technetium-tc-99m-disofenin and Liver-Cirrhosis

Topics: Abdominal Pain; Aged; Female; Gallbladder; Hepatitis C, Chronic; Humans; Liver; Liver Cirrhosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Disofenin

Hepatotoxicity may complicate therapy with methotrexate in patients with rheumatoid arthritis. Prevention of cirrhosis may depend upon early identification of liver damage, usually accomplished by serial biopsy. To determine the adequacy of noninvasive methods for identifying hepatotoxicity, 22 sets of data were obtained in patients undergoing therapy with methotrexate for rheumatoid arthritis. Comparisons were made between liver biopsy, hepatocellular enzymes and two noninvasive radioisotopic methods that have been shown to be abnormal in hepatocellular disease: the rate constant of excretion of the 14C-aminopyrine and the time from injection to peak hepatic activity of 99mTc-diisopropylimidodiacetic acid. The hepatocellular enzymes and the time-to-peak-activity of diisopropylimidodiacetic acid were not useful predictors of methotrexate-induced hepatotoxicity. The aminopyrine breath test was abnormal in approximately half the patients with hepatotoxicity but showed poor specificity. Noninvasive methods remain inferior to biopsy for the detection of mild to moderate methotrexate-induced hepatotoxicity in patients with rheumatoid arthritis.

Topics: Adult; Aged; Alanine Transaminase; Aminopyrine; Arthritis, Rheumatoid; Aspartate Aminotransferases; Biopsy; Breath Tests; Clinical Enzyme Tests; Humans; Imino Acids; Liver; Liver Cirrhosis; Methotrexate; Middle Aged; Organotechnetium Compounds; Predictive Value of Tests; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Disofenin

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

Hepatocyte function was analyzed following the injection of 5 mCi of Tc-99m disofenin by the computer generation of three kinds of functional images designed to portray regional rates of hepatic uptake. Nineteen patients were analyzed, of whom eight had no overt liver disease, five had active hepatitis, five had cirrhosis, and one had acute cholecystitis. Functional images were graded according to lack of regional homogeneity of accumulation. Uptake kinetics were found to be significantly more homogeneous in normal subjects, becoming increasingly heterogeneous in hepatitis and cirrhosis patients, respectively. Thus functional imaging may provide a tool for the quantitative analysis of parenchymal disruption in liver disease.

Topics: Adult; Aged; Female; Hepatitis; Humans; Imino Acids; Liver; Liver Cirrhosis; Liver Function Tests; Male; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin; Time Factors

Tc-99m-diisopropyl-IDA (DISIDA) and Tc-99m-p-butyl-IDA (BIDA) were compared in each of 33 patients who had serum bilirubins ranging from normal to 23.5 mg/dl. DISIDA exhibited quantitatively a higher liver uptake and faster rate of washout at all levels of bilirubinemia. There was a tendency for BIDA to have a slower blood clearance, particularly in hyperbilirubinemias exceeding 5 mg/dl. On visual comparison of the images, BIDA failed to identify the gallbladder in three icteric patients and dilated biliary tracts in two others.

Topics: Adult; Aged; Biliary Tract; Bilirubin; Cholestasis, Intrahepatic; Female; Gallbladder; Humans; Imino Acids; Kinetics; Liver; Liver Cirrhosis; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin