National Imaging Associates, Inc.

Clinical guidelines: Original Date: July 2008

LIVER SPECT SCANS Page 1 of 3
(Single Photon Emission CT)
CPT Codes: 78205, 78206 Last Review Date: August 2014
(With vascular flow)
Guideline Number: NIA_CG_077 Last Review Date: August 2014
Responsible Department: Implementation Date: January 2015
Clinical Operations

INTRODUCTION:

Single-photon emission computed tomography (SPECT) is a nuclear medicine imaging

technique based on the use of computed tomography to localize data from gamma ray
emitting injected radiopharmaceuticals to specific anatomical locations within the patient.
The resulting 3D images can be reconstructed in multiple planes. As a general rule, the
detection efficiency and spatial resolution improves as the number of detecting cameras
comprising the imaging system increases. Radiopharmaceuticals used vary based on the
clinical indication. The technique is applied in brain, cardiac, pulmonary, abdominal,
endocrine and musculoskeletal imaging.

Due to the improved anatomical detail afforded by CT, MRI and Ultrasound, these
techniques have largely replaced radionuclide liver and spleen imaging. Liver and spleen
Single-Photon Emission Computed Tomography (SPECT) imaging, depending on the
indication, can be undertaken using either the IV injection of sulfur colloid or red blood
cells labeled with Tc99M. Sulfur colloid images are created by taking advantage of the
reticuloendothelial cells ability to phagocytize the agent. Indications using this agent
include the detection of hepatosplenomegaly, hepatocellular disease and certain focal
hepatic lesions. Red blood cell scanning is limited to the evaluation of liver hemangiomas.
The ability to create 3D multiplanar images with the SPECT technique greatly improves
the diagnostic capability over traditional planar imaging.

INDICATIONS FOR A LIVER SPECT SCAN:

 Evaluation of hepatic artery catheter placement.

 Detection of accessory splenic tissue or asplenia AND patient has not had a previous
Nuclear Liver or Spleen scan.
 Evaluation of focal nodular hyperplasia.
 Evaluation of patients with suspected liver or spleen rupture or hematoma and an
Abdominal CT or MRI is contraindicated AND patient has not had a previous Nuclear
Liver or Spleen scan within the past three (3) months.
 Evaluation of size, shape, and position of liver and spleen and an Abdominal CT or MRI
is contraindicated AND patient has not had a previous Nuclear Liver or Spleen scan
within the past three (3) months.
 Detection of space-occupying lesions: abscesses, cysts, and primary tumors and an
Abdominal CT or MRI is contraindicated AND patient has not had a previous Nuclear
Liver or Spleen scan within the past three (3) months.

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 Evaluation of hepatic metastasis (pre and post-therapy) AND patient has a
contraindication to a PET scan or a PET scan is unavailable.

ADDITIONAL INFORMATION RELATED TO A LIVER SPECT SCAN:

Hepatobiliary imaging or HIDA scan: (hepatobiliary iminodiacetic acid) an imaging

procedure utilizing the IV administration of Tc99M labeled iminodiacetic acid which is
excreted by hepatocytes like bile. Unlike Liver and spleen imaging this technique utilizes a
series of standard planar images over time to determine the progression of the radionuclide
through the biliary system. HIDA scanning is used to evaluate cystic duct obstruction
(cholecystitis), common bile duct obstruction, congenital biliary system anomalies and bile
leaks.

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 REFERENCES

American College of Radiology. (2014). ACR Appropriateness Criteria® Retrieved from

https://acsearch.acr.org/list.

Hirsch, A.T., Haskal, Z.J., Hertzer, N.R., Bakal, C.W., Creager, M.A., Halperin, J.L, . . .
Roegel, B. (2006). ACC/AHA 2005 guidelines for the management of patients with
peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic):
executive summary a collaborative report from the American Association for Vascular
Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and
Interventions, Society for Vascular Medicine and Biology, Society of Interventional
Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to
Develop Guidelines for the Management of Patients With Peripheral Arterial Disease)
endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation;
National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic
Inter-Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol.
47(6):1239-312. doi: 10.1016/j.jacc.2005.10.009.

Mettler, F.A. & Guiberteau, M.J. (2012). Essentials of Nuclear Medicine Imaging 6th edition.
Published by Elsevier ISBN: 978-1-4557-0104-9.

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