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

There have been evolutionary changes in the management of pathological conditions of the hepatobiliary system over recent years, particularly with an increasing emphasis on modern hepatobiliary surgical techniques. Concurrent advances have occurred in imaging technology and availability, leading to a greater use of ultrasound, multidetector computed tomography (CT), and magnetic resonance imaging (MRI) in the primary evaluation of hepatobiliary disease. Radionuclide imaging using technetium(99m) (Tc(99m)) hepatobiliary iminodiacetic acid (HIDA) derivatives is an established technique that complements morphological imaging, providing valuable functional information in both pre- and postoperative evaluation of patients with suspected or known hepatobiliary disease. This review discusses the current clinical indications for Tc(99m) HIDA scintigraphy using clinical cases to demonstrate how this technique continues to play a valuable diagnostic role in the assessment of the functional integrity of the hepatobiliary system.

Topics: Biliary Tract Diseases; Chelating Agents; Humans; Liver Diseases; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Lidofenin

Topics: 3-Iodobenzylguanidine; Amphetamines; Biliary Tract Diseases; Brain Diseases; Coronary Disease; Gastrointestinal Diseases; Humans; Imino Acids; Iodobenzenes; Iofetamine; Krypton; Liver Diseases; Lung Diseases; Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Thallium; Tomography, Emission-Computed

Topics: Bile Reflux; Biliary Tract Diseases; Gastritis; Gastrointestinal Motility; Humans; Imino Acids; Postgastrectomy Syndromes; Technetium; Technetium Tc 99m Lidofenin

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: Adolescent; Biliary Tract Diseases; Child; Child, Preschool; Female; Hepatitis; Humans; Imino Acids; Male; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Lidofenin

Discordant hepatic uptake between Tc-99m HIDA and Tc-99m colloid occurred in a 63-year-old female with segmental biliary obstruction due to cholangioma. Radiographic CT and a percutaneous transhepatic cholangiogram revealed the obstructed right hepatic duct as well as the dilated intrahepatic duct in the right lobe. At surgery this was confirmed, and a 2 cm mass encasing the right hepatic duct was identified. It should be included in the gamut of discordant hepatic uptake of Tc-99m IDA and Tc-99m colloid.

Topics: Adenoma, Bile Duct; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Biliary Tract Diseases; Constriction, Pathologic; Female; Humans; Imino Acids; Liver; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Technetium; Technetium Compounds; Technetium Tc 99m Lidofenin; Tin; Tin Compounds

Topics: Biliary Tract Diseases; False Negative Reactions; Humans; Imino Acids; Liver Diseases; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Lidofenin

The authors proposed a method of cholescintigraphy with functional imaging reflecting RP distribution within the entire area in the field of vision of a gamma-chamber detector taking account of the type of motor activity of the gall bladder. This method was based on plotting an activity-time curve along the outer contour of a gall bladder image, the determination of moments of change in gall bladder motor activity on this curve, and the calculation of corresponding gradients of RP accumulation and clearance functions represented on an image where the color of each element was determined by a sign of the gradient and its intensity--by its absolute value. The use of this method in 92 patients made it possible to reveal conditions with possible B-bile reflux into the intrahepatic ducts, and to raise its diagnostic accuracy by 7% as compared to a routine analysis of activity-time curves by decreasing the number of false-negative results.

Topics: Adult; Bile Reflux; Biliary Tract Diseases; Female; Humans; Imino Acids; Male; Methods; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Lidofenin

Gastric aspiration and HIDA scintigraphy have been compared to assess duodenogastric bile reflux. Gastric aspiration was performed on two separate occasions with a total examination time of 3 h. The highest 1-h output and the highest concentration of bile acids were recorded. HIDA scintigraphy was carried out for 90 min after an injection of 60 MBq 99mTc-dimethyl-iminodiacetic acid (HIDA). Forty-six patients with different gastrointestinal disorders were studied; 24 patients were positive and 13 negative in both tests. Accordingly, the methods agreed in 37 to 46 patients (80.4%). It is concluded that gastric aspiration is as reliable as HIDA scintigraphy to assess fasting bile reflux.

Topics: Adult; Aged; Bile Acids and Salts; Bile Reflux; Biliary Tract Diseases; Duodenum; Female; Gastric Juice; Humans; Imino Acids; Inhalation; Male; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Respiration; Technetium Tc 99m Lidofenin

One hundred and thirty-four sequential patients who underwent 99mTC HIDA cholescintigraphy have been studied. Patients were investigated for suspected acute cholecystitis, chronic cholelithiasis, enterogastric reflux or jaundice, and in the assessment of biliary tract drainage after transplantation of the liver and other operations of the biliary tract. The technique is most valuable in the diagnosis of acute cholecystitis when its accuracy rate is 96 per cent; it is also useful in the assessment of postoperative biliary drainage. It is least helpful in the investigation of jaundice and suspected chronic cholelithiasis.

