technetium-tc-99m-disofenin and Cholangitis

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

Sixteen patients with documented AIDS cholangitis who underwent Tc-99m DISIDA hepatobiliary scintigraphy were retrospectively reviewed to assess the spectrum of changes observed in this disease. AIDS cholangitis was documented by either ERCP with aspiration/biopsy or the presence of typical sonographic/CT abnormalities with positive stool culture and a minimum of 6 months follow-up. Images were graded as regards parenchymal function (blood pool clearance, peak parenchymal activity, and degree of parenchymal retention), gallbladder visualization, presence of ductal dilatation, and time of intestinal activity. Three patterns were identified: 1) focal ductal dilatation with focal narrowing and focal or diffuse parenchymal retention; 2) ductal dilatation, without narrowing, and diffuse parenchymal retention; and 3) severe diffuse parenchymal retention with or without ductal abnormality. All 16 studies revealed abnormal parenchymal retention. Gallbladder nonvisualization was demonstrated in nine studies and delayed in two. The hepatobiliary scan is a very sensitive technique for evaluating AIDS cholangitis. Although a spectrum of findings may be observed, parenchymal retention with some degree of ductal abnormality is the most commonly observed pattern.

Topics: Adult; AIDS-Related Opportunistic Infections; Biliary Tract; Cholangitis; Cryptosporidiosis; Cytomegalovirus Infections; Female; Humans; Imino Acids; Liver; Male; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Disofenin

Topics: Adult; Cholangitis; Female; Graft Rejection; Hepatitis; Humans; Imino Acids; Liver; Liver Circulation; Liver Transplantation; Male; Organotechnetium Compounds; Radionuclide Imaging; Reference Values; Technetium Tc 99m Aggregated Albumin; 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

The purpose of this study was to determine whether 99mTc-iminodiacetic acid planar biliary scintigraphy combined with single photon emission computed tomography could detect sclerosing cholangitis and provide additional information regarding the extent and severity of disease. Thirteen patients with sclerosing cholangitis and 13 normal control subjects were studied. Scintigraphic results were also compared with previously reported studies of patients with isolated common bile duct obstruction and with primary biliary cirrhosis. The planar scintigraphy in patients with sclerosing cholangitis showed beading or bandlike constrictions of the biliary tract corresponding to lesions seen on cholangiography, and the image pattern was distinctly different from images obtained from patients with isolated common bile duct obstruction or primary biliary cirrhosis. The single photon emission computed tomography images of the liver in patients with sclerosing cholangitis demonstrated multiple focal areas of 99mTc-iminodiacetic acid retention, representing bile stasis in intrahepatic bile ducts. Compared to controls, the mean hepatic clearance half-time of 99mTc-iminodiacetic acid was markedly delayed in patients with sclerosing cholangitis (6-10 times normal). Individual patients with sclerosing cholangitis had wider variation in isotope clearance half-time from three regions of the liver than patients with isolated common bile duct obstruction, consistent with regional difference in disease severity and variable impairment of bile flow. In 4 patients with sclerosing cholangitis with incomplete filling of the right and left hepatic ducts at cholangiography, planar and single photon emission computed tomographic scintigraphy provided evidence of significant intrahepatic sclerosing cholangitis. In conclusion, combined 99mTc-iminodiacetic acid planar and single photon emission computed tomographic scintigraphy is a sensitive noninvasive test for the diagnosis of sclerosing cholangitis and reliably differentiates sclerosing cholangitis from isolated common bile duct obstruction or primary biliary cirrhosis. Measurement of isotope clearance half-time provides quantitative physiologic data that may be useful in the longitudinal follow-up of patients with sclerosing cholangitis.

Topics: Adult; Biliary Tract; Cholangitis; Female; Humans; Imino Acids; Liver; Male; Sclerosis; Technetium; Technetium Tc 99m Disofenin; Tomography, Emission-Computed

We retrospectively evaluated the utility of hepatobiliary scintigraphy and various clinical factors in differentiating intrahepatic cholestasis from biliary atresia in 28 consecutive infants with neonatal cholestasis. One millicurie of technetium-labeled diisopropyliminodiacetic acid (DISIDA) was administered intravenously, and images were obtained for up to 24 hours or until gastrointestinal excretion was noted. Nine separate studies in seven infants with biliary atresia were correctly interpreted as showing no gastrointestinal excretion of radionuclide. Of the 21 patients with intrahepatic cholestasis, only nine had gastrointestinal excretion on the first study; in eight without excretion, a second study was done, and five of these showed gut excretion. All infants with either neonatal hepatitis (six) or inspissated bile syndrome (three) had demonstrable gastrointestinal excretion either on the first or second DISIDA study. However, five of six infants with paucity of intrahepatic bile ducts, two of six infants with cholestasis secondary to total parenteral nutrition, and one infant with cholangiolitis did not show evidence of gastrointestinal excretion. The mean birth weight, mean gestational age, and mean weight at study were significantly greater (P less than 0.005) for infants with biliary atresia without excretion than for infants with intrahepatic cholestasis without excretion. The mean direct bilirubin concentration was 6.0 mg/dL for both infants with biliary atresia and infants with intrahepatic cholestasis without excretion; however, infants with excretion had a significantly lower (P less than 0.02) mean direct bilirubin value of 3.4 mg/dL. Excretion was noted in four infants with total bilirubin values greater than 10.0 mg/dL. The absence of gut excretion on the first DISIDA study was 100% sensitive but only 43% specific for biliary atresia. In infants without gut excretion of DISIDA, birth weight greater than 2200 g was 100% sensitive and 92% specific for biliary atresia. We conclude that DISIDA scanning, together with clinical data, is useful in differentiating extrahepatic from intrahepatic cholestasis. The absence of gut excretion on the first DISIDA study does not necessarily indicate extrahepatic obstruction; the study should be repeated if the diagnosis is not clear.

Topics: Bile Ducts, Intrahepatic; Biliary Atresia; Biliary Tract; Bilirubin; Cholangitis; Cholestasis, Intrahepatic; Diagnosis, Differential; Hepatitis; Humans; Imino Acids; Infant, Newborn; Jaundice, Neonatal; Liver; Methods; Organometallic Compounds; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Disofenin; Time Factors

Four patients with primary sclerosing cholangitis (PSC) were examined with the hepatobiliary agent Tc-99m-labeled DISIDA (diisopropylphenylcarbamoyl iminodiacetic acid), and the results correlated with those of invasive cholangiography. Three of the four patients exhibited a typical pattern of multiple, persistent focal "hot spots" in the duct system, representing stasis within the segmental ductal dilatations (beading), also seen on cholangiography. Cholescintigraphy is superior to cholangiography in cases of suspected PSC where there is nonfilling of biliary radicals due to high-grade stenosis. The finding of delayed hepatic parenchymal clearance can allow estimation of the degree of obstruction of the various branches of the major bile ducts. Cholescintigraphy offers a noninvasive method of investigating patients with suspected sclerosing cholangitis, leading to earlier diagnosis. Confirmation with invasive cholangiographic procedures is recommended.

Topics: Adolescent; Adult; Biliary Tract; Cholangiography; Cholangitis; Female; Humans; Imino Acids; Liver; Male; Middle Aged; Radionuclide Imaging; Sclerosis; Technetium; Technetium Tc 99m Disofenin