Case 6.-This patient was admitted for investigation of his enlarged liver and a radioactive scan showed a low count rate over the whole liver and also a high spot over the spleen (Fig. 7). This appearance we have come to associate with diffuse metastases throughout the liver and this was confirmed at laparotomy in this patient. Apart from cirrhosis, abnormal defects in the liver scan can result from congenital anomalies of the liver such as an unusually developed fissure or abnormal gall-bladder fossa. Skeletal deformity may also produce a distorted pattern.

We have so far employed this investigation in 46 patients and have been able to compare the scan with direct examination of the liver by laparotomy, peritoneoscopy, or autopsy in the majority of cases. The liver scans were found to provide misleading results in 4 patients: in z the scan suggested the presence of metastases in the liver which could not be detected at operation; in the other 2 patients the reverse situation arose with apparently normal scan, but obvious metastases at operation. It appears therefore that even with the relatively simple apparatus and technique that we have employed, this investigation provides a reasonably accurate prediction of the presence or absence of secondary deposits or other space-occupying lesions within the liver. Wc believe that, with refinement of the detecting apparatus and the method of recording and presenting data obtained, liver scanning will offer a further addition to the complement of preoperative investigations in patients with malignant disease arising within the abdominal cavity.