Quantitation of liver and spleen uptake of (99m)Tc-phytate colloid using SPECT: detection of liver cirrhosis.

Abstract

The purpose of this study was to assess the diagnostic performance of quantitative SPECT of (99m)Tc-phytate colloid in detecting liver cirrhosis and to assess the correlation between the SPECT results and the severity of disease. Quantitative SPECT was performed on 60 patients (38 men, 22 women; mean age, 62.4 y) with liver cirrhosis and 36 control patients (21 men, 15 women; mean age, 58.7 y) without liver cirrhosis, and the results for the 2 groups were compared. Correlation with Child--Pugh classification and receiver operating characteristic methodology was used to analyze the results. Cirrhotic livers had a lower total uptake than did control livers (35.6% plus minus 13.5% vs. 61.6% +/- 10.2%, P < 0.0001). This reduced uptake was associated with a significantly reduced percentage injected dose per cubic centimeter (%ID/cm(3)) (0.024 +/- 0.01 vs. 0.044 +/- 0.01, P < 0.0001). The volume, 1,467 +/- 348 cm(3), was similar to that of control livers (1,487 +/- 397 cm(3), P = 0.80). Total uptake in the spleen was significantly greater in patients with cirrhosis than in control patients (24.9% +/- 12% vs. 7.6% +/- 3.2%, P < 0.0001) because of an increased volume (833 +/- 460 cm(3) vs. 239 +/- 90 cm(3), P < 0.0001). The %ID/cm(3) of spleen tissue was 0.033 +/- 0.01, which was similar to the value in control patients (0.032 +/- 0.01, P = 0.88). Spleen volume showed the best performance in detecting liver cirrhosis, with a mean area under the curve of 0.97 (95% CI = 0.91--0.99). The severity of liver disease correlated better with total liver uptake (r = -0.68, 95% CI = -0.80 to -0.52, P < 0.0001). Individual SPECT quantitation of (99m)Tc-phytate colloid uptake in the liver and spleen could be used as a noninvasive method to separate normal from cirrhotic livers and to evaluate the severity of disease.