(Liver-Spleen Scan, Liver Scintigraphy)
What is a liver scan?
A liver scan is a specialized radiology procedure used to examine the liver to identify certain conditions or to assess the function of the liver. A liver scan may also be used to follow the progress of treatment of certain conditions. This procedure may also be referred to as a liver-spleen scan because the spleen often is examined as well due to its proximity and close functional relationship to the liver.
A liver scan is a type of nuclear medicine procedure. This means that a tiny amount of a radioactive substance is used during the procedure to assist in the examination of the liver. The radioactive substance, called a radiopharmaceutical or radioactive tracer, is formed by the addition of a radioactive atom (radionuclide) to a molecule absorbed by normal liver tissue. The remainder of the radioactive substance is absorbed by the spleen and bone marrow.
The radionuclide used in liver scans is usually a form of technetium. Once absorbed into the liver tissue, the radionuclide emits a type of radiation, called gamma radiation. The gamma radiation is detected by a scanner, which processes the information into a picture of the liver.
By measuring the behavior of the radionuclide in the body during a nuclear scan, the doctor can assess and diagnose various conditions, such as tumors, abscesses, hematomas, organ enlargement, or cysts. A nuclear scan may also be used to assess organ function and blood circulation.
The areas where the radionuclide collects in greater amounts are called "hot spots." The areas that do not absorb the radionuclide and appear less bright on the scan image are referred to as "cold spots."
Other related procedures that may be used to diagnose problems of the liver include abdominal X-rays, abdominal ultrasound, computed tomography (CT scan) of the abdomen or liver, or a liver biopsy.
Anatomy of the liver
Click image to enlarge
The liver is the largest organ in the body. This dark reddish brown organ is located in the upper right side of the abdomen, beneath the diaphragm, and on top of the stomach, right kidney, and intestines.
The wedge-shaped liver is made up of 2 main lobes. Each lobe is made up of thousands of lobules. These lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic duct. The hepatic duct moves the bile (fluid that helps break down fats and gets rid of wastes in the body) that is made by the liver cells to the gallbladder and duodenum (the first part of the small intestine).
The liver carries out many important functions, such as:
Making bile. Bile is a fluid that helps break down fats and gets rid of wastes in the body
Changing food into energy
Clearing the blood of drugs and other poisonous substances
Producing certain proteins for blood plasma
Regulating blood clotting
The spleen, an egg-shaped organ that lies between the stomach and the diaphragm on the left side of the body, helps to keep the blood healthy. The spleen plays a role in the production of lymphocytes (white blood cells that fight infection and disease), destruction of red blood cells, and filtration and storage of blood.
The biliary system is made up of the organs and ducts (bile ducts, gallbladder, and associated structures) that make and transport bile.
What are the reasons for a liver scan?
A liver scan may be done to check for diseases such as liver cancer, hepatitis, or cirrhosis. Lesions such as tumors, abscesses, or cysts of the liver or spleen may be seen on a liver scan. A liver scan may be done to assess the condition of the liver and/or spleen after trauma to the abdomen or when there is unexplained pain in the right upper quadrant of the abdomen. Enlargement of the liver or spleen may be seen on a liver scan.
A liver scan may also be used to assess response to therapy for liver disease and/or to monitor the course of liver disease. Portal hypertension (elevated blood pressure within the liver's circulation) may be detected with a liver scan when more of the radionuclide is absorbed by the spleen rather than the liver.
There may be other reasons for your doctor to recommend a liver scan.
What are the risks of a liver scan?
The amount of the radionuclide injected into your vein for the procedure is small enough that there is no need for precautions against radioactive exposure. The injection of the radionuclide may cause some slight discomfort. Allergic reactions to the radionuclide are rare, but may occur.
For some patients, having to lie still on the scanning table for the length of the procedure may cause some discomfort or pain.
Patients who are allergic to or sensitive to medications, contrast dyes, or latex should notify their doctor.
If you are pregnant or suspect that you may be pregnant, you should notify your health care provider due to the risk of injury to the fetus from a liver scan. If you are lactating, or breastfeeding, you should notify your health care provider due to the risk of contaminating breast milk with the radionuclide.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.
Certain factors or conditions may interfere with the accuracy of a liver scan. These factors include, but are not limited to, the following:
How do I prepare for a liver scan?
PRECAUTIONS: If you are pregnant or think you might be pregnant, please check with your doctor before scheduling the exam. We will discuss other options with you and your doctor.
BREASTFEEDING: If you are breastfeeding, you should notify your health care provider due to the risk of contaminating breast milk with the tracer.
CLOTHING: You may be asked to change into a patient gown. A gown will be provided for you. Lockers are provided to secure your personal belongings. Please remove all piercings and leave all jewelry and valuables at home.
EAT/DRINK: Generally, no prior preparation, such as fasting or sedation, is required prior to a liver scan.
ALLERGIES: Notify the radiologist or technologist if you are allergic to or sensitive to medications, contrast dyes or iodine. The injection of the radiotracer may cause some slight discomfort. Allergic reactions to the radiotracer are rare, but may occur.
What happens during a liver scan?
A liver scan may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor's practices.
Generally, a liver scan follows this process:
You will be asked to remove any clothing, jewelry, or other objects that may interfere with the procedure.
You will be asked to remove clothing and will be given a gown to wear.
An intravenous (IV) line will be started in the hand or arm for injection of the radionuclide.
The radionuclide will be injected into your vein. The radionuclide will be allowed to concentrate in the liver tissue for approximately 30 minutes.
You will be asked to lie still on a scanning table, as any movement may affect the quality of the scan.
The scanner will be placed over the right upper quadrant of the abdomen in order to detect the gamma rays emitted by the radionuclide in the liver tissue.
You may be repositioned during the scan in order to obtain views of all the surfaces of the liver.
When the scan has been completed, the IV line will be removed.
While the liver scan itself causes no pain, having to lie still for the length of the procedure might cause some discomfort or pain, particularly in the case of a recent injury or invasive procedure such as surgery. The technologist will use all possible comfort measures and complete the procedure as quickly as possible to minimize any discomfort or pain.
What happens after a liver scan?
You should move slowly when getting up from the scanner table to avoid any dizziness or lightheadedness from lying flat for the length of the procedure.
You may be instructed to drink plenty of fluids and empty your bladder frequently for about 24 hours after the procedure to help flush the remaining radionuclide from your body.
The IV site will be checked for any signs of redness or swelling. If you notice any pain, redness, and/or swelling at the IV site after you return home following your procedure, you should notify your doctor as this may indicate an infection or other type of reaction.
You may resume your usual diet and activities, unless your doctor advises you differently. Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.