Interesting Image

Unexpected Hepatic Uptake of Tc-99m-MAA in Lung Perfusion Scintigraphy in a Patient with End-stage Renal Disease


  • Kadir Alper Küçüker
  • İsa Burak Güney
  • Kairgeldy Aikimbaev
  • Saime Paydaş

Received Date: 09.11.2017 Accepted Date: 15.10.2018 Mol Imaging Radionucl Ther 2019;28(1):27-29 PMID: 30942059

Extra-pulmonary accumulation of Tc-99m-macroaggregated albumin (MAA) is described as uptake areas out of the lung in perfusion scintigraphy. If the particles spread throughout the body before reaching the lung via venous collaterals or due to right-to-left shunt, or if the particles are too small to occlude the pulmonary capillaries, then the agent can be seen at different locations of the body. Extra-pulmonary accumulation of Tc-99m-MAA can be detected mostly in the liver as well as in the brain, kidney, thyroid, myocardium, spleen and vertebra. Herein, we present lung scanning images with unexpected hepatic accumulation of Tc-99m-MAA. This pulmonary perfusion scintigraphy was performed in a patient with end-stage renal disease due to dyspnea in the post-operative period of kidney transplantation

Keywords: Tc-99m-macroaggregated albumin, perfusion scintigraphy, collateral circulation, liver, end-stage renal disease


Informed Consent: Consent form was filled out by all participants.

Peer-review: Externally peer-reviewed.

Authorship Contributions

Surgical and Medical Practices: K.A.K., İ.B.G., K.A., S.P., Concept: K.A.K., İ.B.G., Design: K.A.K., İ.B.G., Data Collection or Processing: K.A.K., İ.B.G., K.A., S.P., Analysis or Interpretation: K.A.K., İ.B.G., K.A., S.P., Literature Search: K.A.K., İ.B.G., Writing: K.A.K., İ.B.G.

Conflict of Interest: No conflict of interest was declared by the authors.

Conflict of Interest: No conflict of interest was declared by the authors.


  1. Kapur S, Paik E, Rezaei A, Vu DN. Where there is blood, there is a way: unusual collateral vessels in superior and inferior vena cava obstruction. Radiographics 2010;30:67-78.
  2. Kume N, Suga K, Uchisako H, Matsui M, Shimizu K, Matsunaga N. Abnormal extra pulmonary accumulation of Tc-99m-MAA during lung perfusion scanning. Ann Nucl Med 1995;9:179-184.
  3. Gale B, Chen C, Chun KJ, Lan J, Cynamon J, Freeman LM. Systemic to Pulmonary Venous Shunting in Superior Vena Cava Obstruction: Unusual Myocardial and Thyroid Visualization. Clin Nucl Med 1990;15:246-250.
  4. Esser JP, Oei HY, de Bruin HG, Krenning EP. Liver and vertebral uptake of Tc-99m macroaggregated albumin (MAA). Clin Nucl Med 2004;29:793-794.
  5. Karls S, Hassoun H, Derbekyan V. Vertebral Uptake of Tc-99m Macroaggregated Albumin (MAA) with SPECT/CT Occurring in Superior Vena Cava Obstruction. Nucl Med Mol Imaging 2016;50:266-269.
  6. Goshen E, Oksman Y, Rotenberg G, Zwas ST. Absent pulmonary uptake on Tc-99m-MAA perfusion lung scan due to severe right to left shunt. Semin Nucl Med 2004;34:157-158.