INTRAHEPATIC, EXTRAMEDULLARY HEMATOPOIESIS MIMICKING HEMANGIOMA ON TC-99M RED-BLOOD-CELL SPECT EXAMINATION

Cavernous hemangiomas are the most common lesion of the liver. Because of the risk of hemorrhage inherent in percutaneous biopsy of such les ions, noninterventional modalities (such as CT, ultrasound, MRI and Te chnetium-99m red blood cell imaging) have been utilized for differenti ating them from other lesions, The sensitivities and specificities of these techniques vary greatly. Technetium-99m red blood cell imaging w ith planar and SPECT imaging has been shown to have an overall sensiti vity of 89%, a specificity of 100%, and an overall accuracy of 92%, De spite its high accuracy, rare false positives have been reported with Technetium-gsm red blood cell imaging with SPECT. Review of the litera ture indicates four cases of hepatocellular carcinoma, one case of hep atic angiosarcoma, and one case of hepatic metastases from colorectal carcinoma as having an appearance identical to hemangioma with this mo dality. We present an additional false positive of a focal region of i ntrahepatic extramedullary hematopoiesis in a patient with Gaucher's d isease as having an appearance on Technetium-99m red blood cell imagin g with SPECT identical to that of hemangioma.