Topics: Biliary Tract Diseases; Cholecystitis; False Negative Reactions; Humans; Imino Acids; Liver Transplantation; Postoperative Period; Technetium; Technetium Tc 99m Lidofenin

The organ distribution data for the two hepatobiliary agents HIDA and p-butyl-IDA in mice showed substantial differences in the extent and rate of hepatobiliary clearance of radioactivity. 99mTc-HIDA and 99mTc-p-butyl-IDA were used in computer assisted serial hepatobiliary scintigraphy. In normal subjects, the data of dynamic studies showed that the kidneys were no longer seen after 2.5 min with p-butyl-IDA. Liver radioactivity decreased significantly after 10 min with HIDA compared to 35 min with p-butyl-IDA. The gall bladder was always visualized at the 10-12th min and the 25-30th min with HIDA and p-butyl-IDA respectively. 99mTc-HIDA provided superior hepatic duct images.

Topics: Animals; Biliary Tract Diseases; Humans; Imino Acids; Kidney; Liver Diseases; Mice; Organotechnetium Compounds; Protein Binding; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

The paper is concerned with the results of assaying hepatocyte function on the basis of an adaptive pharmacokinetic model worked out by the authors. Hepatoscintigraphy with 99mTc-HIDA was used in 3 phases: the vascular phase of RP transport (the 1st min of investigation, scintigrams with a 2 s interval), the parenchymatous phase (with a 20 s interval in subsequent 10 min), the biliary phase (with a 3 min interval). The hepatocytic phase of 99mTc-HIDA transport was evaluated on the basis of the adaptive 5-compartmental model calculating the value of transport constants. In terms of differential diagnosis, the intercompartmental constants K1,2 (blood-liver) and K2,1 (liver-blood) turned out to be the most informative. Thus the assaying of hepatocyte transport function using the proposed adaptive model helps to define the degree of liver involvement in a pathological process, to choose the therapeutic tactics and method, to evaluate its efficacy and to predict possible complications.

Topics: Biliary Tract Diseases; Biological Transport; Diagnosis, Differential; Humans; Imino Acids; Kinetics; Liver; Liver Diseases; Models, Biological; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Topics: Bile Reflux; Biliary Tract Diseases; Gastrectomy; Humans; Imino Acids; Postoperative Complications; Radionuclide Imaging; Stomach; Technetium; Technetium Tc 99m Lidofenin

In 5 patients with partial gastric resection and esophagitis, in whom esophageal pH metry was unable to demonstrate significant gastroesophageal reflux (GER), we administered i.v. 5 mCi (185 MBq) of 99mTc-HIDA, the patient lying under a computer-assisted LFOV gamma camera. When gallbladder image was evident, caerulein was administered i.v. at a physiologic dose in order to induce gallbladder contraction, and in the subsequent 45 min the patient was asked to perform a standard series of manoeuvres that increase the intraabdominal pressure (Valsalva, etc.) and favour GER. Scintigraphic images and time/activity curves obtained from areas of interest corresponding to gastric remnant and distal esophagus showed that at least one of these manoeuvres in each case was followed by the appearance of the radiocompound in the distal esophagus, indicating a 99mTc-HIDA-tagged bile GER. Consequently, we believe that HIDA-GER dynamic scintigraphy may be more useful than esophageal pH metry in demonstrating the biliary origin of an esophagitis.

Topics: Bile Reflux; Biliary Tract Diseases; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Imino Acids; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Topics: Adult; Aged; Biliary Tract Diseases; Biopsy, Needle; Cholangiography; Female; Humans; Imino Acids; Liver; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

The pharmacodynamics of Tc-99m dimethyliminodiacetic acid were studied for normal subjects and for patients with a variety of hepatobiliary disorders. It was determined that, in normal subjects, approximately 65% of the gallbladder agent bypassed the gallbladder and was excreted directly from the liver into the small intestine. This bypassing of the gallbladder was even higher in patients with cystic-duct or common-duct obstruction. The radiation burdens to the gallbladder wall and other critical organs were calculated using the dynamic data obtained from patients with a variety of gallbladder disease. The dose to the gallbladder wall was found to be significantly lower than previously reported. Gallbladder ejection and clearance characteristics when stimulated by food intake were studied for normal subjects. Dosimetry calculations demonstrated a fivefold reduction of absorbed dose to the gallbladder wall when the gallbladder was stimulated to contract using a fatty meal. Accordingly, a fatty meal is recommended for patients at the end of all gallbladder imaging studies.

Topics: Biliary Tract Diseases; Dietary Fats; Female; Humans; Imino Acids; Kinetics; Liver Diseases; Male; Radiation Dosage; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

This is a report of 21 patients presenting with epigastric pain, bilious vomiting, upper gastrointestinal bleeding, iron-deficiency anemia, and weight loss, who had undergone Billroth II gastrectomy from 3 to 35 yr earlier. Eighteen of 21 patients were found to have significant enterogastric reflux indices varying from 60% to 95% demonstrated by 99mTc HIDA scintigraphy. Thirteen patients had diversion antireflux surgery in the form of a Roux-en-Y procedure, and 1 patient had a Henley loop jejunal interposition. Postoperative 99mTc HIDA scintigraphic studies showed the enterogastric reflux indices to have decreased significantly to a range of 2%-26% (p less than 0.00001). There was marked improvement of symptoms, including correction of anemia and weight gain in those patients who had been anemic or who had sustained earlier weight loss. The enterogastric reflux indices of 10 asymptomatic control patients after Billroth II gastrectomy ranged from 4% to 45%. 99mTc HIDA scintigraphy is useful in evaluating patients before and after bile diversion surgery, and demonstrates the quantitative decrease in enterogastric reflux after such surgery.

