Boulahdour H, Cherqui D, Charlotte F, Rahmouni A, Dhumeaux D, Zafrani E S, Meignan M
Department of Nuclear Medicine, Hôpital Henri Mondor, Université Paris XII-Val de Marne, Créteil, France.
J Nucl Med. 1993 Dec;34(12):2105-10.
A prospective study was performed on 14 patients with histologically proven focal nodular hyperplasia (FNH) using a hepatobiliary scan with trimethylbromoimino-diacetic acid (TBIDA) and a colloid scan with rhenium sulfur colloids. TBIDA uptake was relatively normal in the region of the tumor, but during the clearance phase 23/25 of the tumors were detected by a hot spot of radioactivity. Depending on the relative contrast achieved between the tumor and normal liver, this hot spot appeared early or later, but was always present at 60 min. In three tumors, a "doughnut" pattern was observed within the hot spot due to a central defect. Hypervascularization was observed during the perfusion phase in 76% of the tumoral sites and normal colloid uptake in only 64%. The detectability of FNH appears greater with TBIDA (92%) than with CT or MRI (84%). The high prevalence of hot spots may be due to careful technological conditions when obtaining hepatobiliary scans. Late images, overexposed films, multiple views and stimulation of gallbladder excretion increased tumor detectability. The hot spot sign may be a useful tool when combined with the results of other imaging modalities in the diagnosis of FNH. The peculiar pathology of FNH with fibrosis, hyperplastic hepatocytes and cholangiolar proliferation might explain this scintigraphic appearance.
对14例经组织学证实为局灶性结节性增生（FNH）的患者进行了一项前瞻性研究，采用三甲基溴亚氨基二乙酸（TBIDA）肝胆扫描和铼硫胶体胶体扫描。肿瘤区域的TBIDA摄取相对正常，但在清除期，23/25的肿瘤通过放射性热点被检测到。根据肿瘤与正常肝脏之间实现的相对对比度，这个热点出现得早或晚，但在60分钟时总是存在。在三个肿瘤中，由于中央缺损，在热点内观察到“甜甜圈”模式。在灌注期，76%的肿瘤部位观察到血管过度增生，只有64%的肿瘤部位胶体摄取正常。与CT或MRI（84%）相比，TBIDA对FNH的可检测性似乎更高（92%）。热点的高发生率可能是由于在进行肝胆扫描时仔细的技术条件。延迟图像、过度曝光的胶片、多个视图以及刺激胆囊排泄增加了肿瘤的可检测性。当与其他成像方式的结果相结合时，热点征象可能是诊断FNH的有用工具。FNH伴有纤维化、增生性肝细胞和胆小管增生的特殊病理可能解释了这种闪烁显像表现。
