Podcast
Questions and Answers
Which organ is primarily localized with 85% of Tc99m-sulfur colloid distribution?
Which organ is primarily localized with 85% of Tc99m-sulfur colloid distribution?
What artifacts can distort the shape of the liver during imaging?
What artifacts can distort the shape of the liver during imaging?
Which appearance is indicative of severe diffuse liver disease on imaging?
Which appearance is indicative of severe diffuse liver disease on imaging?
What is a potential consequence of imaging too soon after Tc99m-sulfur colloid injection?
What is a potential consequence of imaging too soon after Tc99m-sulfur colloid injection?
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How can breast shadow artifacts be minimized during imaging?
How can breast shadow artifacts be minimized during imaging?
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What underlying condition can cause liver displacement observed in imaging?
What underlying condition can cause liver displacement observed in imaging?
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Which imaging technique can help differentiate artifacts from true defects?
Which imaging technique can help differentiate artifacts from true defects?
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What appearance is associated with areas of decreased or absent tracer uptake in imaging?
What appearance is associated with areas of decreased or absent tracer uptake in imaging?
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What primary function is performed by the RE cells in the liver?
What primary function is performed by the RE cells in the liver?
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Which imaging technique is recommended to be performed before GI tract studies using contrast agents?
Which imaging technique is recommended to be performed before GI tract studies using contrast agents?
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What is the composition of the liver primarily made of?
What is the composition of the liver primarily made of?
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What is the primary purpose of SPECT imaging in liver and spleen assessment?
What is the primary purpose of SPECT imaging in liver and spleen assessment?
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What is the dosing of Technetium-99m sulfur colloid typically used for liver/spleen imaging?
What is the dosing of Technetium-99m sulfur colloid typically used for liver/spleen imaging?
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What condition should be evaluated through liver/spleen imaging?
What condition should be evaluated through liver/spleen imaging?
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What specific imaging position is essential for flow studies?
What specific imaging position is essential for flow studies?
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What happens to technetium colloid when administered for liver imaging?
What happens to technetium colloid when administered for liver imaging?
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What percentage of RE cells are primarily found in the liver?
What percentage of RE cells are primarily found in the liver?
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What is the main reason for performing liver/spleen imaging before GI tract studies?
What is the main reason for performing liver/spleen imaging before GI tract studies?
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Which imaging view is NOT standard for liver/spleen imaging?
Which imaging view is NOT standard for liver/spleen imaging?
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What component of blood supply does the liver receive from the hepatic portal vein?
What component of blood supply does the liver receive from the hepatic portal vein?
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What is the typical biodistribution process of Technetium-99m sulfur colloid upon administration?
What is the typical biodistribution process of Technetium-99m sulfur colloid upon administration?
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Which procedure is essential to evaluate liver diseases such as cirrhosis or hepatitis?
Which procedure is essential to evaluate liver diseases such as cirrhosis or hepatitis?
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What type of cells are primarily responsible for the liver's phagocytic function?
What type of cells are primarily responsible for the liver's phagocytic function?
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At what time frame does static imaging begin after tracer localization?
At what time frame does static imaging begin after tracer localization?
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Which of the following is NOT a cell type found in the liver?
Which of the following is NOT a cell type found in the liver?
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What is the total mCi dose standard for Technetium-99m sulfur colloid in liver/spleen imaging?
What is the total mCi dose standard for Technetium-99m sulfur colloid in liver/spleen imaging?
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What impact does emphysema have on liver imaging?
What impact does emphysema have on liver imaging?
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Which factor could contribute to the appearance of artifacts during liver imaging?
Which factor could contribute to the appearance of artifacts during liver imaging?
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What specific imaging technique can minimize respiration artifacts?
What specific imaging technique can minimize respiration artifacts?
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What characteristic appearance is typically observed in diffuse liver disease?
What characteristic appearance is typically observed in diffuse liver disease?
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Which artifact can result from skin folds during imaging?
Which artifact can result from skin folds during imaging?
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What is the significance of visualizing bone marrow in liver imaging?
What is the significance of visualizing bone marrow in liver imaging?
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What should take priority when scheduling imaging procedures involving the liver and spleen?
What should take priority when scheduling imaging procedures involving the liver and spleen?
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What factor can affect the visualization of the spleen during imaging?
What factor can affect the visualization of the spleen during imaging?
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In what situation might one observe a colloid shift during imaging?
In what situation might one observe a colloid shift during imaging?
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Which location is typically associated with the best visualization of the spleen?
Which location is typically associated with the best visualization of the spleen?
