technetium-tc-99m-disofenin and Cholestasis

We review the discrepancies and the reasons for them, in two articles in this issue of the Journal to conclude that clinical findings hold the key to selection of the proper imaging test in biliary obstruction. Cholescintigraphy is a more rewarding approach in detecting low grade obstruction, as by common duct stones, whereas in the patient with prolonged painless jaundice, and the high likelihood of a malignancy, computed tomography or ultrasound will yield the best results. Because of the potential for noninvasive imaging to miss choledocholithiasis and because of ever increasing therapeutic options, direct cholangiography will continue to be the mainstay in definition evaluation of the biliary tract.

Topics: Cholestasis; Diagnosis, Differential; Dilatation, Pathologic; Evaluation Studies as Topic; Humans; Imino Acids; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Diethyl-iminodiacetic Acid; Technetium Tc 99m Disofenin; Ultrasonography

Topics: Cholangiography; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis; Cholestasis, Extrahepatic; Humans; Imino Acids; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid; Ultrasonography

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

To evaluate the efficacy of ultrasonographically (US)-guided percutaneous cholecystocholangiography (PCC) for early diagnosis and characterization of biliary atresia in infants with cholestatic liver disease.. Institutional review board approval was obtained for this study. Parental informed written consent was obtained. From October 2003 to August 2010, 22 infants (12 male, 10 female; age range, 1-138 days) were referred to the radiology department for PCC. Indications for PCC were suspected biliary atresia at 24-hour delayed technetium 99m-diisopropyl-phenylcarbamoylmethyl-iminodiacetic acid (DISIDA) scintigraphy because no excretion was observed in the small bowel (n = 17) or when the results of the scan or liver biopsy could not be obtained within 3 days because of a delay in schedule (n = 5). A diagnosis of biliary atresia was excluded when there was contrast material visualized in the gallbladder, biliary system, and passage to the duodenum. Patients with biliary atresia underwent surgery as the reference standard.. Among the 18 patients who underwent successful PCC, biliary atresia was excluded in 13, with diagnoses as follows: total parenteral nutrition-associated cholestasis (TPNAC) (n = 6), neonatal hepatitis (n = 4), congenital syphilis (n = 1), neonatal lupus (n = 1), and congenital cytomegalovirus hepatitis (n = 1). Biliary atresia was diagnosed in five patients (four with type IIIb and one with type IIIa) and was confirmed at surgery. In four infants in whom US-guided gallbladder puncture had failed, biliary atresia (n = 2) and TPNAC (n = 2) were diagnosed.. PCC is a safe and useful technique for early exclusion when biliary atresia cannot be ruled out after traditional screening tests; in addition, it may be useful for preoperative type determination of biliary atresia. © RSNA, 2011.

Topics: Biliary Atresia; Cholangiography; Cholecystography; Cholestasis; Contrast Media; Early Diagnosis; Female; Humans; Infant; Infant, Newborn; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Disofenin; Treatment Outcome; Triiodobenzoic Acids; Ultrasonography, Interventional

HBS is used in the management of liver transplantation, a significant complication of which is biliary stricture. Strictures may be intraparenchymal within segments and main duct (non-anastomotic) or at the biliary-enteric anastomosis (anastomotic). Strictures are definitively diagnosed, and often managed, by PTC. This is invasive, technically challenging, and requires general anesthesia in young children. HBS may allow early detection of these complications and is non-invasive. The aim of this study was to review the scintigraphic pattern of biliary strictures using (99m)TcDISIDA HBS following pediatric orthotopic liver transplantation, and to assess its role in the diagnostic algorithm of suspected biliary strictures. All available hepatobiliary studies performed post-transplant in 101 episodes of liver transplantation in 92 pediatric patients were reviewed. Twenty-three (23%) patients had known biliary strictures. Twenty-two patients had adequate studies available for review; five had intrahepatic (non-anastomotic) strictures alone, nine had a stricture of the anastomosis alone, and eight had both intrahepatic and anastomotic strictures. HBS patterns (either segmental or global changes) correlated very highly with clinically significant biliary strictures. All patients with known strictures had abnormal HBS; hence, in patients with abnormal liver function tests post-liver transplant, a normal HBS makes strictures very unlikely. We propose that HBS can thus be used to determine if further investigation is required.

