indicator substance, and is also not recommended for pregnant women.

HEPATOSCINTIGRAPHY- this is a study that visualizes the liver by scintigraphy on a gamma camera with a further determination of functional activity and the amount of functioning parenchyma during the use of colloidal radiopharmaceuticals. A special colloid with an activity of 2 MBq/kg is injected intravenously.

Hepatoscintigraphy allows to determine the functional dynamics of reticuloendothelial cells. The mechanism of accumulation in such cells is phagocytosis.

Hepatoscintigraphy is performed 30-60 minutes after the administration of radiopharmaceuticals. Planar hepatoscintigraphy is performed in several standard projections: lateral, anterior and right lateral.

Indications for hepatoscintigraphy

Splenomegaly or hepatomegaly.

Relaxation of the right dome of the diaphragm.

Hepatitis with risk of progression to cirrhosis.

Cirrhosis of the liver.

Lymphogranulomatosis in order to clarify the diagnosis.

Suspicion of a liver abscess or echinococcal or other cyst.

Primary and secondary tumors.

Active control of the liver after surgery.

Anterior projection is used to calculate the parameters of the functional capacity of the liver. The main parameters of planar scintigraphy are the topography of the liver, its size, shape, distribution and accumulation of radiopharmaceuticals according to the standard gradation: uneven (focal, diffuse), uniform. During normal functioning, the colloid is evenly distributed throughout the liver. One of the most important parameters of hepatoscintigraphy is the fixation of radiopharmaceuticals in the spleen-liver system, which normally equals about 95 percent. If the radiopharmaceutical begins to accumulate in greater amounts in the spleen, then this is a sign of liver failure and signs of portal hypertension.

Contraindications for hepatoscintigraphy

Complicated and serious condition of the patient.

breastfeeding period.

Scintigraphic anatomy of the liver

In direct projection, a healthy liver looks like a triangle, the hypotenuse of which coincides with the right costal arch. The upper face of the liver has a convex shape at the level of the fifth rib.

The scintigram clearly shows the right and left lobes, i.e. depressions at the top and a recess at the bottom, which corresponds to the gallbladder fossa. The lateral edge of the liver is even. The intensity of the image is as follows: the maximum intensity falls on the center of the right lobe and gradually it decreases towards the periphery, so here is the largest volume of the hepatic mass. In the left lobe, the image is thirty percent less intense than in the right lobe. The radiopharmaceutical is distributed relatively evenly across all departments. In lateral protection, the liver leaves a shadow similar in shape to a rhombus or oval. The left lobe is largely shielded by the spine, so the image shows more of the right lobe.

In the spleen in the anterior protection, the drug is not particularly observed, and only in the posterior projection can its image be present (since in this part it is located closer to the detector). The size of the spleen and the level of concentration of the radiopharmaceutical should be studied in a direct anterior projection.

Four grades of fixation of radiopharmaceuticals in the spleen

The spleen is displayed, you can see its shape, size, accumulation of the radiopharmaceutical from ten to fifteen percent.

The spleen is well distinguished in the image, has an enlarged size, the accumulation of the radiopharmaceutical is from twenty to forty percent.

The spleen takes up more radiopharmaceutical than the liver, has a significant increase in size, and accumulates more than fifty percent radiopharmaceutical.

Gradations

Manifested in chronic hepatitis.

It is observed in patients with hepatitis with the transition to cirrhosis of the liver.

It is characteristic of cirrhosis of the liver.

The degree of gradation is determined by the doctor based on the pictures taken.

Another important point is the fixation of the radiopharmaceutical in the brain.

There are two gradations:

There is accumulation.

There is no accumulation.

A high amount of radiopharmaceutical in the bone marrow indicates clear portal hypertension and is a sign of liver cirrhosis.

Depending on the age and physique of a person, the protrusion of the liver from under the edge of the hypochondrium by one and a half centimeters can be considered normal. Pathological formations accumulate the radiopharmaceutical more than healthy liver tissue, so these areas will be highlighted on the images as “hot spots” (increased intensity). Tumors, abscesses and cysts are expressed on the pictures as "cold areas", that is, with reduced intensity. Characteristic signs for them are: enlarged liver, deformity, fuzzy contours, sometimes uneven distribution of the radiopharmaceutical with characteristic "cold zones", symptoms of healthy tissue shifting down, sideways or up. In the right lobe, it is possible to identify a focus of destruction of the liver tissue with a size of at least three centimeters, and in the left lobe - at least two centimeters.

