Hepatic hemangioma in cirrhotics with portal hypertension: Evaluation with Tc-99m red blood cell SPECT

PURPOSE: To determine whether extensive shunting associated with portal hypertension (PH) adversely affects the diagnostic accuracy of technetium- 99m red blood cell (RBC) single photon emission computed tomography (SPECT) for hepatic hemangioma (HH). MATERIALS AND METHODS: Nineteen possible HHs (1.0-11.0 cm in diameter) in 15 cirrhotics with PH were studied with RBC SPECT. RESULTS: RBC SPECT allowed correct categorization of four HHs (1.5, 2.8, 4.0, and 4.0 cm in diameter) and 13 non-HHs (1.5-11.0 cm in diameter). Two small HHs (1.0 and 1.4 cm in diameter) were 'missed.' Sensitivity, specificity, and accuracy were 67%, 100%, and 89%, respectively. CONCLUSION: Despite abnormal liver blood flow dynamics due to portosystemic collateralization, RBC SPECT allows reliable identification of HH in cirrhotics with PH. As in noncirrhotics, its major limitation is small lesion size.