technetium-tc-99m-lidofenin and Biliary-Dyskinesia

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

Hepatobiliary Iminodiacetic Acid (HIDA) scan provides a technique to quantify gallbladder ejection fraction (EF) in patients suffering acalculous biliary colic (ACBC). We wished to evaluate the accuracy of EF in the prediction of gallbladder pathology in patients undergoing cholecystectomy.. Data were retrieved from a database of patients referred for HIDA scan for ACBC, including EF and the pathological outcome of those undergoing cholecystectomy, and compared to normal values obtained from a review of related studies. Significant associations were demonstrated by chi-square, Mann-Whitney test, and linear regression. The predictive accuracy of different cut-offs of EF was demonstrated by the ROC curve analysis.. Of 83 patients referred for HIDA scan for ACBC, 41 underwent cholecystectomy. The median EF of this group (33%) was significantly lower than the composite normal median value from previous studies (56%). Thirty-two patients revealed evidence of gallbladder pathology. The EF declined with age (coefficient = -0.51, 95% CI = -0.99 to -0.33), but the median value did not differ between those with gallbladder pathology (34%) and those with normal gallbladders (29%).. Although an EF cut-off of 35% had the greatest accuracy in the prediction of pathology of those tested (0.56), the poor negative predictive value (23.5%) was a major contributor to its low accuracy. Although patients with ACBC have reduced gallbladder EF compared to the normal population, its quantitative assessment is of limited value in the prediction of gallbladder pathology.

Topics: Adult; Aged; Biliary Dyskinesia; Cholecystectomy, Laparoscopic; Female; Gallbladder; Gallbladder Diseases; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Lidofenin

Imaging with technetium-99m analogs of imminodiacetic acid has been shown to be useful in the diagnosis of various hepatobiliary diseases. The biliary ductal dilatation is usually late response of obstruction. With the development of TC-99m IDA scintigraphy, however, the functional aberrations associated with obstruction can be detected prior to the development of ductal enlargement identifiable by US & CT. We report a case of post-cholecystectomy pain due to biliary dyskinesia diagnosed by 99m TC-HIDA hepatobiliary imaging.

Topics: Biliary Dyskinesia; Biliary Tract; Humans; Male; Middle Aged; Pain, Postoperative; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Lidofenin

Gallbladder ejection fraction (GBEF) measured with a fatty meal (half-and-half milk) was compared with that measured with 2 equal sequential intravenous infusions of cholecystokinin (CCK-8) in a paired study of healthy subjects.. GBEF was measured by (99m)Tc-hepatic iminodiacetic acid cholescintigraphy in 13 healthy subjects. Each subject received 2 sequential doses of CCK-8 (3 ng/kg/min for 10 min) on day 1, followed by, on day 2, a 240-mL (8 oz) fatty meal (half-and-half milk) per 70 kg of body weight.. The mean +/- SD GBEF of 53.6% +/- 20.2% with fatty meal was significantly lower than the mean of 75.8% +/- 16.3% (P < 0.01) with the first dose of CCK-8 and 71.3% +/- 17.4% (P < 0.05) with the second dose. Fatty meal GBEF varied widely, from 23.5% to 91.8%. Percentile rankings of the fatty meal GBEF were determined as the preferred methodology for reporting results. Latent and ejection periods were significantly longer with fatty meal than with either dose of CCK-8.. GBEF measured with fatty meal can serve as an alternative method to intravenous injection of CCK-8 when the hormone is no longer available for clinical use. The measurement of GBEF with fatty meal requires careful attention to the details of the meal and the measurement time sequence.

Topics: Adult; Biliary Dyskinesia; Fats; Female; Gallbladder Emptying; Humans; Infusions, Intravenous; Liver; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sincalide; Technetium Tc 99m Lidofenin

Topics: Biliary Dyskinesia; Cholangiopancreatography, Endoscopic Retrograde; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Radiopharmaceuticals; Technetium Tc 99m Lidofenin

Between April 1, 1989, and January 1, 1994, 38 patients with chronic acalculous cholecystitis underwent an advanced (3-puncture) laparoscopic cholecystectomy at our institution. The 30 women and 8 men had a mean age of 39 years (range, 23 to 65 years) and represented 4.5% of our overall gallbladder patient population. In each case, the disease produced typical biliary colic, but no gallstones were visualized on ultrasound examination; cholecystokinin-stimulated cholescintigraphy revealed a dysfunctional gallbladder, as evidenced by an ejection fraction of < or = 35% or nonvisualization or nonemptying of the organ. In all 38 cases, cholecystectomy resulted in the complete relief of symptoms. Although an increasing number of physicians are recommending this operation for acalculous gallbladder disease, it should not be performed on the basis of clinical history alone. Rather, objective criteria confirming the need for surgical intervention should be obtained by means of appropriate preoperative testing, including cholecystokinin-stimulated cholescintigraphy.

