PubMed Health⌕ Search

Biomedical subjects

H J Gallowitsch

Publications and source records attributed to H J Gallowitsch.

54 records · Page 3Linked to original sources
PubMed1997

Technetium 99m tetrofosmin parathyroid imaging. Results with double-phase study and SPECT in primary and secondary hyperparathyroidism.

RATIONALE AND OBJECTIVES: The aim of our study was to evaluate the sensitivity, specificity, and positive predictive value (PPV) of technetium 99m (99mTc) tetrofosmin double-phase scintigraphy and single-photon emission computer tomography (SPECT) in preoperative localization of parathyroid adenoma in case of primary and secondary hyperparathyroidism (HPT). METHODS: Sixty-eight consecutive patients biochemically or sonographically suspected of parathyroid adenoma were included in our study. Apart from biochemical analysis of serum calcium, phosphate, and intact parathyroid hormone, double-phase scintigraphy was performed in each patient 5 and 45 minutes after injection of 370 MBq 99mTc tetrofosmin, followed by SPECT imaging. In consciousness of the scintigraphic results, ultrasound of the neck was performed as well to exclude false-positive results due to thyroid adenomas. RESULTS: Depending on the results of the biochemical analysis in combination with the results of the scintigraphic and ultrasound examination, the patients were classified retrospectively into three groups: group A with primary HPT (n = 35), group B with secondary HPT (n = 13), and group C without any biochemical suspicion of primary or secondary HPT (n = 20). In group A, double-phase study localized 25 of 36 (69.2%) parathyroid adenomas (one double adenoma) as against 34 of 36 (94.4%) with SPECT. Nine adenomas could be visualized only by SPECT. The reason for nonvisualization on planar scans was suspected to be an ectopic location in 2 cases (retrotracheal dislocation, retrovascular dislocation), a maximal diameter less than 15 mm (9-13 mm) in 6 cases, and oxyphilic-cell-poor cellularity in 1 case. Four false-positive retention (3 thyroid adenomas and 1 papillary thyroid carcinoma) were observed. SPECT showed a sensitivity of 94.4%, a specificity of 85%, and a PPV of 91.9% in biochemically suspected primary HPT. In group B, planar scintigraphy demonstrated 12 hyperplastic glands in 5 of 13 patients, and SPECT demonstrated 20 hyperplastic parathyroid glands in 8 out of 13 patients, which corresponds to a sensitivity of 38% and 61.5%, respectively. CONCLUSIONS: Technetium 99m tetrofosmin seems to be a promising alternative tracer with similar capabilities to 99mTc sestamibi in localization of parathyroid adenoma. SPECT showed clear advantages in terms of sensitivity over planar scintigraphy and should be used at least in cases with poor or no uptake in double-phase study. In endemic goiter areas, ultrasound of the neck should be performed to exclude false positive retention in thyroid adenomas. Technetium 99m tetrofosmin, like 99mTc sestamibi, is not ideal for localization of hyperplastic glands in secondary hyperparathyroidism because of low sensitivity.

Adenoma↗
PubMed1997

Technetium-99m-MIBI scintigraphy of thyroid nodules in an endemic goiter area.

UNLABELLED: Technetium-99m-methoxyisobutylisonitrile (MIBI) was introduced for myocardial imaging as an alternative to 201TI. According to biodistribution studies, MIBI also accumulates in the thyroid gland. The aim of this study was to find out which thyroid nodules retain MIBI and whether preoperative evaluation of malignancy is possible. METHODS: Single injection, dual-phase (30 min and 2 hr) thyroid scintigraphy with 99mTc-MIBI was performed on 62 patients who showed a cold nodule on previously performed 99mTc scintigraphy. MIBI scans were considered positive if there was a clear tracer retention in the late 120-min image compared to the early 30-min image. Sonographic examination and fine-needle aspiration biopsy, guided by ultrasonography, was also done on each patient. In the following days and weeks, all patients underwent surgery. RESULTS: Histopathological diagnoses revealed a total of 12 thyroid carcinomas, five were MIBI positive and seven MIBI negative. Out of 27 patients with thyroid adenomas (nine microfollicular, ten follicular, eight oxyphilic), 18 were MIBI positive and nine MIBI negative. There was no MIBI retention on the scans of 22 patients with degenerative changes in the goiter and the one with Hashimoto's disease. CONCLUSION: These results indicate that MIBI accumulation and retention is not specific for thyroid malignancy. Indeed, all evidence points to the fact that a positive MIBI scan is more likely to indicate thyroid adenoma than a malignant tumor.