In patients suffering from fatty liver or chronic hepatitis, there is an increase in the liver in size and the contrast of one of the lobes decreases. There are no clear boundaries. In some cases, small elevations of the radiopharmaceutical are observed in the spleen. Only doctors with extensive experience and with the availability of modern diagnostic equipment can accurately determine the localization.

With cirrhosis, which occurs with the syndrome of portal hypertension and with an increase in the spleen, a decrease in the size and deformation of the hepatic contours is often found. At the same time, there is a reduced contrast and a high increase in the concentration of nuclides in the spleen, red bone marrow (pelvic bones, spine). In particularly difficult cases, in case of circulatory disorders with serious congestive changes, the image of the organ on scintigraphy is greatly enlarged, while diffuse and focally uneven distributions of the drug are observed.

HEPATOBILISCINTIGRAPHY- this study of liver imaging by scintigraphy on a gamma camera is carried out in order to determine the functional activity of hepatocytes and the biliary system using radiopharmaceuticals based on imudodiacetic acid.

Hepatobiliscintigraphy is carried out only on an empty stomach (the patient must fast for some time before this).

Indications for hepatobiliary scintigraphy

Evaluation of hepatic and general blood flow.

Evaluation of the contractile and concentrating ability of the gastric bladder.

In violation of the functions of the hepatobiliary system.

Evaluation of the functioning of the parenchyma.

LIVER SPECT WITH 99M TC-COLLOID

The method is based on visualization of the liver by scintigraphy on a single photon emission tomograph, the purpose of which is to determine the features of the distribution of radiopharmaceuticals in each individual layer.

SPECT of the liver allows you to make a tomographic study, evaluate each layer for the distribution of radiopharmaceuticals in three projections that are interconnected.

In planar scintigraphy, the gamma-camera detectors remain motionless all the time, and during SPECT, these cameras make a complete revolution around the patient's body at the level of the liver. In the future, a computer reconstruction of the image is made, which makes it possible to analyze the data of three mutually perpendicular projections: axial, sagittal and frontal.

99MTS - HIDA (MEZIDA)

99mTc - HIDA (mesis) is injected into the body intravenously with an activity of 0.5 MBq/kg, after the patient is laid down. He lies on his back under the detectors of a gamma camera, which is placed as close as possible to the patient's stomach, so that part of the intestine and the entire liver fall into his field of vision. Studies begin after intravenous administration of the radiopharmaceutical and last for sixty minutes.

Simultaneously with the process of diagnosing, registration systems are included in the process. At every thirtieth minute, the patient is given a breakfast of two raw chicken yolks, which is necessary for the passage of bile.

Healthy hepatocytes quickly absorb drugs from the blood and excrete it in the bile. The mechanism of accumulation of the radiopharmaceutical in this case is active transport. The normal time for a radiopharmaceutical to pass through a hepatocyte is two to three minutes. The first portions appear in the bile stream after ten minutes. After two to five minutes, the scintigram shows the general and hepatic flow of bile, and after two to three minutes - the gallbladder. Maximum radioactivity occurs twelve minutes after the radiopharmaceutical is administered. By this time, the radioactivity curve has already reached its maximum. Further, it acquires the character of a plateau: at this time, the rate of capture and excretion of the radiopharmaceutical is almost the same. Gradually excreted, the radioactivity of the radiopharmaceutical decreases by fifty percent in thirty minutes, and the intensity of radiation over the gallbladder increases.

Very little radiopharmaceutical enters the intestine. In order to cause a bowel movement and assess the patency, the patient is given a choleretic breakfast. After that, in the area of the gallbladder, the radioactivity decreases, and in the area of the intestine it increases. Four zones are selected from the memory of the computer: liver, gallbladder, intestines and intestines.

The time when the maximum accumulation of the drug in the liver occurred.

Indicators of motor functions of the gallbladder.

Blood clearance.

The half-life of the drug.

The duration of the latent time before the onset of gallbladder emptying.

Intensity and time of onset of radiopharmaceutical entry into the intestine.

The advantage of scintigraphy - this is not only information about the function of the organ, but also obtaining quantitative characteristics of the degree of its damage at the earliest stages. The spleen is not displayed on the scintigram, that is, the accumulation of the radiopharmaceutical is less than or equal to five percent.