technetium-tc-99m-disofenin and Abdominal-Injuries

Technetium-99m IDA cholescintigraphy has provided a new, noninvasive means of visualizing biliary tract function. It has become the procedure of choice in patients with suspected acute cholecystitis because of its ability to most accurately detect functional obstruction or patency of the cystic duct as opposed to ultrasound's ability to detect only anatomic changes such as the presence of calculi or a thickened gallbladder wall. These latter findings are more important in establishing the diagnosis of chronic cholecystitis where ultrasound shares a position of prime importance with the oral cholecystogram. Tc-99m IDA cholescintigraphy has also been particularly useful in evaluating bile leaks, biliary-enteric anastomosis patency and the post-cholecystectomy patient with recurrent pain. In the patient with cholestasis, ultrasound is usually the procedure of choice since it establishes whether or not ductal dilatation is present and frequently can determine the cause of obstruction. Cholescintigraphy has played an ancillary role in many cases by demonstrating the level of partial obstruction, but it does not have the anatomic resolution to visualize the cause of obstruction. Occasionally, in the evaluation of cholestasis, cholescintigraphy has proven to be the only modality which has identified the presence of acute common duct obstruction or localized intrahepatic ductal obstruction. All in all, Tc-99m IDA cholescintigraphy has had a dramatic impact upon hepatobiliary diagnosis.

Topics: Abdominal Injuries; Adolescent; Biliary Tract Diseases; Cholangiography; Cholecystitis; Cholestasis; Hepatic Duct, Common; Humans; Imino Acids; Male; Organotechnetium Compounds; Postoperative Period; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Lidofenin; Ultrasonography

Topics: Abdominal Injuries; Aged; Hernia, Diaphragmatic; Humans; Hypertrophy; Imino Acids; Liver; Male; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Scintiangiography and hepatobiliary scintigraphy were performed in 45 patients with abdominal trauma. There were 18 gunshot wounds, six stab wounds, and 21 blunt injuries. Thirty-one of 45 patients showed abnormalities (69%). There were nine bilomas (4 with leaks), three leaks without biloma, (7 total leaks), five liver hematomas, three liver infarcts, one liver abscess, four renal injuries, one post-traumatic hepatic artery aneurysm, one acute acalculus cholecystitis, and four bowel injuries including one fistula, two obstructions, and one stricture. Two of the renal injuries and the hepatic artery aneurysm were identified only during scintiangiography. Eighteen of 38 gallbladders were not visualized despite normal bowel transit and delayed views to 4 hours (47%). Fourteen of 16 gallbladders were grossly normal at surgery, one had gallstones, and one had post-traumatic acalculus cholecystitis (6%). Hepatobiliary scintiangiography showed unique characteristics of vascular and renal lesions that were not seen on routine images. Sulfur colloid had no advantage over disofenin in evaluating liver injuries in nine cases. A high percentage of nonvisualized gallbladders (47%) were noted in acutely traumatized patients, and caution is recommended in diagnosing acute cholecystitis in the face of trauma.

Topics: Abdominal Injuries; Adolescent; Adult; Aged; Biliary Fistula; Biliary Tract; Child; Cholecystitis; Extravasation of Diagnostic and Therapeutic Materials; Female; Humans; Imino Acids; Liver; Male; Middle Aged; Organometallic Compounds; Radionuclide Angiography; Technetium Tc 99m Disofenin; Wounds, Gunshot; Wounds, Nonpenetrating; Wounds, Stab