Adult↗
PubMed1997

Preoperative scintigraphic and intraoperative scintimetric localization of parathyroid adenoma with cationic Tc-99m complexes and a hand-held gamma-probe.

AIM: The aim of our study was to evaluate the possibility of intraoperative scintimetric detection of parathyroid adenomas with Tc-99m labelled tracers for its usefulness in dystropic or ectopic adenomas. METHODS: 12 women with biochemically confirmed hyperparathyroidism were included in our study. After injection of 370 MBq Tc-99m tetrofosmin e.g. sestamibi, preoperative scintigraphy (double phase study and SPECT) was performed and T/NT ratios were evaluated for early, delayed and SPECT images. Surgery was performed using a hand-held gamma-probe after preoperative injection of 555-925 MBq Tc-99m tetrofosmin e.g. sestamibi. Count rates (cts/10 sec) were measured and used for calculating in situ- and ex situ-T/NT ratios. RESULTS: In 9 out of 12 patients, adenoma could be detected on static images. Mean T/NT ratios for Tc-99m tetrofosmin were 1.29 for early and 1.23 for delayed images, respectively 1.39 and 1.23 for early and delayed Tc-99m sestamibi scan. Three cases could only be detected with SPECT reconstruction, 11 of 12 parathyroid adenomas could be confirmed intra-operatively. CONCLUSION: SPECT with Tc-99m labelled cationic complexes showed advantages in detection, precise localization and contrast over static scintigraphy and should therefore be performed at least in cases with poor or no uptake on static images to avoid failures in detection of deeply sited, dislocated glands or adenomas with low uptake. Intraoperative localization and confirmation of parathyroid adenoma with Tc-99m labelled cationic complexes and a gamma probe is possible an 1 may be useful in case of dys- or ectopic adenoma by influencing surgical approach and operating time.

Adenoma↗
PubMed1997

Technetium-99m-tetrofosmin whole-body scintigraphy in the follow-up of differentiated thyroid carcinoma.

UNLABELLED: The purpose of this study was to evaluate prospectively the reliability of the new nonspecific tumor-searching tracer tetrofosmin in the postoperative follow-up of differentiated thyroid carcinoma (DTC) during TSH suppressive thyroid hormone treatment. METHODS: Whole-body scintigraphy was performed in 114 patients under TSH suppressive L-T4 treatment 20 min after intravenous injection of 370 MBq 99mTc-tetrofosmin by means of a dual-head gamma camera followed by three-dimensional SPECT in case of suspicious tracer uptake. The results of serum thyroglobulin, ultrasonography of the neck, 131I whole-body scintigraphy, chest radiograph, transmission CT or MRI, and bone scintigraphy were also available. RESULTS: A group of 68 patients without thyroid remnants who were tumor free and had no history of metastases or tumor recurrence showed a negative 99mTc-tetrofosmin whole-body scan. Another 24 patients (papillary carcinoma pT1NOMO) were also in complete remission, but had sonographically proven remnants (echonormal). Sixteen of them (67%) exhibited 99mTc-tetrofosmin accumulation in the thyroid bed, which corresponded excellently to the localization of the remnant. The third group comprises seven cases of local recurrence confirmed by histopathology after reoperation or by cytology after fine-needle aspiration where tetrofosmin scintigraphy clearly revealed relapse of malignancy in all cases. A total of 17 patients had distant metastases (11 pulmonary, 3 bone, 2 bone and pulmonary, 1 bone and soft tissue) discovered by different modalities, resulting in 44 lesions to be evaluated. Of the 23 radioiodine negative metastases, 17 were detected by tetrofosmin (74%), whereas all 21 radioiodine accumulating lesions also showed tetrofosmin positive scans. The overall sensitivity of 99mTc-tetrofosmin in detecting distant metastatic lesions was 86%. Four additional cases with radioiodine-negative disseminated lung metastases showed diffuse pulmonary tetrofosmin uptake. CONCLUSION: Technetium-99m-tetrofosmin is a promising tracer to detect malignant recurrence and distant metastases in the follow-up of DTC without the necessity of thyroid hormone withdrawal.

