Liver scanning is a nuclear study performed to assist in diagnosing abnormalities in the structure and function of that organ. It can be performed simultaneously with spleen scanning or in combination with lung scanning to assist in the diagnosis of masses or inflammation in the diaphragmatic area. The radionuclide 99mTc as technetium Tc 99m sulfur colloid is injected IV and taken up by the Kupffer cells that normally function to remove particulate matter, including radioactive colloids, in the liver. Early or delayed and increased or decreased uptake indicate pathology when flow studies are performed (dynamic scintigraphy). Static imaging reveals abnormalities in size and shape of the liver in the presence of pathology.⁵²

Liver scans are evaluated with liver function laboratory studies and can complement ultrasonography and CT in confirming a diagnosis. Scanning is also performed to confirm catheter placement for chemotherapy and to determine whether a tumor is being infused and the normal parenchyma bypassed. This procedure is accomplished by imaging after the slow IV infusion of 99mTc administered as technetium Tc 99m MAA and later imaging after an injection of technetium Tc 99m sulfur colloid and computer subtraction.⁵³

• Normal size, shape, position, and function of the liver; no tumors, cysts, inflammation, trauma, or infiltrative disease

• Inability of client to remain still during the procedure
• Barium in the gastrointestinal tract from previous radiography
• Other nuclear scans performed on the same day

[Show Section Outline]

Indications

• Diagnosing primary or metastatic tumor and differentiating between them as revealed by uptake that appears as a filling defect or by solitary or multiple focal "cold" defects
• Diagnosing diffuse hepatocellular disease, such as hepatitis, cirrhosis (early and advanced), or hepatomegaly; shunting to spleen or bone marrow revealed by patchy, decreased uptake in hepatitis or atrophy; and shunting to spleen or bone marrow and decreased or absent uptake in cirrhosis
• Diagnosing benign tumors such as adenoma or cavernous hemangiomas as revealed by hepatomegaly or solitary "cold" defect
• Detecting bacterial abscess revealed by solitary or multiple "cold" defects, especially after gastrointestinal surgery
• Detecting amebic abscess revealed by solitary defect, especially after amebiasis
• Diagnosing cystic focal disease revealed by "cold" defects
• Determining the effect of traumatic lesions such as lacerations or hematomas
• Detecting infiltrative processes of the liver such as sarcoidosis or amyloidosis
• Evaluating palpable abdominal masses and differentiating between splenomegaly and hepatomegaly
• Determining superior vena cava obstruction or Budd-Chiari syndrome revealed by increased uptake of the radionuclide, or "hot spots"
• Evaluating liver damage caused by radiation therapy or hepatotoxic drug therapy

Contraindications

• Pregnancy, unless the benefits of performing the procedure greatly outweigh the risks to the fetus

[Section Outline]

• Indications
• Contraindications

Nursing Care Before the Procedure

Client teaching and physical preparation are the same as for any nuclear scan study (see section under "Brain Scanning").

• Inform the client of the scanning schedule and explain that the study takes 1 hour.
• History should include hepatic disorders and any signs and symptoms associated with the liver as well as past medical and surgical treatment or regimens.

The client is placed on the examining table in a supine position. The client is then requested to remain still during the scanning and the radiopharmaceutical is administered IV. Scanning follows in 1 to 2 seconds and continues for 30 minutes to 1 hour to perform flow studies. A 1-minute blood pool image can also be performed. This image is followed by static imaging in the anterior, posterior, laterals, anterior-oblique, and posterior-oblique views to determine the size and shape of the liver. Defects that fail to take up the radionuclide (normally concentrated in the Kupffer cells in the liver) are known as "cold spots." Normal indentations in the liver can be confused for focal diseases of the liver. SPECT imaging, a three-dimensional study, can be performed to obtain more specific views of the liver. The liver scan is performed in combination with a lung scan when a systemic tumor or infection is suspected in the upper abdomen or below the diaphragm.

Nursing Care After the Procedure

Care and assessment after the procedure are the same as for any nuclear scan study (see section under "Brain Scanning").