Topics: Child; Cholestasis; Dilatation, Pathologic; Female; Gamma Cameras; Humans; Liver Transplantation; Male; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Disofenin

We investigated the usefulness of hepatobiliary scintigraphy (HBS) for diagnosing biliary obstruction after curative hepatic resection with biliary-enteric anastomosis. The study population consisted of 54 patients who underwent surgery for benign (n=18) or malignant (n=36) biliary disease. We analysed 68 technetium-99m DISIDA scintigrams which were performed at least 1 month after the surgery (median: 9 months). Final diagnosis was made by operative exploration, other invasive radiological studies or clinical and radiological follow-up for at least 6 months after the surgery. Diagnostic accuracy was analysed according to the pretest likelihood of biliary obstruction. There were two total and 15 segmental biliary obstructions. In patients with symptoms of biliary obstruction and abnormal liver function, HBS always allowed correct diagnosis (two instances of total obstruction, seven of segmental obstruction and seven of non-obstruction). Among the patients with nonspecific symptoms or isolated elevation of serum alkaline phosphatase, HBS diagnosed segmental biliary obstruction in seven of the eight instances, and non-obstruction in 22 of 23 instances. There were no cases of biliary obstruction and no false-positive results of HBS in 21 instances with no clinical signs or symptoms of biliary obstruction. The diagnostic sensitivity and specificity of HBS for biliary obstruction were 94% (16/17) and 97% (50/51), respectively. In conclusion, HBS is a highly accurate modality for the diagnosis of segmental biliary obstruction during long-term follow-up after hepatic resection with biliary-enteric anastomosis.

Topics: Biliary Tract Surgical Procedures; Cholestasis; Female; Follow-Up Studies; Humans; Liver; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Disofenin; Time Factors

To correlate a triangular area of high signal intensity in the porta hepatis on T2-weighted magnetic resonance (MR) cholangiograms of biliary atresia with ultrasonographic (US) and histopathologic findings in a portal mass observed during a Kasai procedure.. Twenty-one consecutive neonates and infants (age range, 13-88 days; mean age, 59 days) with cholestasis underwent US and single-shot MR cholangiography. In 12 patients with biliary atresia diagnosed at histopathologic examination, MR cholangiographic findings in the porta hepatis were correlated with US and histopathologic findings in the portal mass.. At US, eight of the 12 patients had round, linear, or tubular hypoechoic portions within a triangular cord; MR cholangiography revealed a triangular area of high signal intensity confined to the porta hepatis. Histopathologic examination of the portal mass revealed a cystic or cleftlike lesion surrounded by loose myxoid mesenchyme and platelike fetal bile ducts. Neither the large cystic lesion without ductal epithelium nor the small cleftlike lesion with scanty epithelium demonstrated bile staining. Similar areas of high signal intensity were not seen on T2-weighted images in the remaining patients (four with biliary atresia and nine with neonatal hepatitis).. In biliary atresia, T2-weighted single-shot MR cholangiography can show a triangular area of high signal intensity in the porta hepatis that may represent cystic dilatation of the fetal bile duct.

