technetium-tc-99m-disofenin and Biliary-Tract-Diseases

The 99mTc iminodiacetic acid analogues are a group of radiopharmaceuticals which are rapidly metabolized by the hepatocytes and excreted into the biliary tract. In essence, they function as bile markers and are therefore used to trace bile flow pathways by external imaging. There are various facets of liver and biliary tract disorders which can now be investigated with these new agents at a greater confidence level than heretofore possible with the older test agent, 131I-rose bengal. These include determination of cystic duct patency, assessment of the integrity of surgically altered biliary and gastrointestinal anatomy, disclosure of biliary gastric reflux, and distinction between medical and surgical jaundice.

Topics: Biliary Dyskinesia; Biliary Tract; Biliary Tract Diseases; Biliary Tract Surgical Procedures; Cholecystitis; Diagnosis, Differential; Digestive System; Digestive System Surgical Procedures; Humans; Imino Acids; Jaundice; Liver; Liver Diseases; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid; Technetium Tc 99m Disofenin; Technetium Tc 99m Lidofenin

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: Abscess; Aged; Biliary Tract Diseases; Female; Gallium Radioisotopes; Humans; Liver Abscess; Postoperative Complications; Radiopharmaceuticals; Staphylococcal Infections; Technetium Tc 99m Disofenin; Tomography, Emission-Computed, Single-Photon

Topics: Adult; Aniline Compounds; Biliary Tract; Biliary Tract Diseases; Child; Glycine; Humans; Imino Acids; Liver; Liver Diseases; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Disofenin

Hepatobiliary scintigraphy using iminodiacetic (IDA) radiopharmaceuticals provides clinically useful information on the function of the biliary tract in a variety of pathological processes in children, including neonatal jaundice, gallbladder dysfunction, trauma, and liver transplantation. Phenobarbital premedication (5 mg/kg per day for a minimum of 5 days in divided doses) is used in infants who are being examined for neonatal jaundice to increase the accuracy of 99mTc-IDA scintigraphy in differentiating extrahepatic biliary atresia from neonatal hepatitis. Biliary atresia can be ruled out in an infant if a patent biliary tree is shown with passage of activity into the bowel. If no radiopharmaceutical is noted in the bowel on imaging up to 24 hours, distinction between severe hepatocellular disease and biliary atresia cannot be made. The literature reports 91% accuracy, 97% sensitivity, and 82% specificity for hepatobiliary imaging in the diagnosis of biliary atresia. The impairment of both intrahepatic and extrahepatic biliary drainage is an important cause of liver disease in cystic fibrosis. Hepatobiliary scintigraphy in cystic fibrosis has shown characteristic patterns of dilatation of mainly the left hepatic duct, narrowing of the distal common bile duct, gallbladder dysfunction, and delayed bowel transit. Cholecystitis in children may be acalculous. Sensitivity and specificity for the scintigraphic diagnosis of acute acalculous cholecystitis is reported to range from 68% to 93% and 38% to 93%, respectively. Cholescintigraphy in a suspected bile leak provides information generally not available with other techniques, except for direct cholangiography. If the amount of intraperitoneal accumulation of the tracer is greater than that entering the gastrointestinal tract, surgery is usually indicated. Hepatobiliary imaging in children who have undergone liver transplantation will assess graft vascularity, parenchymal function, biliary drainage, presence of a leak, and obstruction.

Topics: Adolescent; Biliary Tract; Biliary Tract Diseases; Child; Female; Humans; Imino Acids; Infant; Liver; Liver Diseases; Male; Organotechnetium Compounds; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Disofenin

The vast majority of biliary tract disease is correlated with calculi, and the diagnosis of biliary disease is made simpler when calculi are detected. There are good screening studies for the detection of calculi; however, a reproducible objective test for biliary tract disease in the absence of gallstones has been lacking. Occult biliary tract disease should be considered when symptoms typical of biliary tract disease are present, gallstones cannot be demonstrated, and other diseases have been ruled out. This is characteristically a diagnosis of exclusion, with only the subjective criteria of pain relief to validate surgical intervention. Recently, we have used a nuclear medicine test that simulates the gallbladder response to normal postprandial physiologic stress, to study in an objective fashion the gallbladder function of a group of patients who have symptoms typical of biliary tract disease, but no demonstrable calculi. We have found that the CCK DISIDA study has correlated well with occult pathology. The experience at Easton Hospital has confirmed that the CCK augmented DISIDA scan with calculation of ejection fraction is a reasonably accurate study, with a sensitivity of 88% in detecting previously suspected but undemonstrable pathology in this selected population. This corresponds closely to the observed finding that the pathology reports of 77% of the resected gallbladders noted some abnormality. Of further interest is the long term symptomatic relief achieved in 85% of the patients available for follow up interviews, including a symptomatic benefit in eight of the 11 patients with a normal pathology report.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Biliary Tract Diseases; Cholecystectomy; Cholecystokinin; Female; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

