A novel diagnostic role of 99mTc-GSA scintigraphy in distinguishing hepatocellular carcinoma from hepatic angiomyolipoma.

PURPOSE: Hepatic angiomyolipoma (HAML) is a rare benign liver tumor that is difficult to differentiate from hepatocellular carcinoma (HCC) preoperatively. This study aimed to evaluate the diagnostic value of Technetium-99 m-diethylenetriaminepentaacetic acid-galactosyl human serum albumin (99mTc-GSA) scintigraphy for HAML.

METHODS

Six patients with HAML were enrolled, and 139 patients with hepatocellular carcinoma were analyzed as a control group. Imaging findings from computed tomography, magnetic resonance imaging, and 99mTc-GSA scintigraphy were investigated, and the radioactivity of 99mTc-GSA scintigraphy was measured in patients with HAML and HCC.

RESULTS

In 5 cases, early enhancement was observed in five cases, and three cases showed washout in the delayed phase. Hepatocyte phase defects were detected in all cases, and early venous return was observed in two cases. All cases showed a defect in radioactivity on 99mTc-GSA scintigraphy, and the immunohistochemistry of asialoglycoprotein receptor (ASGPR) was negative in HAML compared to normal liver tissue in all cases. The tumor-to-liver signal ratio was significantly higher in hepatocellular carcinoma than in hepatic angiomyolipoma (p < 0.01).

CONCLUSION

99mTc-GSA scintigraphy may help distinguish hepatic angiomyolipoma from hepatocellular carcinoma.