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Study Notes
Liver and Spleen Imaging Study Notes
- Liver Location: Located on the right side, beneath the ribs, and directly below the diaphragm.
- Liver Composition: Composed of Kupffer cells (RE cells) and hepatocytes.
- Liver Size: The largest solid organ in the body.
- RE Cell Function: Responsible for phagocytosis, ingesting particulate matter like bacteria.
- RE Cell Distribution: Primarily found in the liver (80%), with smaller amounts in the spleen, bone marrow, and lymph system.
- Liver Blood Supply: Receives oxygenated blood from the hepatic artery and nutrient-rich blood from the hepatic portal vein.
Clinical Indications
- Assessing liver and spleen size, shape, and position.
- Detecting tumors, hematomas, cysts, abscesses, and trauma.
- Evaluating liver diseases like cirrhosis and hepatitis.
Radiopharmaceutical
- Technetium-99m sulfur colloid: Used for liver/spleen imaging.
- Mechanism of Action (MOA): Engulfed by RE cells, distributed uniformly throughout the liver.
- Dose: 10 mCi.
- Route of Administration (ROA): Intravenous (IV).
- Mechanism of Localization (MOL): Phagocytosis
Patient Preparation
- No specific preparation needed.
- Important Patient History: Patient diagnosis, serum bilirubin level, liver enzyme levels (SGOT, SGPT), serum alkaline phosphatase, total serum protein levels (including globulin and albumin), urine bilirubin level, previous abdominal surgery.
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Imaging Priority: Liver/spleen imaging before GI tract studies using barium or contrast agents.
- Reason: Contrast agents cause artifacts on nuclear medicine images.
Flow Imaging
- Positioning: Patient positioned under camera before tracer administration.
- Purpose: Demonstrates the vascularity of defects visible on static images.
Static Imaging
- Imaging Time: Static imaging begins after 10-15 minutes for tracer localization.
- Standard Views: Anterior, posterior, right lateral, left lateral, right anterior oblique, left anterior oblique, right posterior oblique, and left posterior oblique projections.
- Additional Image: Anterior image with a reference marker along the right costal margin for liver size and location assessment.
SPECT Imaging
- Purpose: To better assess the size, location, and depth of liver and/or spleen abnormalities.
- Benefits: Aids in assessing abnormalities, distinguishing between artifacts and true lesions, and detecting lesions not visible on planar images.
Imaging Findings
- Tc99m-Sulfur Colloid Distribution: Primarily localized in the liver (85%), followed by the spleen (10%), with minimal presence in the bone marrow.
- Liver Location/Variations: Typically situated above the right costal margin, exhibiting diverse shapes, including the enlarged Reidel’s lobe.
- Spleen Location/Visualization: Located in the left upper quadrant above the left costal margin, best visualized on the posterior view due to its posterior positioning.
- Artifact Sources: Heart, right kidney, porta hepatis, and gallbladder can distort the liver’s shape.
- Artifact Differentiation: SPECT imaging or additional planar views can help distinguish artifacts from true defects.
- Liver Displacement Causes: Emphysema, subphrenic abscess, or an enlarged left hepatic lobe can cause liver displacement.
- Tumor/Cyst/Abscess Appearance: Single or multiple areas of decreased or absent tracer uptake.
- Diffuse Liver Disease Appearance: Decreased or uneven tracer distribution throughout the liver.
- Severe Diffuse Liver Disease Appearance: Colloid shift, bone marrow visualization, and increased spleen tracer concentration.
Technical Considerations
- Timing: Imaging too soon after injection of Tc99m-sulfur colloid may result in cardiac blood-pool activity being seen.
- Attenuation Artifacts: Residual barium in the GI tract, particularly in the hepatic and splenic flexures, may appear as artifacts.
- Other Artifacts: Female breast tissue overlying the superior portion of the liver’s right lobe.
- Imaging Priority: Liver/spleen imaging should be performed before radiographic procedures using any contrast.
- Breast Shadow Artifacts: Can be eliminated by positioning the breast out of the way.
- Skin Fold Artifacts: Can be alleviated by imaging obese patients in an upright position.
- Respiration Artifacts: Can be decreased by imaging patients in an upright position.
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Description
This quiz covers essential details about liver and spleen imaging, focusing on their anatomy, clinical indications, and the use of radiopharmaceuticals like Technetium-99m sulfur colloid. It provides insights into liver size, blood supply, and the role of Kupffer cells in phagocytosis. Test your knowledge on this critical aspect of medical imaging.
