technetium-tc-99m-disofenin and Bile-Duct-Diseases

We report a 61-year-old asymptomatic man who had a hepatic lesion whose nature was undetermined, based on biochemistry, serology, ultrasonography, computed tomography, and magnetic resonance imaging studies. Biliary hamartomas were diagnosed by echo-guided needle biopsy. Functional studies of bile excretion, using 99mTc-diisopropyl iminodiacetic acid (99mTc-DISIDA) scintigraphy liver single-photon emission computed tomography (SPECT) showed the delayed transit of tracers from hepatocytes to the biliary hamartomas and the delayed emptying of tracers to the neighboring bile ducts. Therefore, biliary hamartomas should be included in the differential diagnosis of single or multiple hepatic lesions whose nature is undetermined, and a liver biopsy would be warranted for further treatment plans. We believe this is the first functional study of bile excretion in biliary hamartomas using radionucleotide studies; such studies may have prognostic implications.

Topics: Bile Acids and Salts; Bile Duct Diseases; Biopsy, Needle; Follow-Up Studies; Hamartoma; Humans; Image Enhancement; Immunohistochemistry; Male; Middle Aged; Risk Assessment; Sensitivity and Specificity; Technetium Tc 99m Disofenin; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Treatment Outcome

Topics: Bile; Bile Duct Diseases; Cholecystectomy; Female; Fluid Shifts; Follow-Up Studies; Humans; Middle Aged; Radiopharmaceuticals; Subtraction Technique; Technetium Tc 99m Disofenin; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Hepatobiliary scintigraphy is an established method for the diagnosis of a bile leak from the biliary system. A bile leak should be considered in any patient after cholecystectomy who has unexplained abdominal pain after operation. Three patients with bile leak diagnosed by scintigraphy are described, one of whom had an unusual pattern of hepatic subcapsular collection of the bile. The second patient had a bile leak through the postsurgical drainage tube, whereas the third patient had a more typical pattern of leakage into the peritoneal cavity.

Topics: Abdominal Pain; Adult; Aged; Bile Duct Diseases; Bile Ducts; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis; Cholecystectomy, Laparoscopic; Cholelithiasis; Drainage; Female; Humans; Injections, Intravenous; Male; Postoperative Nausea and Vomiting; Radionuclide Imaging; Reoperation; Rupture, Spontaneous; Sensitivity and Specificity; Stents; Technetium Tc 99m Disofenin

A 60-year-old male suffered from abdominal pain, chills and fever for two weeks. A vivid Ascaris lumbricoides in the common bile duct and intrahepatic ducts was identified in operation. Chronic cholecystitis was also noted. We discuss the findings of multiple image modalities in biliary ascariasis and review the literature.

Topics: Ascariasis; Bile Duct Diseases; Cholangiopancreatography, Endoscopic Retrograde; Humans; Imino Acids; Liver; Male; Middle Aged; Organotechnetium Compounds; Technetium Tc 99m Disofenin; Tomography, X-Ray Computed; Ultrasonography

Intra- and extrahepatic impairment of biliary drainage is important in the pathogenesis of liver disease in cystic fibrosis. Distal common bile duct obstruction is reported to occur in 13% to 96% of these patients. Between 1975 and 1993, 17 of 372 children (4.5%) with cystic fibrosis attending The Children's Memorial Medical Center in Chicago had liver disease based on clinical and laboratory findings.. Hepatobiliary scintigraphy (HBS) with 99mTc-DISIDA was performed on 12 of the 17 children (mean age at the time of exam was 9 yr, with a range of 1 mo to 21 yr).. All had hepatomegaly, four had splenomegaly and two had bleeding esophageal varices. Twenty HBS exams on these 12 patients documented nonvisualization of the gallbladder in 7, dilated intrahepatic ducts in 6 (only the left lobe was involved in 3 patients), nonvisualization of bowel in two, delayed peaking time in the liver (> 10 min) in four patients, and delayed clearance from the liver parenchyma (T1/2 > 20 min) in 11. There appears to be a spectrum of abnormal HBS findings in cystic fibrosis patients with liver disease. These are delayed clearance of liver parenchyma, nonvisualization of the gallbladder and dilated intrahepatic ducts with a predilection for the left lobe of the liver. These abnormal findings fluctuate in time and may not correlate with the findings on ultrasonography.. Quantitative hepatobiliary scintigraphy is a valuable tool in the evaluation and management of the liver disease in this patient population.

Topics: Bile Duct Diseases; Bile Ducts, Intrahepatic; Child; Cystic Fibrosis; Female; Gallbladder; Humans; Imino Acids; Liver; Liver Diseases; Male; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

Topics: Ampulla of Vater; Bile Duct Diseases; Endoscopy; Humans; Imino Acids; Manometry; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Tc-99m sulfur colloid images of the liver are frequently falsely reported as tumor or metastases in certain space occupying lesions of the liver. Whether a primary malignancy is known or not, every suspicious space-occupying lesion of the liver should be given the benefit of alternate diagnostic studies before a firm diagnosis of neoplasia is made. This is critical when the decision regarding chemotherapy has to be made. Timely intervention by other diagnostic modalities may obviate the consideration of chemotherapy in cases where there are no liver metastases. The case presented below illustrates the value of hepatobiliary tract imaging in pseudotumors of the liver.

