Liver and Pancreas Scans

To the Editor.—  The photograph that accompanied our letter (229:763, 1974) was intended to illustrate our diagnosis rather than prove it. The scan in question was made with selenomethionine Se 75, which often produces excess optical density in the liver portion. However, we obtained similar results with technetium Tc 99m sulfur colloid; again the liver appeared small, with areas of decreased count in the lower portion (fibrosis?), giving the liver the same profile. Further, we find that images obtained with a recently acquired camera (Ohio Nuclear) agree with those made with our scanner (Picker) in these details (Figure). Indeed, the changes shown by the camera are more pronounced, especially if the patient holds his breath for 20 seconds or more.We never make our diagnosis on the basis of one criterion alone. We obtain the size and shape of the liver by scanning techniques. We determine the shape of and