Topics: Bile; Bile Ducts, Intrahepatic; Biliary Atresia; Cholangiography; Choledochal Cyst; Cholestasis; Dilatation, Pathologic; Epithelium; Female; Hepatitis; Humans; Infant; Infant, Newborn; Liver; Magnetic Resonance Imaging; Male; Mesoderm; Predictive Value of Tests; Radiopharmaceuticals; Sensitivity and Specificity; Statistics as Topic; Technetium Tc 99m Disofenin; Ultrasonography, Doppler

Topics: Cholestasis; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Disofenin

To determine whether the scintigraphic evaluation of technetium-99m diisopropyl iminodiacetic acid (DISIDA) uptake and excretion can distinguish among liver transplant patients with biopsy evidence for rejection, cholestasis or neither condition, we reviewed scintigrams and biopsies in 36 patients. There were 76 scintigrams with corresponding biopsies. Uptake and excretion were graded from image data on scales reflecting normal through severely abnormal values. Biopsies were evaluated for findings of cholestasis and rejection. The majority of scintigrams demonstrated normal uptake (60/75, 80%) and delayed excretion (65/76, 85%), which was most marked immediately after transplantation. One-way analysis of variance showed that the mean excretion values significantly differed between patients with normal biopsies and those with cholestasis and/or rejection (P = 0.0003). However, mean uptake scores demonstrated no statistically significant difference between these two groups of patients (P = 0.1). These findings suggest that 99mTc-DISIDA scintigraphy can differentiate between transplants with and without rejection/cholestasis but not between rejection and cholestasis. If 99mTc-DISIDA excretion is normal, rejection and cholestasis are unlikely.

Topics: Cholestasis; Female; Graft Rejection; Humans; Imino Acids; Liver; Liver Transplantation; Male; Organotechnetium Compounds; Radionuclide Imaging; 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

Topics: Acute Disease; Adult; Cholecystitis; Cholestasis; Humans; Imino Acids; Male; Organotechnetium Compounds; Radionuclide Imaging; Syndrome; Technetium Tc 99m Disofenin

Extracorporeal shock wave lithotripsy (ESWL) has been reported to be a safe and relatively effective non-invasive treatment for radiolucent gallbladder calculi in selected patients. Ideally, the goal of successful treatment is the passage of all fragments from the gallbladder into the intestinal tract. Biliary colic has been reported in up to 35% of treated patients, although complications such as cholecystitis, cholangitis, common bile duct obstruction, and pancreatitis are surprisingly infrequent. Cholescintigraphy is the procedure of choice in patients with biliary colic and suspected acute cholecystitis. It has proven to be more sensitive than ultrasound in detecting acute common bile duct (CBD) obstruction, since functional obstruction precedes morphologic dilatation of the CBD. This report reviews two cases of post-lithotripsy cystic and common duct obstruction and discusses the role of Tc-DISIDA scintigraphy following gallstone ESWL.

Topics: Adult; Cholelithiasis; Cholestasis; Cholestasis, Extrahepatic; Common Bile Duct Diseases; Cystic Duct; Female; Humans; Imino Acids; Lithotripsy; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

Topics: Cholestasis; Female; Hemobilia; Humans; Imino Acids; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

The whole blood pharmacokinetics of intravenously administered 99mTc-disofenin (DISIDA) have been studied in dogs. Serial blood sampling permitted calculation of whole blood disposition rates, which principally represent liver clearance. There were striking differences in these rates between 6 normals and 7 animals in whom liver damage was induced by chronic bile duct ligation (256 vs 58 ml/min, P less than 0.001). Blood levels of radioactivity fell in a biexponential fashion characterized by rapid and slow disposition phases, whose half times were 2.4 and 58 min in normal animals. On 3 occasions, plasma was obtained from 1 animal by exsanguination 35 min after the administration of DISIDA and rapidly transfused into a 2nd animal. The whole blood pharmacokinetics of the second (recipient) animal showed a predominance of the slow disposition phase and a small rapid phase. The hepatic extraction ratio of blood radioactivity was measured in 3 dogs and was high (75%-90%) early after injection of DISIDA, but fell rapidly to remain around 10%. These experiments suggest the presence of two different species in the radiopharmaceutical studied, each being removed from the blood stream by the liver, but at different rates. The contribution of renal clearance to overall whole blood pharmacokinetics was negligible, since three nephrectomized dogs displayed similar pharmacokinetics to normals. Whole blood DISIDA pharmacokinetics are more complex than previously thought but appear to be capable of providing an accurate measure of liver function.

