Diagnostic Potential of Technetium-99m Macroaggregated Albumin (Tc-99m MAA) in Hepatobiliary Imaging

Technetium-99m macroaggregated albumin (Tc-99m MAA) is a radiopharmaceutical used extensively in medical imaging, playing a crucial role in hepatobiliary scintigraphy. Hepatobiliary imaging, also known as hepatobiliary scintigraphy or HIDA scan, is a diagnostic procedure used to visualise and evaluate the function of the liver, gallbladder, and bile ducts. This article outlines the characteristics of Tc-99m MAA, its applications in hepatobiliary imaging, the procedure involved, and the interpretation of results, along with its advantages and potential limitations.

Characteristics of Technetium-99m MAA

Technetium-99m is a radioisotope of technetium and is the most widely used radiotracer in the field of nuclear medicine. It has a short half-life of about 6 hours, which is advantageous for diagnostic purposes as it minimises the patient’s exposure to radiation. Macroaggregated albumin (MAA) is a substance made up of denatured albumin particles aggregating together to form larger particles. When labelled with Tc-99m, it forms Tc-99m MAA (Pulmotech), a compound that can be detected using gamma cameras.

Application in Hepatobiliary Imaging

In hepatobiliary imaging, Tc-99m MAA (Pulmotech)is administered intravenously to the patient. Once injected, the MAA particles are trapped in the capillaries of the liver, allowing for the visualisation of liver parenchyma. This trapping of MAA in the liver is based on the size of the particles, which are too large to pass through the capillaries, resulting in temporary embolisation. The gamma radiation emitted by Tc-99m is then captured using a gamma camera, producing images that provide valuable information about the structure and function of the liver, gallbladder, and bile ducts.

Procedure and Protocol

The hepatobiliary imaging procedure involves the intravenous administration of Tc-99m MAA, followed by a series of images taken over a specific time period. The patient is usually positioned supine on the imaging table, and a gamma camera is placed above the abdominal area. Images are captured at different time intervals, providing a dynamic representation of the radiotracer’s distribution and movement through the hepatobiliary system.

Before the procedure, patients are typically advised to fast for a certain period, as food intake can affect the accuracy of the results. Additionally, certain medications that can influence bile flow may need to be temporarily discontinued. The radiologist or nuclear medicine physician will provide specific instructions based on the patient’s medical history and the purpose of the study.

Image Interpretation

The interpretation of hepatobiliary images involves assessing the radiotracer’s uptake, distribution, and excretion. Normal findings would show prompt and uniform uptake of the Tc-99m MAA by the liver, followed by its progression into the gallbladder and bile ducts, eventually reaching the small intestine. Any deviations from this pattern can indicate abnormalities.

Delayed or irregular uptake by the liver may suggest liver dysfunction or disease, while an absence of radiotracer in the gallbladder could indicate cholecystitis or biliary obstruction. The radiologist will analyse the images in conjunction with the patient’s clinical history and symptoms to provide a comprehensive assessment.

Advantages and Benefits

Tc-99m MAA in hepatobiliary imaging offers several advantages. The short half-life of Tc-99m minimises radiation exposure to the patient, making it a safer option for diagnostic imaging. The non-invasive procedure provides functional information that other imaging modalities, such as CT or MRI, may not offer. This functional aspect is crucial in evaluating conditions like biliary obstruction, gallbladder dysfunction, and liver disease.

Moreover, hepatobiliary imaging with Tc-99m MAA can be particularly beneficial in preoperative planning, helping to assess the liver function of patients who are candidates for liver resection or transplantation. The information obtained can guide surgical decisions and assist in predicting postoperative outcomes.

Potential Limitations

While Tc-99m MAA hepatobiliary imaging is a valuable diagnostic tool, it has limitations. The image resolution is lower than other imaging modalities, sometimes making visualising small abnormalities challenging. Additionally, the procedure relies on the patient’s liver function and bile flow, and in cases of severe liver dysfunction or complete biliary obstruction, the results may be inconclusive.

In some instances, the MAA particles can embolise the lungs, which is generally harmless but can interfere with image interpretation. Proper preparation and patient selection are vital to minimise these risks and ensure accurate results.


Technetium-99m macroaggregated albumin is pivotal in hepatobiliary imaging, providing valuable functional information about the liver, gallbladder, and bile ducts. Its short half-life, ease of administration, and ability to offer dynamic imaging make it an indispensable tool in nuclear medicine. While there are potential limitations, the benefits and insights provided by Tc-99m MAA hepatobiliary imaging are substantial, aiding in the diagnosis, management, and preoperative planning for various hepatobiliary conditions. With advancements in technology and imaging techniques, the applications and accuracy of Tc-99m MAA in hepatobiliary imaging continue to evolve, further cementing its place as a crucial component in diagnostic imaging.

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