IS Case 227: Focal nodular hyperplasia on sulfur colloid imaging

Scott Mooney, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-22


Patient is a 32-year-old female with Incidental discovery of large liver mass on chest CT. Patient takes oral contraceptives.


There is increased uptake in the left hepatic lobe lesion compared to the normal liver parenchyma on sulfur colloid examination.


Focal nodular hyperplasia on sulfur colloid imaging


There are different modalities for evaluation of hepatic masses. A technetium 99m sulfur colloid liver-spleen exam utilizes uptake by the reticuloendothelial cells of the liver and the spleen, known as Kupffer cells in the liver. Planar images are usually obtained, but SPECT imaging provides greater localization and visualization of lesions.

Most hepatic masses are photopenic on sulfur colloid examination. The exception is focal nodular hyperplasia (FNH), which contains Kupffer cells, and can be either demonstrate a photopenic defect (30%), normal activity (30%), or increased activity (40%).

FNH is a benign hepatic tumor most commonly seen in females aged 20 to 40 years. It is often asymptomatic, but can cause pain if it is large enough to stretch the Glisson capsule. It is not caused by the use of oral contraceptives. The classic CT and MR appearance of FNH is a homogeneous lesion with a central scar.

If imaging findings are indeterminate, follow up evaluation for stability of the lesion or needle biopsy may be performed. FNH is usually not a surgical lesion.


  1. Buetow PC, Pantongrag-Brown L, Buck JL, Ros PR, Goodman ZD. Focal nodular hyperplasia of the liver: radiologic-pathologic correlation. Radiographics. 1996 Mar;16(2):369-88. [PMID: 8966294]
  2. Mettler FA, Guiberteau MJ. Essentials of Nuclear Medicine Imaging. 4th ed., WB Saunders. 1998:237-249.

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