Topics: Animals; Cholestasis; Dogs; Imino Acids; Kidney; Organometallic Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

This report details an 11-year experience with 17 patients ranging from newborn to 17 years with choledochal cyst. Two distinct groups were noted: an infantile group (mean age: 3 months) with obstructive jaundice identical to biliary atresia and a late onset group (mean age: 9 years) with various combinations of pain, mass, and jaundice. Two patients had cystoduodenostomy performed and both required revision. One of six patients who had Roux-Y cystojejunostomy required revision. All seven patients who had primary cyst excision and two patients who had secondary cyst excision with Roux-Y hepaticojejunostomy have been followed prospectively and have done well. The follow-up period ranges from 1-11 years with an average of 5.8 years. Cyst excision should be performed as a primary or secondary procedure whenever feasible. The rare patients with intrahepatic ductal dilatation (Caroli's disease) are best approached by hepatic lobectomy when possible, and those with choledochocele should be treated by unroofing the cyst as indicated by the anatomy encountered.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Cholestasis; Common Bile Duct Diseases; Cysts; Female; Follow-Up Studies; Humans; Imino Acids; Infant; Infant, Newborn; Male; Organometallic Compounds; Technetium Tc 99m Disofenin; Ultrasonography

The presence of normal biliary flow was established in a patient with an indwelling hepatic catheter placed to drain an intrahepatic cyst cavity with the use of sequential hepatobiliary scintiscans. In the initial study drainage was demonstrated from the indwelling catheter; when the catheter was clamped, drainage was observed in the native biliary system. Serial biliary scintigraphy not only confirmed the patency of the hepatobiliary system, but served as a guide in the removal of the intrahepatic catheter.

Topics: Catheters, Indwelling; Cholestasis; Cysts; Drainage; Humans; Imino Acids; Liver Diseases; Male; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid

A case of acute acalculous cholecystitis in which sequential hepatobiliary scintigraphy demonstrated apparent transient biliary obstruction is presented. An initial technetium-99m diisopropyliminodiacetic acid ([99mTc]DISIDA) study in a patient suspected of acute cholecystitis showed persistent hepatic activity, nonvisualization of the gallbladder, and minimal intestinal activity seen only at 24 hr. Following a second injection of [99mTc]DISIDA administered shortly after the 24-hr image from the first study, the gallbladder and bowel were both visualized within 75 min. At subsequent surgery, acute and chronic cholecystitis were present without evidence of choledocholithiasis or other source of obstruction. Intrahepatic cholestasis following clearance of biliary obstruction may result in late bowel visualization on delayed cholescintigraphic images similar to that seen in partial obstruction. Accurate reflection of the state of hepatobiliary function may require reinjection with [99mTc]DISIDA.

Topics: Acute Disease; Aged; Cholecystitis; Cholestasis; Humans; Imino Acids; Male; Organometallic Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Time Factors

Serial liver biopsy and close clinical monitoring in 55 consecutive hepatic allografts have disclosed a syndrome of cholestatic jaundice that simulates rejection. This syndrome is associated with distinct histologic findings and resolves spontaneously without modification of immunosuppressive management. The cause of the cholestasis is probably related to subcellular organelle damage produced by cold ischemia, and its importance stems from the confusion it creates with regard to rejection diagnosis. Recognition of this syndrome can result in decreased immunosuppression in hepatic allograft recipients, a secondary decrease in infectious complications, and improvement in the survival rate.