Topics: Adult; Aged; Biliary Dyskinesia; Cholecystectomy, Laparoscopic; Cholecystitis; Cholecystokinin; Chronic Disease; Female; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Technetium Tc 99m Lidofenin; Ultrasonography

Biliary pain without obvious biliary obstruction is common in postcholecystectomy patients. We studied 20 symptomatic patients with episodes of biliary-type pain after cholecystectomy (all having undergone endoscopic retrograde cholangiography), and in 18 asymptomatic postcholecystectomy controls. We performed quantitative hepatobiliary radionuclide analysis with dimethyl-imidodiacetic acid. From a series of 90 dynamic images at 1-min intervals using a gamma camera coupled to a computer, time-activity curves were produced in regions of interest in the liver, intrahepatic biliary tree, common duct, and heart, from which quantitative biliary excretion indexes were obtained. The results demonstrate a biliary kinetic dysfunction in patients with postcholecystectomy pain without morphological abnormalities.

Topics: Abdominal Pain; Biliary Dyskinesia; Cholecystectomy; Cholestasis; Humans; Imino Acids; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sphincter of Oddi; Technetium Tc 99m Lidofenin; Time Factors

A total of 25 children with bronchial asthma and 40 children with cutaneous and dermato-respiratory + manifestations of allergy and concomitant injury to the gastrointestinal tract were under observation at an allergological clinic. In addition to the general clinical and allergological examination, radionuclide studies were performed by means of scintipneumography with 99mTc and hepatobiliscintigraphy with 99mTc HIDA. The data obtained indicate that radionuclide methods can be used in childhood allergological practice in the capacity of screening diagnosis as well as in the capacity of adjuvant + methods of examination, making it possible to perform investigations necessary for diagnosis establishment in a more precise and atraumatic manner.

Topics: Asthma; Biliary Dyskinesia; Child; Child, Preschool; Common Bile Duct Diseases; Dermatitis, Atopic; Food Hypersensitivity; Gallbladder Diseases; Humans; Imino Acids; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Lidofenin

A study of 118 patients, operated on with Billroth II gastrectomy for peptic disease and affected by postgastrectomy syndromes, was carried out. Fifty patients were investigated by means of technetium-99m HIDA hepatobiliary scanning. In 18 patients, in whom an afferent loop syndrome was clinically suspected, hepatobiliary scanning demonstrated an altered afferent loop emptying in 8 and atonic distension of the gallbladder without afferent loop motility changes in 10. Among the patients in the first group, four were treated with a biliary diversion surgical procedure and in the second group, two patients underwent cholecystectomy. Our findings indicate that biliary vomiting, right upper abdominal pain pyrosis, and biliary diarrhea in Billroth II gastrectomized patients are not always pathognomonic symptoms of afferent loop syndrome. Technetium-99m HIDA hepatobiliary scanning represents the only diagnostic means of afferent loop syndrome definition. A differential diagnosis of abnormal afferent loop emptying and gallbladder dyskinesia is necessary for the management planning of these patients, and furthermore, when a surgical treatment is required, biliary diversion with Roux-Y anastomosis or Braun's biliary diversion seems the treatment of choice for afferent loop syndrome, whereas cholecystectomy represents the best procedure for atonic distension of the gallbladder.

Topics: Adult; Afferent Loop Syndrome; Aged; Biliary Dyskinesia; Biliary Tract; Cholecystectomy; Diagnosis, Differential; Female; Gastrectomy; Humans; Imino Acids; Liver; Male; Middle Aged; Peptic Ulcer; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Time Factors

Topics: Biliary Dyskinesia; Child; Cholecystitis; Chronic Disease; Female; Gallbladder; Humans; Imino Acids; Radionuclide Imaging; Scintillation Counting; Technetium; Technetium Tc 99m Lidofenin

Topics: Adolescent; Biliary Dyskinesia; Cholecystitis; Female; Gallbladder; Gallbladder Diseases; Humans; Imino Acids; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin