99mTc HIDA is More Sensitive than 99mTc Sulphur Colloid in Diagnosing Focal Nodular Hyperplasia (FNH)
The diagnosis of focal nodular hyperplasia (FNH) and hepatic adenoma (HA) remains a diagnostic challenge. It is important to differentiate the two as treatment and management options are different. Imaging in Nuclear Medicine plays an important role in differentiating between these two tumours.
A 43 year old woman presented for evaluation of a liver lesion found incidentally on ultrasound and further delineated on CT.
A 99m Tc HIDA scan and a 99m Tc sulphur colloid scan were performed on different days.
The HIDA scan showed preferential activity in the known lesion in the right lobe of the liver anteriorly. This was identified on the early and delayed planar images as well as the SPECT study. These HIDA scan findings were characteristic of FNH. The sulphur colloid images showed no abnormal uptake at the site of the known lesion.
In a study with 25 cases of FNH, 23 (92%) appeared as focal regions of increased 99m Tc HIDA uptake while in 16 (64%) sulphur colloid uptake was normal and non-diagnostic (1).
The findings in this patient reflect the literature recommendations that 99m Tc HIDA is more sensitive than 99m Tc sulphur colloid in diagnosing FNH.
(1) Kotzerke J, Schwarzrock R, Krischek O et al 1989. Technetium-99m DISIDA hepatobiliary agent in diagnosis of hepatocellular carcinoma, adenoma and focal nodular hyperplasia. Journal of Nuclear Medicine 30:1278-1280.