Topics: Bilirubin; Cholestasis; Diagnosis, Differential; Graft Rejection; Humans; Imino Acids; Liver; Liver Transplantation; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Time Factors

Topics: Adult; Aged; Aged, 80 and over; Cholestasis; Evaluation Studies as Topic; Female; Gastrointestinal Motility; Humans; Imino Acids; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Ultrasonography

The new HIDA derivative, 99mTc-diethyl-iodine-HIDA (JODIDA), was compared with 99mTc-diisopropyl-HIDA (DISIDA) in 17 patients with jaundice by means of paired cholescintigraphic imaging studies. The following parameters were visually assessed: the extent of urinary tract visualization, biliary contrast and appearance time, and gallbladder visualization and appearance time. In the 6 patients with a total bilirubin level of between 19 and 66 mumol/l (1.1 and 3.9 mg/dl), both radiopharmaceuticals gave similar results except for the moderate visualization of the urinary tract with DISIDA in contrast to JODIDA. In the remaining 11 patients with a total bilirubin level between 102 and 1303 mumol/l (6 and 76 mg/dl). JODIDA showed significant advantages over DISIDA: nonvisualization of the urinary tract, stronger and faster biliary contrast, and better gallbladder visualization. JODIDA thus offered substantial diagnostic advantages over DISIDA in 8 of these patients. In 4 patients, the differential diagnosis of jaundice (intrahepatic or mechanical disorder) was possible with JODIDA, whereas DISIDA either could not visualize intestinal or gallbladder activity at all or could not differentiate it from the urinary tract. In one patient, JODIDA offered faster (18 h) diagnosis. In the remaining 3 patients, other, substantially false interpretations could be avoided through the use of JODIDA. Further clinical experience with JODIDA in more than 40 patients confirmed the results of this study. We concluded that JODIDA is of significant advantage over DISIDA in clinical situations such as total bilirubin level above 80-100 mumol/l (4.7 to 5.8 mg/dl), examination of small children and critically ill patients and suggestion of bile leakage.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Bile; Cholestasis; Female; Gallbladder; Humans; Imino Acids; Infant; Liver; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Unexplained abdominal pain after cholecystectomy has been attributed to sphincter of Oddi dysfunction, but no objective diagnostic criteria exist. Biliary excretion was quantitated by computer-assisted cholescintigraphy in 35 postcholecystectomy controls without symptoms, 9 patients with suspected sphincter of Oddi dysfunction (studied before and after sphincterotomy), and 18 patients with overt cholestasis from other causes (6 with extrahepatic obstruction and 12 with parenchymal liver disease). In patients with sphincter of Oddi dysfunction or with cholestasis, the time to attain maximal activity in the biliary system was significantly (p less than 0.05) longer, the percent of radiotracer excreted at 45, 60, and 90 min was less, and the emptying rate was slower compared with the controls. Cholecystokinin (0.02 U/kg X min) did not abolish biliary output, excluding a paradoxical response of the sphincter. After sphincterotomy, biliary activity peaked earlier and the percent excreted at 45 min increased but did not revert to normal. Relief of symptoms occurred in 8 of 9 patients. The one failure had normal emptying characteristics before sphincterotomy, and did not change after surgery. Another developed recurrent pain and a corresponding deterioration in biliary emptying on serial scans. Thus, functional obstruction at the sphincter of Oddi exists, is not due to any paradoxical response to cholecystokinin, and in the absence of overt cholestasis, can be detected by quantitative cholescintigraphy. Successful sphincterotomy may not completely restore biliary emptying to normal.

Topics: Adult; Aged; Ampulla of Vater; Cholecystectomy; Cholecystokinin; Cholestasis; Common Bile Duct Diseases; Female; Humans; Imino Acids; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Sphincter of Oddi; Technetium; Technetium Tc 99m Disofenin

Topics: Aged; Cholestasis; Common Bile Duct Neoplasms; Endometriosis; Humans; Imino Acids; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

One hundred consecutive Tc-99m IDA hepatobiliary scans were reviewed revealing 14 scans (14%), that showed nonvisualization of the common bile duct (CBD), gallbladder (GB), and small bowel (SB), but good hepatic uptake of Tc-99m IDA derivative, a pattern designated by us as "the liver scan appearance." In 11 of 14 cases (79%), the diagnosis of complete CBD obstruction was confirmed by surgery, percutaneous transhepatic cholangiogram (PTC), endoscopic retrograde cholangiopancreatography (ERCP), and/or percutaneous needle biopsy (PBx). Common bile duct obstruction was suspected but not proven in the other three cases. The cholescintigraphic, ultrasound, PTC, ERCP, intraoperative cholangiogram, clinical, laboratory, and surgical findings are presented and correlated. The "liver scan-appearance" by cholescintigraphy should suggest a diagnosis of complete common bile duct obstruction; however, it does not specifically differentiate between stone or tumor as the cause of obstruction.

