Hepatic hemangiomas: pitfalls in scintigraphic detection

The evaluation of solitary hepatic lesions detected on scintiscans is a common clinical problem. It is usually assumed that radionuclide rapid sequence flow studies and blood pool images are reliable and accurate methods of demonstrating the vascularity of hepatic lesions. Our recent experience with 3 patients with angiographically proven hepatic hemangiomas indicates that radionuclide techniques may fail to detect the vascularity of hemangiomas. We speculate that blood flow within a hepatic hemangioma may be sluggish and its vascularity may be appreciated only by arteriography. Therefore, we alert the clinician to assess the vascularity of solitary hepatic tumors by angiography before percutaneous liver biopsy and thereby avert the possibility of life-threatening exsanguination, as occurred in one of our patients.