Cholescintigraphy using technetium-99m disofenin tracer is accepted as a routine component of preoperative evaluation of the biliary tract in selected patients but is not used regularly in postoperative management. This is a retrospective analysis of the utility of the nuclide scan in 27 patients after laparoscopic cholecystectomy (LC). Most patients had vague postoperative symptoms such as nausea, pain, and low grade fever. Two patients developed jaundice. Seven of the 27 patients had biliary leaks, and two had common bile duct obstructions. We conclude that cholescintigraphy is a sensitive noninvasive test for the evaluation of biliary complications after LC and is a pivotal component of an algorithmic approach to postoperative complications. Because of the subtle clinical findings and the potential for delayed diagnosis of biliary complications after LC, early performance of this test will minimize patient morbidity.

Topics: Adult; Aged; Aged, 80 and over; Biliary Tract; Biliary Tract Diseases; Cholecystectomy, Laparoscopic; Female; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Disofenin; Time Factors

One hundred and four adult patients with cystic fibrosis were evaluated for the presence of liver disease as defined by abnormal liver function tests of six months' duration, histological evidence of fibrosis or cirrhosis, or the presence of portal hypertension, or both. Twenty patients fulfilled these criteria and were evaluated further for the presence of biliary tract abnormalities with biliary scintigraphy using 99Tc diisopropylphenyl-carboxymethyl iminodiacetic acid (DISIDA) and endoscopic retrograde cholangiography. Clearance of 99Tc DISIDA from the liver and biliary tree was diminished at 45 (E45) and 60 (E60) minutes in the patients with liver disease compared with those without liver disease; E45 = 37.8% and 65.8%, p less than 0.01; E60 = 48.2% and 77.5%, p less than 0.01 respectively. Serial analogue images of the extrahepatic biliary tree were consistent with common bile duct obstruction with retention of DISIDA and tapering of the common bile duct in seven of 18 patients with and two of 10 patients without liver disease. Endoscopic retrograde cholangiography showed changes consistent with sclerosing cholangitis, with beading and stricturing of the intrahepatic ducts in 12 of the 14 patients. In all 14 patients, including those in whom biliary scintigraphy had suggested obstruction, no abnormality of the common bile duct was identified. These results indicate that abnormalities of the bile ducts in patients with cystic fibrosis related liver disease are confined to the intrahepatic biliary tree and that common bile duct strictures do not contribute to either the progression or development of liver disease in these patients.

Topics: Adolescent; Adult; Biliary Tract Diseases; Child; Cholangiopancreatography, Endoscopic Retrograde; Cystic Fibrosis; Female; Humans; Hypertension, Portal; Imino Acids; Liver Cirrhosis; Liver Diseases; Male; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

Twelve patients with biliary colic had no evidence of gallstones but underwent cholecystokinin-augmented hepatobiliary scintigraphy that revealed gallbladder ejection fractions of less than 35%. All 12 patients underwent cholecystectomy. Biliary colic was relieved in all patients at a mean postoperative follow-up of 2.5 years. The biliary colic in these patients was probably caused by abnormal gallbladder emptying, itself apparently produced by either cystic duct obstruction or abnormal motility. Biliary abnormality was seen at operation in most patients, and all patients had abnormalities of the gallbladder or cystic duct seen grossly or histologically. These abnormalities included cystic duct stenosis or adhesions, chronic inflammation, and cholesterolosis.

