Radionuclide imaging of the injured spleen and liver

After the introduction of Tc-99m sulfur colloid and the gamma camera, radiocolloid liver-spleen imaging displaced angiography as the primary modality for diagnosing injury because of its sensitivity and non-invasiveness. A splenic defect may be nonspecific since it can be caused by a congenital variant. Specificity can be increased by awareness of common morphologic variations and judicious use of detector angulation to separate an overlapping left lobe. An increased incidence of overwhelming sepsis in postsplenectomy patients led to a more conservative approach to splenic injury, aided by sequential scintigraphy to demonstrate healing of traumatic defects. This decreased the significance of an initial false-positive scan that was caused by congenital variation, since the clinical "bottom line" was failure of a defect to enlarge or cause delayed rupture. Computed tomography (CT) is also a sensitive method of diagnosing injury or spleen and liver as well as other intraabdominal organs such as the kidneys. Its performance has not been compared to simultaneous multiorgan scintigraphy, an underutilized but very useful approach.