Focal porta hepatis scintiscan defects: What is their significance?

A total of 537 consecutive liver scintiscans were retrospectively reviewed and 80 of them revealed suspicious focal decreased activity in the region of the prota hepatis. Postmortem, surgical, or biopsy correlation was obtained in 40 of these cases: 14 were pathologically negative; 9, cirrhosis or fibrosis; 10, metastases; 3, dilated bile ducts; 1, viral hepatitis; 1, hepatic laceration; 1, falciform ligament cyst; and 1, ruptured gallbladder with abscessed head of the pancreas. Thus, only 42% represented significant disease. Sixty-eight percent of the defects were seen only on the anterior scintiscan. Appearance of the majority of defects was nonspecific. Subjective grading of defects according to size and comparative decrease in density was not beneficial. Elevations of serum alkaline phosphatase, total serum bilirubin, and serum glutamic-oxalacetic transaminase were nonspecific.