[daisybaby]

Hi everyone, RN from the OB/GYN board dropping by with a few questions...

While in the ER with suspected diverticulitis (which was ruled out by CT), a small 3.5cm mass was noticed, incidentally, on my liver. Radiology suggested an MRI to differentiate the mass (focal nodular hyperplasia (FNH) vs. carcinoma or hemangioma). Unfortunately the MRI couldn't further distinguish the mass, and it's been recommended that I have a SPECT scan. My primary MD thinks it's 'an unnecessary test' and won't order it because I'm otherwise healthy.

I understand that it's very likely the focal nodular hyperplasia, but, given the differential diagnoses, I'd really like to be as sure as possible. I have a GI consult in a few weeks (to figure out why I have attacks of LLQ pain with -sorry if this is TMI- bloody diarrhea) and am thinking perhaps GI would agree that the SPECT scan would be appropriate and might order it.

Would that be a reasonable request? Is anyone familiar with FNH or liver masses in general? Not looking for advice so much as looking to find out more info. WebMD was helpful but pretty general, and the abstracts on the subject from scholarly journals were over this labor & delivery nurse's head!

Thanks in advance

[core0]

Originally Posted by daisybaby

Hi everyone, RN from the OB/GYN board dropping by with a few questions...

While in the ER with suspected diverticulitis (which was ruled out by CT), a small 3.5cm mass was noticed, incidentally, on my liver. Radiology suggested an MRI to differentiate the mass (focal nodular hyperplasia (FNH) vs. carcinoma or hemangioma). Unfortunately the MRI couldn't further distinguish the mass, and it's been recommended that I have a SPECT scan. My primary MD thinks it's 'an unnecessary test' and won't order it because I'm otherwise healthy.

I understand that it's very likely the focal nodular hyperplasia, but, given the differential diagnoses, I'd really like to be as sure as possible. I have a GI consult in a few weeks (to figure out why I have attacks of LLQ pain with -sorry if this is TMI- bloody diarrhea) and am thinking perhaps GI would agree that the SPECT scan would be appropriate and might order it.

Would that be a reasonable request? Is anyone familiar with FNH or liver masses in general? Not looking for advice so much as looking to find out more info. WebMD was helpful but pretty general, and the abstracts on the subject from scholarly journals were over this labor & delivery nurse's head!

Thanks in advance

Allnurses does not give medical advice and advises you to see your health care provider (thats what the mod will say).

That being said I would be happy to talk about liver lesions in general (but not yours specifically). Liver lesions are very common.

The most common is a hemangioma which is a vascular lesion. This is most commonly differentiated on MRI but can usually be differentiated on a triple phase CT.

Focal Nodular Hyperplasia is the second most common liver lesion. It is thought to be a flow response to an AVM and there is controversy over whether it is related to OCPs. It is more common in women and usually appears in the 3rd or 4th decade of life.

These are by far the most common and probably account for more than 90% of liver lesions. Other lesions include hepatic adenoma which is rare in the US and Hepatocellular Carcinoma which is rare without some other type of liver disease.

Focal Nodular Hyperplasia is very hard to differentiate on imaging and frequently must be diagnosed by biopsy. Triple phase CT is the weapon of choice for HCC. For metastatic disease PET (positive emission tomography) is the weapon of choice but has poor characteristics with HCC. I have not seen Spect used but it seems to be used in areas that do not have PET.

While not commenting on your situation in particular, I would have a hard time justifying things if a physician disregardeded the recommendation of another medical professional recommending a test. The hard part of Spect or PET is getting insurance approval (Medicare will only pay for this with a diagnosis of cancer for example).

In cases where a dedicated triple phase CT (dedicated liver protocol) has not been done this may help differentiate liver lesions.

Hope this helps.

David Carpenter, PA-C