Topics: Adult; Aged; Aniline Compounds; Biliary Tract Diseases; Cholecystectomy; Colic; Female; Follow-Up Studies; Gallbladder; Glycine; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sincalide; Technetium Tc 99m Disofenin

Spontaneous perforation of the extrahepatic biliary tree during infancy is an uncommon event. The cause of bile duct perforation is unclear, but one-quarter of reported cases have been associated with a stone or bile sludge obstructing the distal common bile duct. A 4-week-old girl had jaundice, and a DISIDA (99m technetium diisopropyl iminodiacetic acid) scan revealed perforation of the biliary tree. Exploratory surgery showed distal common bile duct obstruction with proximal perforation. No attempt was made to remove the obstructing lesion because of duct inflammation. Common bile duct obstruction persisted until week 5 after surgery when cholangiography revealed free flow of contrast into the duodenum through a common bile duct of normal caliber without a filling defect. In the presence of acute inflammation associated with perforation of the biliary tree, exploration of the common bile duct to relieve a distal obstruction could prove hazardous. Our case and a review of the literature suggest that the obstructing stone or sludge may pass spontaneously if managed expectantly.

Topics: Biliary Tract Diseases; Cholangiography; Cholestasis; Female; Hepatic Duct, Common; Humans; Imino Acids; Infant, Newborn; Organotechnetium Compounds; Technetium Tc 99m Disofenin

Tc-99m DISIDA is widely used for studying a variety of biliary conditions. It is generally recognized that the spleen is normally visualized on DISIDA imaging only during the blood pool phase. Upon review of our experience with DISIDA, visualization of the spleen was found more common than generally acknowledged. All DISIDA examinations performed at our two institutions were retrospectively reviewed; 95 studies were performed at Institution #1 and 150 studies at Institution #2. There were 138 men and 107 women. Quality control to confirm radiochemical purity included sephadex gel column chromatography. Of 245 patient studies, persistent splenic visualization was identified in one patient (1.0%) at Institution #1 and in 11 patients (7.3%) at Institution #2. There was no correlation between age, sex or final diagnosis and persistent visualization of the spleen. It is suggested that persistent splenic visualization may be caused by an elevated concentration of reduced hydrolized technetium (colloid) in DISIDA.

Topics: Biliary Tract Diseases; Female; Humans; Imino Acids; Male; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Spleen; Technetium Tc 99m Disofenin

These are the first human experiments with 97Ru-DISIDA, a potentially new alternative to 131I-rose bengal where delayed imaging is indicated. 97Ru has a convenient half life. A DISIDA labeling kit was utilized to prepare the radiotracer for 17 patients (age 6 weeks-84 years). The cholescintigraphic data correlated well with other imaging procedures and with clinical findings. Dosimetric calculations were carried out and were compared with the radiation burden associated with the use of 99mTc-DISIDA and 131I-rose bengal.

Topics: Biliary Tract Diseases; Cholecystitis; Humans; Imino Acids; Liver Diseases; Organometallic Compounds; Radiation Dosage; Radionuclide Imaging; Reagent Kits, Diagnostic; Ruthenium Radioisotopes; Technetium Tc 99m Disofenin

The amount of enterogastric biliary reflux was assessed in patients who previously underwent Henley operation (n = 8) or Roux-en-Y biliary diversion (n = 7) using the radiopharmaceutical 99mTechnetium-DISIDA. Two other groups were investigated: a control group consisting of patients with unoperated duodenal ulcer (n = 10) and a group of patients who underwent Billroth II gastrectomy (n = 7). The length of the interposed segment of jejunum ranged from 20 to 30 cm (median of 22.5 cm) in the Henley patients, and from 30 to 60 cm (median of 40 cm) in the Roux-en-Y group. In Henley patients, the percentage of administered 99mTechnetium-DISIDA that was recovered from the stomach (median of 0.92%) was lower (p less than 0.01) than that obtained for Billroth II patients (median of 32.28%) and did not differ (p greater than 0.10) from that of the Roux-en-Y (median of 0.36%) and duodenal ulcer groups (median of 2.53%). These results indicate that Henley operation is as effective as Roux-en-Y diversion in promoting the reduction of the amount of enterogastric biliary reflux that follows Billroth II distal gastrectomy.

Topics: Adult; Aged; Anastomosis, Roux-en-Y; Bile Reflux; Biliary Tract Diseases; Duodenal Ulcer; Duodenum; Evaluation Studies as Topic; Female; Gastrectomy; Gastrointestinal Contents; Humans; Imino Acids; Jejunum; Male; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin; Time Factors