Topics: Cholangiography; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis; Common Bile Duct; Common Bile Duct Diseases; Gallbladder; Humans; Imino Acids; Liver; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Ultrasonography

The detection, localization, and quantitation of the degree of obstruction was successfully accomplished by [99mTc]IDA scintigraphy in 13 of 14 patients with cholangiographically documented common bile duct (CBD) obstruction. Ductal dilatation was present on ultrasound examination in only seven patients. The accuracy of biliary scintigraphy was enhanced by several innovations including: (a) selection of a radiopharmaceutical with rapid hepatic uptake and excretion; (b) shorter imaging interval over longer period of time; (c) substitution of image parameter for appearance time; and (d) quantitative measurement of bile emptying parameters following cholecystokinin infusion. Scintigraphically, the partial obstruction was characterized by CBD segmental narrowing or intraluminal filling defects and bile stasis within the area and segmental ducts. The gallbladder mean (+/- s.d.) ejection fraction of 20.0 +/- 17.5%, ejection period of 6.8 +/- 1.6 min, and ejection rate of 3.1 +/- 2.6% per min following 3-min infusion of 10 ng/kg of cholecystokinin octapeptide were reduced significantly when compared to control subjects. The level of CBD obstruction correlated well with the results of cholangiography. It is concluded that quantitative biliary dynamic scintigraphy employing modern techniques can accurately detect and localize CBD obstruction.

Topics: Adult; Aged; Cholangiography; Cholestasis; Common Bile Duct Diseases; Humans; Imino Acids; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Time Factors; Ultrasonography

A 64-year-old man presented with jaundice. Hepatobiliary imaging using 99mTc-DISIDA revealed complete hepatobiliary tract obstruction with a photopenic area corresponding to a dilated gallbladder and a large photopenic region corresponding to a distended stomach as a result of gastric outlet obstruction. At surgery, carcinoma of the head of the pancreas was found to be the cause of the combined common bile duct and gastric outlet obstruction.

Topics: Cholestasis; Common Bile Duct Diseases; Humans; Imino Acids; Male; Middle Aged; Pancreatic Neoplasms; Radionuclide Imaging; Stomach Diseases; Technetium; Technetium Tc 99m Disofenin

Fourteen patients with a cystic duct syndrome (CDS) underwent cholecystokinin (CCK) cholescintigraphy. All patients presented with persistent postprandial right upper quadrant pain and biliary colic. None of the patients had an abnormal oral cholecystography, gallbladder (GB) ultrasound exam or upper GI series. Each patient (NPO after 12 a.m.) received 5 mCi of technetium-99m disofenin. When the GB maximally filled, 0.02 microgram/kg CCK was administered (3 min) intravenously. Background corrected gallbladder ejection fractions (GBEFs) were determined every 5 min X 4 by rationing the pre-CCK GB counts minus post-CCK GB counts to pre-CCK GB counts. GBEFs were: 12% (3 patients), 17% (2), 0%, 1.3%, 3%, 4%, 6%, 11%, 14%, 18.5%, and 22% (1 each). All patients underwent a surgical exploration and all had macro- or microscopically abnormal cystic ducts (five fibrotic, seven elongated and narrow, two kinked) with (12 patients) or without (2 patients) concomitant chronic cholecystitis. No patient with a partially occluded cystic duct with or without concomitant chronic cholecystitis had an ejection fraction that exceeded 22%. In an appropriate clinical setting, a low EF response to CCK should alert the physician to the presence of either chronic acalculous cholecystitis, CDS, or the combination of both.