Adenocarcinoma, Follicular↗
PubMed1997

Scintimammography using Tc-99m tetrofosmin.

Breast cancer, the most common malignancy in women, still poses a challenge to diagnostic procedures and therapy. Despite low specificity routine mammography is the method of choice to screen women for breast cancer. In the last years other additional diagnostic procedures such as high frequency ultrasonography (US) and especially magnetic resonance imaging (MRI) have improved breast cancer diagnosis. However, all these imaging methods are lacking in specificity which makes biopsy or surgery necessary. The purpose of our study was to evaluate prospectively the sensitivity, specificity, PPV and NPV of scintimammography with a new cationic complex Tc-99m tetrofosmin in patients with suspicious mammographic lesions. One hundred and thirty seven patients in whom mammography and/or high resolution ultrasonography (10 MHz) revealed suspicious breast lesions were studied with Tc-99m tetrofosmin scintimammography. In 84 of them biopsy and/or surgery was performed for histological evaluation. After intravenous injection of 555 MBq Tc-99m tetrofosmin planar images in anterior and lateral projections (5 min.p.i.) and SPECT imaging including 3-D-reconstruction (20 min.p.i.) were performed. Scintimammography was evaluated as negative, equivocal (+), probably (+2) or definitely (+3) positive. Planar scintimammography with Tc-99m tetrofosmin was negative in 46 patients (43 true negative-f.n; 3 false negative-f.n.) and positive in 38 patients (27 true positive-t.p.; 11 false positive-t.p.). Using SPECT imaging Tc-99m scintimammography was negative in 43 cases (41 t.n.; 2f.n.) and positive in 41 cases (28 t.p.; 13 t.p). Sensitivity of Tc-99m tetrofosmin scintimammography in this prospective study was 90%, specificity 80%, PPV 71% and NPV 93% for planar imaging and 93%, 76%, 68% and 95% for SPECT, respectively. Scintimammographic results in patients with suspicious breast lesion show, that Tc-99m tetrofosmin accumulates in breast cancer as well as in some fibroadenoma with high cellularity. However, the high NPV of 93 and 95% respectively excludes breast cancer in suspicious mammographic lesions to a very high degree and therefore reduces the need of biopsy and/or surgery in most of these patients.

Adenocarcinoma↗
PubMed1997

[Use of a gamma probe for intraoperative localization of parathyroid adenomas with Tc-99m-tetrofosmin and Tc-99m-sestamibi].

Especially ectopic adenomas may be problematic in intraoperative localization despite preoperative imaging resulting in a longer operating time and more extensive surgical preparation. The aim of our study was to evaluate the possibility of intraoperative scintimetric detection of parathyroid adenomas with cationic, Tc-99m labelled tracers for its usefulness in ectopic adenomas. 12 women with biochemically confirmed hyperparathyroidism were included in our study. After injection of 370 MBq Tc-99m Tetrofosmin respectively Sestamibi, preoperative scintigraphy (double phase study and SPECT) was performed and T/NT ratios were evaluated for early, delayed and SPECT images. Surgery was performed using a hand-held gamma probe after preoperative injection of 555-925 MBq Tc-99m Tetrofosmin or Sestamibi. Count rates (cts/10 sec) were measured and used for calculating in situ- and ex situ-T/NT ratios. In 9 out of 12 patients, adenoma could be detected on static images. Three cases could only be detected with SPECT. 11 of 12 parathyroid adenomas could be confirmed intraoperatively. Intraoperative localization of parathyroid adenoma with Tc-99m-labelled cationic complexes and a gamma probe is possible and may be useful in case of ectopic adenoma by influencing surgical approach and operating time.

Adenoma↗
PubMed1997

Technetium-99m-tetrofosmin uptake in sarcoidosis stage I.

The uptake of 99mTc-tetrofosmin in enlarged lymph nodes, of the lung hilus, in the case of sarcoidosis Stage I (histopathologically confirmed by mediastinoscopic biopsy) is demonstrated. On a routine chest radiograph of a 78-yr-old woman, hilar lymphadenopathy was first detected. In the following mammography, disseminated micro calcifications were found in the left breast and a 99mTc-tetrofosmin study was performed for detection of breast cancer. Scintigraphy using 99mTc-tetrofosmin showed clear uptake in the hilar lymph nodes, but not in the left breast. The 99mTc-tetrofosmin uptake in the hilar lymph nodes was due to sarcoidosis confirmed by histology. Therefore, 99mTc-tetrofosmin scintigraphy may be useful in patients with suspected sarcoidosis, especially in Stage I.

