The value of Tc-99m red blood cell SPECT in differentiating giant cavernous hemangioma of the liver from other liver solid masses

Purpose: Giant cavernous hemangioma (GCH) of the liver has the potential risk for rupture and bleeding, which may cause sudden death. The purpose of this retrospective study was to compare the value of Tc-99m-labeled red blood cell (RBC) SPECT with ultrasound (US) in differentiating GCH from other solid liver masses. Methods: Twenty-two patients with giant solid liver masses, equal to or greater than 8 cm in at least one dimension, identified by US were examined by Tc-99m RBC SPECT. Final diagnoses were based on findings of surgery, biopsy or follow-up by US for a minimum of 24 months after the scan. Results: In all, US detected 23 giant liver masses in 22 patients (3 men, 19 women). Eighteen GCHs were detected in 17 patients by Tc-99m RBC SPECT. Nine showed a homogeneously increased blood pool; 9 revealed peripheral high, but central low, uptake. The US patterns in these 18 GCHs were mixed-echoic in 12, hyperechoic in 4, and hypoechoic in 2. The other five large liver tumors, all proved by operation, had no increased uptake area with Tc-99m RBC SPECT. The US patterns of these were mixed-echoic in 3, hyperechoic in 1, and hypoechoic in 1. Conclusions: Our study showed that there was no specific US pattern that would differentiate GCHs from other giant liver masses. Tc-99m RBC SPECT appeared to separate them clearly.