Topics: Bile Duct Diseases; Bile Ducts, Intrahepatic; Cholecystectomy; Common Bile Duct Diseases; Cysts; Diagnosis, Differential; Diverticulum; Female; Humans; Imino Acids; Liver Neoplasms; Middle Aged; Organometallic Compounds; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Topics: Bile Duct Diseases; Bile Ducts, Intrahepatic; Dilatation, Pathologic; Humans; Imino Acids; Liver; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Ultrasonography

Three patients in whom Caroli's disease was diagnosed by cholangiographic methods were studied by scintigraphy with Tc-99m DISIDA. Cholescintigrams showed an intense concentration of the radionuclide in the form of round spots near the hepatic hilus in late images. In two patients with cholestasis, a delayed hepatic clearance of the radionuclide was observed, which improved when the exploration was performed after a choledocoduodenostomy. Tc-99m DISIDA is not only a good noninvasive method to diagnose Caroli's disease, but also a useful technique to evaluate the patency of the biliary tree during the follow-up of such patients.

Topics: Adult; Bile Duct Diseases; Bile Ducts, Intrahepatic; Dilatation, Pathologic; Female; Humans; Imino Acids; Male; Middle Aged; Radionuclide Imaging; Syndrome; Technetium; Technetium Tc 99m Disofenin

In recent years, noninvasive evaluation of Caroli's disease has been demonstrated by computed tomography, ultrasonography, and nuclear scintigraphy. Confirmation of Caroli's disease requires invasive procedures such as percutaneous transhepatic cholangiography or endoscopic retrograde cholangiography. All of the techniques give valuable information making it easier to diagnose Caroli's disease and to determine its extent. In addition, associated abnormalities in organs outside of the biliary system may be revealed. Two cases are presented to illustrate the radiographic and scintigraphic findings of Caroli's disease.

Topics: Adult; Bile Duct Diseases; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy; Female; Humans; Imino Acids; Kidney Diseases, Cystic; Male; Middle Aged; Radionuclide Imaging; Splenomegaly; Sulfur; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

The effect of etiology on findings in cholescintigraphy in patients with extrahepatic obstruction was retrospectively evaluated in 29 patients. Of 11 patients with obstruction secondary to cancer, seven (78%) of nine had complete obstruction (delayed images were not obtained in two) and nine (82%) of 11 had a moderate to severe decreases in hepatocyte clearance. Of 12 patients with obstruction secondary to cholelithiasis, only four (36%) had complete obstruction (delayed images were not obtained in one) (p less than 0.05) and all 11 had normal or only midly decreased hepatocyte clearance (p less than 0.05). All five patients with obstruction secondary to pancreatitis had mild partial obstruction and normal or mildly decreased hepatocyte clearance. One patient had partial obstruction secondary to an abscess adjacent to the common bile duct; hepatocyte clearance was mildly decreased. Cancerous and noncancerous causes of biliary tract obstruction produce significantly different findings in hepatobiliary imaging.

Topics: Abscess; Aged; Bile Duct Diseases; Cholelithiasis; Cholestasis, Extrahepatic; Humans; Imino Acids; Male; Middle Aged; Neoplasms; Pancreatitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid; Technetium Tc 99m Disofenin

Thirty-one patients with a wide range of hepatobiliary function and clinical diagnoses were studied with both diisopropyl-IDA Tc 99m and diethyl-IDA Tc 99m. Images were similar except for an increased liver-to-kidney ratio with diisopropyl-IDA Tc 99m (p less than 0.01) and a tendency toward an increased liver-to-background ratio at five minutes with diisopropyl-IDA Tc 99m (p greater than 0.05). Quantification of the relative hepatocyte extraction efficiency indicated a 16% higher extraction efficiency for diisopropyl-IDA Tc 99m (p greater than 0.05). Cumulative three-hour urine collections following injection demonstrated no significant difference in renal excretion in patients with normal total serum bilirubin levels. Both radiopharmaceuticals demonstrated increasing renal excretion with increasing total serum bilirubin levels; however, renal excretion of diisopropyl-IDA Tc 99m increased more slowly than excretion of diethyl-IDA Tc 99m (p less than 0.01). We conclude that, while the overall differences between these two radiopharmaceuticals are small, diisopropyl-IDA Tc 99m is superior because of a lower renal excretion rate in patients with decreased hepatocyte function.

Topics: Bile Duct Diseases; Bile Ducts; Cholangiography; Evaluation Studies as Topic; Humans; Imino Acids; Liver; Liver Diseases; Radionuclide Imaging; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid; Technetium Tc 99m Disofenin