Aged↗
PubMed1997

[Diagnosis of achalasia using 99m-Tc pertechnetate scintigraphy].

A 73-year-old patient presented a 99mTc scintiscan with a focal tracer accumulation left and caudal of the thyroid gland. Further investigations with sonography, CT, esophagoscopy and barium swallow provided the diagnosis of achalasia as the reason for focal 99mTc retention caudal of the thyroid gland. Explanation for 99mTc accumulation within the esophagus may be the nonspecific accumulation of 99mTc not only in the thyroid gland but also in the salivary glands. Excretion of the tracer follows with the saliva. Structural and motor disorders of the esophagus can thus lead to focal tracer retention within the esophagus simulating thyroid tissue.

Aged↗
PubMed1997

Influence of human anti-mouse antibodies on thyrotropin in-vitro analysis: a comparison of 6 thyrotropin IRMA kits.

OBJECTIVE: The aim of the study was to evaluate the influence of human anti-mouse antibodies on the measurement of thyrotropin. INVESTIGATIONS: Samples from 11 patients with measureable human anti-mouse antibody titres (19 micrograms/l-3880 micrograms/l) after radioimmuno-scintigraphy were analysed with 6 different thyrotropin immuno-radiometric assay kits (IRMA). Each sample was analysed in the routine way (sample influenced by human anti-mouse antibodies), as well as after incubation with murine immunoglobulin to precipitate human anti-mouse antibodies (samples not influenced by human anti-mouse antibodies). RESULTS: Two kits showed clear deviations of measured thyrotropin levels when the human anti-mouse antibody titres were higher than 1350 micrograms/l. A third kit was influenced to a lesser extent by human anti-mouse antibodies. Three of the 6 investigated thyrotropin IRMA kits produced thyrotropin values that were unaffected by the presence of elevated human anti-mouse antibodies. In comparison with former studies after immunotherapy, the thyrotropin deviations were marginal. However, differences were found between the commercially available thyrotropin assays. According to the results of this study only three out of the six investigated kits were unaffected by human anti-mouse antibodies. CONCLUSION: Since thyrotropin is one of the key quantities for the endocrinologist dealing with the thyroid gland, every laboratory should ensure high quality thyrotropin assays by critically analysing their method for human anti-mouse antibody.

Adult↗
PubMed1996

The use of non-specific tracers in the follow up of differentiated thyroid cancer: results with Tc-99m tetrofosmin whole body scintigraphy.