Controversy exists over the relation between gallbladder dysfunction and the propensity for duodenogastric reflux. To evaluate this, Tc-99m DISIDA hepatobiliary imaging studies in 120 patients were reviewed, excluding patients who had had cholecystectomy or subtotal gastrectomy before scintigraphy. Serial images were obtained at 5, 10, 15, 30, 45, and 60 minutes and up to 24 hours, if indicated, after intravenous injection of 5-10 mCi of Tc-99m DISIDA. Normally, the liver, bile ducts, gallbladder, common bile duct, and bowel are visualized sequentially. Reversal of the normal sequence of gallbladder (GB) and bowel visualization indicates GB dysfunction; nonvisualization of the GB reflects cystic duct obstruction or absent GB function. Duodenogastric reflux is identified by radiotracer localized in the area just below or immediately adjacent to the tip of the left hepatic lobe. The intragastric location of the tracer may be verified by oral administration of 300 uCi of Tc-99m sulfur colloid. Twenty-nine patients had duodenogastric reflux between 10 and 60 minutes after injection. Of the 29 patients, 22 had a nonvisualized gallbladder, four had reversal of appearance of GB and bowel activity, and three had a normal study. GB dysfunction or nonfunction is more frequently demonstrated when duodenogastric reflux is present than with normal gallbladder function (P less than 0.001). In conclusion, gallbladder malfunction is closely associated with duodenogastric reflux, an abnormality that may be diagnosed noninvasively by Tc-99m DISIDA hepatobiliary scintigraphy.

Topics: Adult; Aged; Aged, 80 and over; Bile Reflux; Biliary Tract Diseases; Gallbladder Diseases; Humans; Imino Acids; Male; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid

We evaluated the significance of bile seen in the stomach at the time of endoscopy. Twenty-three percent of 110 consecutive patients undergoing elective panendoscopy were found to have bile in their stomachs. Gastric biopsies were obtained from these patients. To assess the significance of bile reflux, the patients underwent a quantitative gastric bile analysis on two separate days. On day 1, gastric juice was aspirated by nasogastric suction, and bile acid concentrations were measured. On day 2, bile reflux into the stomach was quantitated by scintiscan measurement of gastric nucleotide after intravenous administration of 99mTc-DISIDA. Approximately half the patients with bile reflux showed histologic evidence of mucosal injury. However, fewer than half with histologic injury had significant bile reflux when measured by quantitative methods. There was no correlation among the gastric bile acid concentration, degree of histologic injury, or severity of endoscopic changes. We conclude that finding bile reflux at endoscopy is probably of no clinical significance.

Topics: Bile Reflux; Biliary Tract Diseases; Gastric Mucosa; Gastroscopy; Humans; Imino Acids; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

This report is of a 2-month-old child with spontaneous perforation of the common bile duct diagnosed by 99m-Tc disofenin nuclear hepatobiliary imaging. Of the agents available, the radiopharmaceutical properties of this compound allow the most accurate, safe, high-resolution imaging of the hepatobiliary tree in the diagnostic evaluation of jaundiced infants.

Topics: Bile Ducts; Biliary Tract Diseases; Female; Humans; Imino Acids; Infant; Radionuclide Imaging; Rupture, Spontaneous; Technetium; Technetium Tc 99m Disofenin

During hepatobiliary imaging studies, approximately 9% of Tc-99m DISIDA normally is excreted via the kidney. In routine 2, 5, 10, 15, 30, 45, and 60-minute images, the kidneys and urinary bladder are best visualized at 5-10 minutes and after 10-15 minutes, respectively. Nonvisualization of the kidney and/or urinary bladder may indicate renal dysfunction. To evaluate this hypothesis, Tc-99m DISIDA hepatobiliary images of 63 patients were correlated with concurrent serum BUN and creatinine levels (measured within 24 hours of the hepatobiliary study). Serum creatinine and BUN values were normal in patients with renal visualization. In patients without renal visualization, 17 of 19 had abnormal BUN and creatinine levels. The values of BUN and creatinine were significantly elevated (P less than 0.001) in patients without renal visualization when compared with those showing renal visualization. One patient had visualization of a single kidney due to a nephrectomy; in another, persistent visualization was due to hydronephrosis. Nonvisualization of the kidneys and/or urinary bladder suggests abnormal renal function, and asymmetric renal activity raises the possibility of renal disease.

Topics: Adult; Aged; Aged, 80 and over; Biliary Tract Diseases; Humans; Imino Acids; Kidney; Liver Diseases; Male; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Biliary and pancreatic juice has been implicated as a cause of regional inflammation or carcinoma after gastric surgery. We studied 38 patients after gastrectomy using a modification of cholescintigraphy (185 mBq 99m-Tc-DESIDA i.v.). As soon as the tracer had reached the duodenum, a dynamic study (30 min, 120 frames) was started. Thereafter a static image of the epigastrium and thorax in the anterior view with more than 1000 cts/cm2 was recorded. This procedure was repeated after a meal. Of 29 patients without complaints only 4 had a reflux into the jejunal loop. By contrast in 7 of 9 patients with suggestive symptoms this examination demonstrated bile reflux which reached the oesophagus in 6 cases. A stenosis of the distal oesophagus prevented oesophageal reflux in one patient. 2 patients with oesophageal reflux had a history of oesophageal stenosis and oesophagitis confirmed by endoscopy. The remaining 2 patients without demonstrable reflux had neither oesophagitis nor radiologically verified reflux. Cholescintigraphy as modified by us may detect clinical relevant bile reflux into the oesophagus. This is important for surgeons selecting patients with potential benefit from a reoperation. Since most patients with complaints after gastrectomy have had demonstrable bile reflux, reflux-reducing surgical techniques should be used in all.

Topics: Bile Reflux; Biliary Tract; Biliary Tract Diseases; Esophagitis, Peptic; Esophagus; Gastrectomy; Gastroesophageal Reflux; Humans; Imino Acids; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid; Technetium Tc 99m Disofenin; Time Factors

Biloma resulting as a complication of cholcecystectomy is rarely reported. Infection and rupture of biloma into the peritoneal cavity is a reported complication that may need aggressive surgical management. A case of infected biloma is presented in which an active biliary leak was demonstrated on a hepatobiliary scan with Tc-99m DISIDA.

Topics: Bile; Biliary Tract Diseases; Cholecystectomy; Cholecystitis; Cholelithiasis; Drainage; Female; Humans; Imino Acids; Middle Aged; Peritoneal Cavity; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Duodenogastroesophageal reflux is demonstrated using cholescintigraphy in a patient with severe esophagitis.

Topics: Bile Reflux; Biliary Tract Diseases; Esophagitis; Female; Gastroesophageal Reflux; Humans; Imino Acids; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Topics: Bile Reflux; Biliary Tract Diseases; Gastrectomy; Humans; Imino Acids; Male; Middle Aged; Peptic Ulcer; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Six healthy individuals and six patients with a wide range of hepatobiliary function abnormalities were studied with Tc-99m-trimethylbromo-IDA; all normal subjects and four of the six patients were also studied with Tc-99m-diisopropyl-IDA. Visual evaluation of analog images demonstrated a greater liver-to-kidney ratio for Tc-99m-trimethylbromo-IDA (p less than 0.01). Sampling for radiopharmaceutical in urine at three hours following injection demonstrated that Tc-99m-trimethylbromo-IDA had a lower renal excretion rate than Tc-99m-diisopropyl-IDA regardless of whether hepatocyte function was normal or abnormal (p less than 0.01). There were no significant differences between the two radiopharmaceuticals in hepatocyte extraction efficiency or hepatic parenchymal transit time. It is concluded that the lower rate of renal excretion and, therefore, greater hepatocyte specificity of Tc-99m-trimethylbromo-IDA justifies expanded clinical trials and may make it the radiopharmaceutical of choice for hepatobiliary imaging.

Topics: Adult; Aniline Compounds; Biliary Tract; Biliary Tract Diseases; Drug Evaluation; Glycine; Humans; Imino Acids; Liver; Liver Diseases; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Topics: Biliary Tract; Biliary Tract Diseases; Cholecystectomy; Cholecystitis; Cholestasis, Extrahepatic; Cystic Duct; Gallstones; Humans; Imino Acids; Liver; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Topics: Bile Ducts; Biliary Tract Diseases; Cholestasis, Extrahepatic; Cholestasis, Intrahepatic; Humans; Imino Acids; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Tc-99m-diisopropyl-IDA (DISIDA) and Tc-99m-diethyl-IDA (DE-IDA) were compared in each of 44 patients who had serum bilirubin levels ranging from normal to 50 mg/dl. Quantitative and qualitative analysis showed a significantly higher liver uptake relative to background for DISIDA. No significant differences between DISIDA and DE-IDA were found in the blood retention and rate of liver washout. Clinically, the diagnostic information received from both radiopharmaceuticals was essentially the same.

Topics: Adult; Aged; Biliary Tract Diseases; Female; Heart; Humans; Hyperbilirubinemia; Imino Acids; Kinetics; Liver; Liver Diseases; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid; Technetium Tc 99m Disofenin