Topics: Adolescent; Adult; Aged; Cholecystokinin; Cholestasis; Cystic Duct; Female; Gallbladder; Humans; Imino Acids; Middle Aged; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Disofenin

Topics: Abdomen; Acute Disease; Cholangiography; Cholecystitis; Cholecystography; Cholestasis; Common Bile Duct; Gallbladder; Humans; Imino Acids; Intestine, Small; Pain; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Ultrasonography

Hepatobiliary scans using Tc-IDA are reliable in making the diagnosis of acute cholecystitis. Commonly, opioid drugs are administered in patients with acute cholecystitis to relieve pain. Opioid drugs cause biliary sphincter spasm. Whether these drugs adversely affect hepatobiliary scans is unknown. We studied 13 healthy volunteer subjects, performing three hepatobiliary scans in each one. Scans were performed without opioid drugs and 30 minutes after intramuscularly administered meperidine, morphine, hydroxyzine, hydroxyzine plus meperidine, butorphanol, and nalbuphine. Opioid drugs markedly delayed clearance of Tc-IDA from the common bile duct, simulating common bile duct obstruction. Hydroxyzine alone caused an insignificant delay. We have concluded that opioid drugs cause bile duct obstruction in healthy persons. If opioid drugs are administered before a diagnostic hepatobiliary scan, delayed clearance of Tc-IDA from the common bile duct might lead to an erroneous diagnosis and indicate a potentially unnecessary common bile duct exploration. Opioid drugs should not be administered for several hours before a diagnostic hepatobiliary scan.

Topics: Acute Disease; Adult; Biliary Tract; Cholecystitis; Cholestasis; Female; Humans; Hydroxyzine; Imino Acids; Liver; Meperidine; Organotechnetium Compounds; Pain; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Time Factors

Technetium-99m di-isopropylphenylcarbamoylmethylimidodiacetic acid cholescintigraphy, together with measurements of radioactivity in duodenal juice, was used to evaluate 23 infants with prolonged obstructive jaundice. Four patients proved to have biliary atresia. The remainder had neonatal hepatitis. There was distinct differentiation of biliary atresia from neonatal hepatitis when the time-activity curves were analyzed. In neonatal hepatitis the radioactivity in duodenal juice is obviously higher, peaking above 1500 cpm/100 microliter per mCi dose. In biliary atresia the pattern is flattened, with maximal activity below 500 cpm/100 microliter per mCi dose.

Topics: Bile Ducts; Cholestasis; Duodenum; Female; Hepatitis; Humans; Imino Acids; Infant; Infant, Newborn; Intestinal Secretions; Jaundice, Neonatal; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

The records of all patients undergoing hepatobiliary imaging at our hospital from January 1980 to March 1983 were reviewed and 29 scans met the criteria for a pattern consistent with complete biliary tract obstruction. Biliary tract obstruction (due to choledocholithiasis, primary or secondary carcinoma involving the common bile duct, and pancreatitis) was documented in 24 of these patients. However, the remaining five patients had a patent common bile duct, and the etiologic factor was intrahepatic cholestasis secondary to sepsis in four and peritonitis in one. A classification of altered biliary dynamics in hepatobiliary imaging, which is based on the classification of jaundice, is proposed.

Topics: Animals; Bile Ducts; Cholestasis; Cholestasis, Extrahepatic; Cholestasis, Intrahepatic; Dogs; Humans; Imino Acids; Jaundice; Kidney; Liver; Radionuclide Imaging; Rats; Technetium; Technetium Tc 99m Disofenin

Postoperative hepatobiliary scintigraphy is recommended in selected cases of hepatic trauma to evaluate the integrity and patency of the biliary system. We present a patient with a traumatic hematoma that eventuated in a biloma with spontaneous biliary-cutaneous fistula. Repeat study demonstrated biliary obstruction at the canalicular level, which by more invasive imaging was found secondary to total obstruction of the common hepatic duct. The precise anatomical level and cause of his obstruction were defined by the findings of endoscopic retrograde cannulation of the pancreas, percutaneous transhepatic cholangiography, and surgery.