Since many years TI-201, as non-specific tumor-searching radionuclide, plays a certain although somewhat controversial role in the follow-up of differentiated thyroid carcinoma (DTC). Recently some Tc-99m labeled myocardial perfusion agents were introduced, that might be more important for nuclear oncology in the future. Aim of this study was to evaluate prospectively the reliability of the new non-specific tumor searching tracer tetrofosmin (Myoview) in the post operative follow-up of differentiated thyroid carcinoma during TSH suppressive thyroid hormone treatment and to compare the results in patients with metastasizing DTC to Tc-99m sestamibi (Cardiolite) and TI-201. In a pilot study 12 patients with elevated thyroglobulin (Tg) levels of more than 10 ng/ml and known metastatic disease were examined under TSH suppressive L-Thyroxine treatment comparing TI-201, Tc-99m sestamibi and Tc-99m terofosmin whole body scintigraphy (WBS). Furthermore in 146 consecutive follow up patients tetrofosmin WBS was performed under TSH-suppressive L-T4 treatment. The results were compared to serum thyroglobulin (Tg), ultrasonography (US) of the neck, I-131 whole body scintigraphy (I-131 WBS), transmission computed tomography (TCT) or magnetic resonance imaging (MRI) and bone scintigraphy. Whole body scans were performed with TI-201 (74 MBq; 20 min post injection), Tc-99m sestamibi (370 MBq; 20-60 min post injection) and Tc-99m tetrofosmin (370 MBq; 20-60 min post injection). Tumor/background ratios and optional time/activity analyses (up to 120 min post injection) were evaluated using the region of interest approach. In the pilot study tetrofosmin showed the highest T/BG ratios and detection rates (T/BG: 1.76 +/- 0.345) followed by TI-201 (T/BG: 1.59 +/- 0.396) and sestamibi (1.51 +/- 0.31 p = 0.05). From the 146 patients investigated consecutively with Tc-99m tetrofosmin WBS for the routine follow up of DTC, 88 patients (no thyroid remnants, no history of metastases or tumor recurrence) were tumor free. All of them resulted in negative Tc-99m tetrofosmin WBS. Another 32 patients (papillary carcinoma pT1) were also in complete remission, but had sonographically proven remnants (echonormal). Twenty one of them exhibited certain Tc-99m tetrofosmin accumulation in the thyroid bed. In 9 cases with local recurrence as confirmed by histopathology after reoperation or by cytology after fine needle aspiration, the tetrofosmin scintigraphy clearly revealed relapse of malignancy including 2 patients with tetrofosmin positive additional distant metastases. Seventeen patients had distant metastases (11 pulmonary, 3 bone, 2 bone and pulmonary, 1 bone and soft tissue) detected by different modalities and resulting in a total of 44 lesions to be evaluated. In the 23 radioiodine negative metastases, 17 were also detected by tetrofosmin (74%). In the 21 radioiodine accumulating lesions 19 were Tc-99m tetrofosmin positive (90%). Four cases with radioiodine negative disseminated lung metastases showed diffuse pulmonary tetrofosmin uptake. This prospective study shows that Tc-99m tetrofosmin is a new promising tracer to detect malignant recurrence and distant metastases in the follow up of DTC without the necessity of thyroid hormone withdrawl, especially in patients with elevated Tg level and no iodine uptake. Tc-99m tetrofosmin shows slight advantages concerning T/Bg Ratio, background clearance, detection rate and dosimetry compared with TI-201 and Tc-99m sestamibi.

Adenocarcinoma, Follicular↗
PubMed1996

Tc-99m-tetrofosmin scintimammography: a prospective study in primary breast lesions.

UNLABELLED: Despite low specificity routine mammography is the method of choice to screen women for breast cancer. In addition high frequency ultrasonography (US) or magnetic resonance imaging (MRI) can improve breast cancer diagnosis. However there is a lack of conventional imaging to improve the high rate of false positive results that make biopsy or surgery necessary. AIM: The purpose of our study was to evaluate prospectively the sensitivity, specificity, PPV and NPV of scintimammography with a new cationic complex Tc-99m-tetrofosmin. METHODS: Fourtyeight patients in whom mammography and/or high resolution ultrasonography (10 MHz) revealed suspicious breast lesions were studied with Tc-99m-tetrofosmin scintimammography. In thirtyfour of them biopsy and/or surgery was performed for histological evaluation. After intravenous injection of 555 MBq Tc-99m-tetrofosmin dynamic images over three minutes (1 frame/10 sec.) planar images in anterior and lateral projections (5 min. p.i.) and SPECT imaging including 3-D-reconstruction (20 min. p.i.) were performed. Scintimammography was evaluated as negative, equivocal (+), probably (+2) or definitely (+3) positive RESULTS: Scintimammography with Tc-99m-tetrofosmin was negative in 18 patients (17 t.p., 1 f.n.) and positive in 16 patients (10 t.p., 6 f.p.). The false negative scintimammography was observed in a patient with infiltrating ductal carcinoma pT1, the false positive results in a patient with fibrocystic disease; all of the five fibroadenomas were also "false" positive. Sensitivity of Tc-99m-tetrofosmin scintimammography in this prospective study was 91%, specificity 74%, PPV 63% and NPV 94%. Scintimammographic results in patients with suspicious breast lesion show, that Tc-99m-tetrofosmin accumulates in breast cancer as well as in fibroadenoma. However the high NPV of 94% excludes breast cancer in suspicious mammographic lesions in a very high degree and therefore reduces the need of biopsy and/or surgery in most of these patients CONCLUSION: Our first results show that scintimammography with Tc-99m-tetrofosmin might play a role as further diagnostic step before surgery for women in whom mammography and/or ultrasonography show suspicious lesions.

Adult↗
PubMed1996

Tc-99m-tetrofosmin scintigraphy: an alternative scintigraphic method for following up differentiated thyroid carcinoma--preliminary results.

AIM: The usefulness of the myocardial perfusion agent, Tc-99m-tetrofosmin (Myoview) in the follow-up of differentiated thyroid carcinoma was evaluated in a clinical study of 15 patients, primary treated with thyroidectomy and high-dose I-131-therapy (2960-3700 MBq). 12 with suspected recurrence and metastases and three patients without any suspicion and compared with other non-specific tracers like TI-201 and Tc-99m-sestamibi. METHOD: Twelve patients with elevated thyroglobulin (Tg) levels of more than 10 ng/ml (group A), four of these had negative I-131 scans, and three patients with Tg levels less than 10 ng/ml (group B) were examined under TSH suppressive L-Thyroxine treatment. Whole body scans were taken with Tl-201 (74 MBq: 20 mn post injection), Tc-99m-sestamibi (370 MBq: 20-60 min post injection) and Tc-99m-tetrofosmin (370 MBq: 20-60 min post injection). Tumor/background ratios and optional time/activity analyses (up to 150 min post injection) were evaluated using the region of interest approach. RESULTS: Compared with Tl-201 (T/BG: 1.59, +/- 0.396). Tc-99m-tetrofosmin showed slightly but not significant better T/BG ratios and detection rates (T/BG: 1.76, +/- 0.345). Tc-99m-sestamibi (1.51, +/- 0.31 p = 0.05) showed significantly lower values than Tc-99m-tetrofosmin CONCLUSION: In the light of these results, scintigraphy with Tc-99m-tetrofosmin seems to be a possibly sensitive imaging modality in the follow-up of DTC with possible advantages concerning T/Bg ratio, background clearance, detection rate and dosimetry compared with Tl-201 and Tc-99m-sestamibi, especially in patients with elevated Tg level and no iodine uptake, but further investigations are needed to confirm our preliminary results.

Aged↗
PubMed1995

[Diagnosis of SDAT by HMPAO SPECT and vitamin B12 serum concentration].

It is quite difficult to confirm the diagnosis of demential disorders, including senile dementia of the Alzheimer type (SDAT) by clinical means only. Through the combination of 99mTc-HMPAO brain SPECT and serum vitamin B12 determination it was hoped to speed up and improve the diagnosis of SDAT. 116 patients who had been divided into four groups according to their defect pattern in the 99mTc-HMPAO brain SPECT 17 very probably had SDAT; of these 15 showed a defect-pattern with brain SPECT which could be associated to SDAT. The majority of SDAT patients had serum vitamin B12 levels in the lower normal range or pathologically below that range. Both investigations contributed to establishing the SDAT diagnosis without replacing other investigations. The determination of serum vitamin B12 does not require any major additional effort.

Aged↗
PubMed1994

[Thyroid volume and iodine supply of 6 to 17 year old students. Results 3 years after the introduction of increased iodized salt].

In Austria, a law stipulating that table salt should be iodized with 10 mg Kl/kg was introduced in 1963. Nevertheless, investigations carried out between 1982 and 1984 on iodine supply and goitre frequency revealed that there was a general iodine deficiency of first to second degree according to WHO criteria. These results led to an increase in salt iodization to 20 mg Kl/kg in 1990. The aim of the study was to determine iodine supply and thyroid volumes of schoolchildren 3 years thereafter. 734 children at primary and secondary schools were examined. The mean value of iodine excretion was 121 micrograms/g Cr, corresponding to an improvement in iodine intake. Compared to previous data, the corresponding age groups showed lower mean thyroid volumes.

Adolescent↗
PubMed1993

[The role of nuclear medicine methods in the differential diagnosis of focal liver lesions].

In a retrospective study of 160 patients who were examined within 12 months, we analysed the diagnostic value of scintigraphic techniques in the differential diagnosis of solid focal liver lesions. Haemangiomas were found in 77 patients. Bloodpool scintigraphy was true-positive in 66 (sensitivity 85%); for lesions greater than 2 cm in diameter, sensitivity increased to 94%. Metastases of CEA-expressing tumors were found in 42 patients, anti-CEA-immunoscintigraphy was true-positive in 33 patients (sensitivity 78.5%). Focal nodulary hyperplasia was found in 3 patients, adenomas in 6 patients. In the remaining 32 patients we saw 4 hepatocellular carcinomas, 28 metastases from lung and breast cancer, 2 echinococcus cysts and 1 choledochus cyst.

Adenoma↗