Scintigraphic study of regenerative nodules due to fulminant hepatic failure

We report the case of a 25-year-old woman with fulminant hepatic failure (FHF). Liver scintigraphy using 9 9 m Tc-galactosyl human serum albumin (GSA) and 9 9 m Tc-phytate produced interesting findings; regenerative nodules appeared as nodules of increased accumulation of 9 9 m Tc-GSA, whereas these nodules were expressed as defects of accumulation of 9 9 m Tc-phytate. These scintigraphic findings suggested that the functions of hepatocytes in regenerative nodules were maintained, whereas those of Kupffer cells were impaired. Although 9 9 m Tc-GSA scintigraphy indicated hepatic functional reserve enough to survive, she died despite intensive therapy including plasma exchange. Based on this case, it is recommended that not only 9 9 m Tc-GSA scintigraphy but also 9 9 m Tc-phytate scintigraphy is required to evaluate the prognosis of patients with FHF.