Topics: Adult; Biliary Fistula; Biliary Tract; Cholangiography; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis; Fistula; Humans; Imino Acids; Liver; Male; Postoperative Complications; Radionuclide Imaging; Skin Diseases; Technetium; Technetium Tc 99m Disofenin; Wounds, Stab

The authors describe the scintigraphic appearance of a case of subcapsular biliary leak. Hepatobiliary scintigraphy using Tc-99m labeled radiopharmaceuticals is employed primarily for the diagnosis of acute cholecystitis and for the demonstration of biliary tract patentcy. This procedure can also provide functional and morphologic information for evaluation of biliary tract trauma.

Topics: Aged; Biliary Fistula; Cholestasis; Drainage; Female; Humans; Imino Acids; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Hepatobiliary scans were obtained with Tc-99m-disofenin in 15 dogs. Of these, 5 served as controls, 5 were infused with E. coli endotoxin for 4 hours (endotoxic shock group), and 5 were bled to a mean pressure similar to that of the endotoxic shock group (hemorrhagic shock group). Scans of the controls and hemorrhagic shock group were identical. Scans of the endotoxic shock group were markedly abnormal, with a prolonged hepatic phase and little excretion of isotope into the biliary tract, a pattern characteristic of mechanical obstruction of the common bile duct. These results should alert the clinician to the potential danger of abnormal hepatobiliary scans in the septic patient.

Topics: Animals; Blood Pressure; Cholestasis; Dogs; Endotoxins; Escherichia coli; Gallbladder; Imino Acids; Liver; Probability; Radionuclide Imaging; Shock, Septic; Technetium; Technetium Tc 99m Disofenin; Time Factors

Technetium-99m iminodiacetic acid (IDA) cholescintigraphy was performed in 15 patients with acute acalculous cholecystitis. Fourteen of the 15 patients with acute disease had positive findings, indicating the presence of cystic duct or common duct obstruction. One case in which the gallbladder was visualized failed to respond to sincalide stimulation; this was classified as a suggestive finding of disease. The diagnostic accuracy of 99mTc-IDA cholescintigraphy was far superior to the other imaging studies used (8 sonograms, 1 intravenous cholangiogram, 3 oral cholecystograms, 1 percutaneous transhepatic cholangiogram). The 99mTc-IDA study is recommended as the imaging procedure of choice for examining patients with suspected acute acalculous cholecystitis.

Topics: Acute Disease; Aged; Cholecystitis; Cholelithiasis; Cholestasis; Female; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Lidofenin

Topics: Biliary Tract; Biliary Tract Surgical Procedures; Cholecystitis; Cholestasis; Common Bile Duct Diseases; Edema; Gallbladder; Humans; Imino Acids; Intestine, Small; Liver; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Twenty-three patients with surgical diversion of the biliary tract were serially studied with ultrasonography and hepatobiliary scintigraphy using 99mTc-HIDA or 99mTc-disofenin. Refluxed biliary air resulted in nondiagnostic sonograms in 14% of cases. Persistent postoperative dilatation was present in five patients (22%). Scintigraphy allowed differentiation of biliary dilatation with obstruction from nonobstructed dilatation. By coordinating the noninvasive imaging results, those patients requiring study using direct injection of contrast material may be selected.

Topics: Adult; Aged; Bile Ducts, Intrahepatic; Biliary Tract; Biliary Tract Surgical Procedures; Cholestasis; Duodenum; Female; Humans; Imino Acids; Jejunum; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Lidofenin; Ultrasonography

Topics: Adult; Cholestasis; Cholestasis, Extrahepatic; Cholestasis, Intrahepatic; Common Bile Duct Neoplasms; Diagnosis, Differential; Humans; Imino Acids; Infant, Newborn; Jaundice, Neonatal; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin