technetium-tc-99m-disofenin and Acquired-Immunodeficiency-Syndrome

Biliary disease, primarily manifesting as papillary stenosis or sclerosing cholangitis, is being increasingly recognized as a problem in the acquired immunodeficiency syndrome (AIDS) and may be amenable to specific treatment. Ultrasound, followed by endoscopic retrograde cholangiopancreatography (ERCP) for definitive diagnosis, is currently the prime mode of investigation of suspected hepatobiliary diseases in AIDS. There are few published reports of the use of radionuclide cholescintigraphy in the assessment of these patients. This report presents Tc-99m DISIDA cholescintigraphy data from three patients with AIDS-related hepatobiliary disease confirmed by ERCP. Radionuclide cholescintigraphy was abnormal in all three patients. In two of the subjects, there was focal duct dilation with strictures in the biliary tree. The third patient demonstrated diffuse hepatic parenchymal retention with marked delay in tracer washout. Two of the subjects, treated with specific anticryptosporidial therapy, subsequently underwent progress cholescintigraphy. In one of these patients with initial diffuse parenchymal retention, there was marked improvement in scan appearances. The second patient with initial duct dilation had no significant change in scan appearances, but quantitative analysis did demonstrate improvement in hepatobiliary tracer clearance rate. In conclusion, although ERCP remains the gold standard in the diagnosis of AIDS-related biliary disease, radionuclide cholescintigraphy may be a useful modality in these patients as a screening test before proceeding to more expensive and invasive techniques. In addition, quantitative analysis of cholescintigraphy may allow assessment of patient response to specific antimicrobial or surgical intervention.

Topics: Acquired Immunodeficiency Syndrome; Adult; Biliary Tract; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis, Sclerosing; Humans; Imino Acids; Liver; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

Acalculous inflammatory biliary disease has been reported in patients with acquired immune deficiency syndrome (AIDS). AIDS-related cholangitis manifests the intrahepatic and extrahepatic biliary changes seen in sclerosing cholangitis, including strictures, dilatation, and decreased arborization. Biliary scanning was used to evaluate a patient with suspected AIDS-related cholangitis. The hepatobiliary images showed prompt hepatic uptake, with nonvisualization of the gallbladder, common bile duct, and bowel at two hours. Thus, the overall hepatic clearance time approached infinity. There was also a central photopenic region at the porta hepatis. ERCP confirmed the diagnosis of AIDS-related cholangitis. Infection with cytomegalovirus is the proposed etiology. AIDS-related cholangitis should be included in the differential diagnosis of an obstructive cholescintigraphic pattern.

Topics: Acquired Immunodeficiency Syndrome; Adult; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis; Common Bile Duct; Gallbladder; Humans; Imino Acids; Liver; Male; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin