Three different areas of decreased hepatic radioactivity secondary to a hilar mass

A 68-year-old woman with hilar cholangiocarcinoma underwent technetium-99m galactosyl human albumin (Tc-99m GSA) liver scintigraphy for the preoperative evaluation of functional liver reserve. Normal radionuclide uptake was evident in the right anterior segment of the right lobe but there was none in the left lobe. In the right posterior segment, uptake was incomplete. Contrast portography via the superior mesenteric artery showed complete occlusion of the left portal vein. The right anterior segment was well perfused with portal venous flow, whereas there was less perfusion to the right posterior segment. These differences of hepatic parenchyreal radioactivity are probably a result of varying degrees of decrease in portal venous flow secondary to the hilar mass.