Technetium-99m-labelled red blood cell imaging in the diagnosis of hepatic haemangiomas: the role of SPECT/CT with a hybrid camera

  • Orazio Schillaci
  • Roberta Danieli
  • Carlo Manni
  • Francesca Capoccetti
  • Giovanni Simonetti
Short Communication


Delayed liver single-photon emission computed tomography (SPECT) after 99mTc red blood cell (RBC) labelling is helpful in detecting hepatic haemangiomas; however, diagnosis can be difficult when lesions are situated adjacent to structures like the inferior vena cava, the heart or hepatic vessels, where blood activity persists. The aims of this study were to evaluate the usefulness of RBC SPECT and transmission computed tomography (RBC SPECT/CT) performed simultaneously with a hybrid imaging system for correct characterisation of hepatic lesions in patients with suspected haemangioma, and to assess the additional value of fused images compared with SPECT alone. Twelve patients with 24 liver lesions were studied. The acquisitions of both anatomical (CT) and functional (SPECT) data were performed during a single session. SPECT images were first interpreted alone and then re-evaluated after adding the transmission anatomical maps. Image fusion was successful in all patients, with perfect correspondence between SPECT and CT data, allowing the precise anatomical localisation of sites of increased blood pool activity. SPECT/CT had a significant impact on results in four patients (33.3%) with four lesions defined as indeterminate on SPECT images, accurately characterising the hot spot foci located near vascular structures. In conclusion, RBC SPECT/CT imaging using this hybrid SPECT/CT system is feasible and useful in the identification or exclusion of suspected hepatic haemangiomas located near regions with high vascular activity.


Hepatic haemangioma Labelled RBCs Image fusion Hybrid imaging system SPECT/CT 


  1. 1.
    Kammula US, Buell JF, Labow DM, Rosen S, Millis JM, Posner MC. Surgical management of benign tumors of the liver. Int J Gastrointest Cancer 2001; 30:141–146.CrossRefPubMedGoogle Scholar
  2. 2.
    Yoon SS, Charny CK, Fong Y, et al. Diagnosis, management, and outcomes of 115 patients with hepatic hemangioma. J Am Coll Surg 2003; 197:392–402.CrossRefPubMedGoogle Scholar
  3. 3.
    Semelka RC, Martin DR, Balci C, Lance T. Focal liver lesions: comparison of dual-phase CT and multisequence multiplanar MR imaging including dynamic gadolinium enhancement. J Magn Reson Imaging 2001; 13:397–401.CrossRefPubMedGoogle Scholar
  4. 4.
    Kim TK, Choi BI, Han JK, Hong H-S, Park SH, Moon SG. Hepatic tumors: contrast agent-enhancement patterns with pulse-inversion harmonic US. Radiology 2000; 216:411–417.PubMedGoogle Scholar
  5. 5.
    Royal HD, Brown ML, Drum DE, Nagle CE, Sylvester JM, Ziessman HA. Procedure guideline for hepatic and splenic imaging. Society of Nuclear Medicine. J Nucl Med 1998; 39:1114–1116.PubMedGoogle Scholar
  6. 6.
    Ziessman HA, Silverman PM, Patterson J, et al. Improved detection of small cavernous hemangiomas of the liver with high-resolution three-headed SPECT. J Nucl Med 1991; 32:2086–2091.PubMedGoogle Scholar
  7. 7.
    Birnbaum BA, Weinreb JC, Megibow AJ, et al. Definitive diagnosis of hepatic hemangiomas: MR imaging versus Tc-99m-labeled red blood cell SPECT. Radiology 1990; 176:95–101.PubMedGoogle Scholar
  8. 8.
    Hutton BF, Braun M, Thurfjell L, Lau DY. Image registration: an essential tool for nuclear medicine. Eur J Nucl Med Mol Imaging 2002; 29:559–577.Google Scholar
  9. 9.
    Bocher M, Balan A, Krausz Y, et al. Gamma camera-mounted anatomical X-ray tomography: technology, system characteristics and first images. Eur J Nucl Med 2000; 27:619–627.CrossRefPubMedGoogle Scholar
  10. 10.
    Jang HJ, Kim TK, Lim HK, et al. Hepatic hemangioma: atypical appearances on CT, MR imaging, and sonography. AJR 2003; 180:135–141.Google Scholar
  11. 11.
    Helmberger TK, Laubenberger J, Rummeny E et al. MRI characteristics in focal hepatic disease before and after administration of MnDPDP: discriminant analysis as a diagnostic tool. Eur Radiol 2002; 12:62–70.CrossRefPubMedGoogle Scholar
  12. 12.
    Kim T, Federle MP, Baron RL, Peterson M, Kawamori Y. Discrimination of small hepatic hemangiomas from hypervascular malignant tumors smaller than 3 cm with three-phase helical CT. Radiology 2001; 219:699–706.PubMedGoogle Scholar
  13. 13.
    Front D, Israel O, Groshar D, Weininger J. Tc-99m-labeled red blood cell imaging. Semin Nucl Med 1984; 14:226–240.PubMedGoogle Scholar
  14. 14.
    Kaplan IL, Swayne LC. Composite SPECT-CT images: technique and potential applications in chest and abdominal imaging. AJR 1989; 152:865–866.Google Scholar
  15. 15.
    Birnbaum BA, Noz ME, Chapnik J, et al. Hepatic hemangiomas: diagnosis with fusion of MR, CT, and Tc-99m-labeled red blood cell SPECT images. Radiology 1991; 181:469–474.PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Orazio Schillaci
    • 1
    • 2
  • Roberta Danieli
    • 1
  • Carlo Manni
    • 1
  • Francesca Capoccetti
    • 1
  • Giovanni Simonetti
    • 1
  1. 1.Department of Biopathology and Diagnostic ImagingUniversity “Tor Vergata”RomeItaly
  2. 2.RomeItaly

Personalised recommendations