Radioimmunoscintigraphy in the differential diagnosis of hepatic mass lesion

A patient with suspected recurrent cancer of the colon underwent a variety of imaging procedures for the differential diagnosis of a hepatic mass lesion. Computed tomography (CT) showed a low-density lesion in the left hepatic lobe, and the initial CT-guided biopsy of the liver mass was reported to demonstrate a benign lesion. Ultrasonography (US) showed a hypoechoic lesion, and technetium-99m red blood cell (RBC) scan failed to suggest a hemangioma. However, radioimmunoscintigraphy (RIS) using 99mTc- labeled anti-carcinoembryonic antigen (CEA) monoclonal antibody clearly demonstrated increase uptake of antibody in the liver lesion. Scheduled hepatic angiography was canceled and subsequent exploratory laparotomy confirmed liver metastasis. RIS appears most helpful in the diagnosis of hepatic metastasis in patients with colorectal cancer and a rising CEA level. CT, US, and 99mTc-RBC studies for the investigation of hepatic masses are briefly discussed.