Detection of hepatoma in liver cirrhosis

The analogic liver scintigram using 99mTc sulfur colloid in cirrhotic patients does not permit determination of the nature of the areas of decreased uptake. Scintigrams with 67Ga citrate generally show increased activity in cases of hepatoma. In some cases, however, 67Ga citrate is less concentrated in neoplasic tissue, and it is not possible to detect a tumoral lesion in a cirrhotic liver. This is why we used double isotope scintigraphies with 67Ga citrate and 99mTc sulfur colloid, with digital subtraction, after simultaneous recording of 99mTc and 67Ga data on magnetic tape by means of an interface. In our series of 22 patients, the comparison of the results obtained by this double isotope technique with histology showed no false positive in substraction scintigrams. There was one false negative because of the lack of significance in the subtracted image for one of the six patients with cancer of the liver. For three of the six patients with hepatoma, the gallium scintigram showed an increased uptake in the tumor area. For the three other cases, the gallium uptake was equilibrated throughout the liver scintigraphy. It was therefore in cases where the gallium scintigram showed no increased activity that the subtraction technique was of greatest value, for it permitted the diagnosis of hepatoma in two cases.