A liver/spleen scan is performed to demonstrate the anatomy and size of the liver and spleen. It is helpful in determining the cause of right upper quadrant pain and in the detection of metastatic disease, cirrhosis, ascites, infarction due to trauma, and liver damage due to radiation therapy. Most liver and spleen imaging evaluates for metastatic disease and for the differential diagnosis of jaundice. Post–liver transplantation scans detect bile and anastomotic leaks and rule out abnormal perfusion as a sign of rejection.

A liver/spleen RBC scan is performed to assess for the presence of a hemangioma (noncancerous blood vessel mass in the liver). The radioactive material, ^99mTc-labeled sulfur colloid, is injected intravenously. Liver/spleen SPECT imaging provides three-dimensional images of radiopharmaceutical uptake. The radiopharmaceutical most specific for detection of hemangioma in the liver is ^99mTc labeled to a patient’s own RBCs. Ultrasound and CT imaging have mostly replaced this test.

1. Inject the radiopharmaceutical intravenously.

2. Perform a SPECT study and planar images.

3. The entire study usually takes 60 minutes from injection to completion.

4. See Chapter 1 guidelines for safe, effective, informed intratest care.

1. Abnormal liver and spleen scan patterns occur in:

   1. Cirrhosis

   2. Hepatitis

   3. Trauma

   4. Hepatomas

   5. Sarcoidosis

   6. Metastasis

   7. Cysts

   8. Perihepatic abscesses

   9. Hemangiomas

   10. Adenomas

   11. Ascites

2. Abnormal splenic concentrations reveal:

   1. Unusual splenic size

   2. Infarction

   3. Ruptured spleen

   4. Accessory spleen

   5. Tumors

   6. Metastatic spread

   7. Leukemia

   8. Hodgkin disease

3. Spleens larger than 14 cm are abnormally enlarged; those smaller than 7 cm are abnormally small. Areas of absent radioactivity or holes in the spleen images are associated with abnormalities that displace or destroy normal splenic pulp.

4. About 30% of persons with Hodgkin disease (lymphoma, cancer of lymph tissue) with splenic involvement have a normal splenic image.

Pretest Patient Care

1. Explain the purpose, procedure, benefits, and risks.

2. This test can be performed in cases of trauma or suspected ruptured spleen, at the bedside or in the emergency room.

3. Refer to standard NMI pretest precautions.

4. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Normal

Normal liver size, shape, and position within the abdomen

Normal spleen size, cell function, and blood flow

Normally functioning liver and spleen reticuloendothelial system

Absence of hemangioma