Topics: Adult; Anemia, Hypochromic; Bile Reflux; Biliary Tract Diseases; Body Weight; Female; Gastrointestinal Hemorrhage; Humans; Imino Acids; Male; Middle Aged; Postgastrectomy Syndromes; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Time Factors

Topics: Abdominal Injuries; Animals; Biliary Tract Diseases; Cholelithiasis; Cholestasis, Extrahepatic; Cholestasis, Intrahepatic; Dogs; Female; Imino Acids; Liver Diseases; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Wounds, Penetrating

The recent availability of iminodiacetic acid analogues labeled with technetium Tc 99m provides a safe and accurate noninvasive test of biliary function. Biliary scintigraphy is a simple and rapid method of detecting acute cholecystitis in particular but also of distinguishing acute biliary pancreatitis from nonbiliary pancreatitis, of evaluating the patency of the common duct in early obstruction, of assessing possible postcholecystectomy syndrome, of evaluating the patency of a biliary enteric bypass, and of detecting postoperative biliary leaks.

Topics: Acute Disease; Biliary Tract; Biliary Tract Diseases; Biliary Tract Surgical Procedures; Cholecystitis; Cholelithiasis; Cholestasis; Humans; Imino Acids; Methods; Postoperative Complications; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Ultrasonography

Topics: Adult; Aged; Biliary Tract; Biliary Tract Diseases; Female; Humans; Imino Acids; Liver; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Topics: Bile Reflux; Biliary Tract Diseases; Duodenal Ulcer; Female; Humans; Imino Acids; Male; Technetium; Technetium Tc 99m Lidofenin

A method for studying bile reflux into the oesophagus after total gastrectomy is described using 99Tcm-HIDA and an external imaging system. Two reconstructions were studied: oesophagojejunostomy with a diverting entero-anastomosis (omega reconstruction 6 studies) and Roux-en-Y reconstruction (20 studies). The incidence of reflux on scanning correlated well with the incidence of oesophagitis, and the finding of reflux was almost always associated with severe symptoms. The omega procedure was unsuccessful in diverting bile in 5 patients despite an entero-anastomosis as wide as 12 cm. The Roux-en-Y reconstruction was unsuccessful in diverting bile in 5 patients all of whom had a diverting limb 35 cm in length; none of the 9 patients with a diverting limb longer than 35 cm refluxed (range 40--50 cm).

Topics: Bile Reflux; Biliary Tract Diseases; Esophagitis, Peptic; Gastroesophageal Reflux; Humans; Imino Acids; Postgastrectomy Syndromes; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

The value of biliary scintigraphy was studied in 180 patients with suspected biliary tract disease. Scintigraphy was performed after intravenous injection of technetium-99m labelled (1) N-substituted iminodiacetic acid derivative (HIDA) in 91 patients, and (2) butyl derivative of iminodiacetic acid (BIDA) in 89 patients. Most of the patients were investigated additionally by conventional techniques such as cholecystography, cholangiography and ultrasonography. It is concluded that biliary scintigraphy is a simple and safe technique for visualization of the biliary tract. It is particularly useful in the evaluation of acute cholecystitis, in patients with iodine sensitivity requiring imaging of biliary tract, and in the differentiation of obstructive from nonobstructive jaundice. Its value in kinetic disturbances of the gallbladder and in quantitative evaluation of hepatobiliary function needs further study.

Topics: Adolescent; Adult; Aged; Biliary Tract Diseases; Child; Child, Preschool; Cholecystitis; Female; Humans; Imino Acids; Infant; Jaundice; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Scintigraphy was performed on 180 patients with suspected biliary tract disease using technetium-99m-labelled derivatives of iminodiacetic acid. Most of the patients were also evaluated by conventional techniques and the results were correlated with the findings at operation and with histological examination of tissue removed whenever indicated. The technique was very accurate in the diagnosis of acute cholecystitis. In chronic cholecystitis it was useful in the diagnosis only when the cystic duct was obstructed. Scintigraphy has no value in the diagnosis of gallstones. However, it permits visualisation of the biliary tract even in the presence of jaundice and is useful in distinguishing obstructive from non-obstructive types of jaundice.

Topics: Adolescent; Adult; Aged; Biliary Tract Diseases; Child; Child, Preschool; Cholecystitis; Female; Humans; Imino Acids; Infant; Jaundice; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Topics: Adolescent; Adult; Aged; Biliary Tract Diseases; Computers; Humans; Imino Acids; Liver Diseases; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Topics: Adult; Biliary Tract; Biliary Tract Diseases; Chronic Disease; Common Bile Duct; Female; Gallbladder; Humans; Imino Acids; Liver; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Topics: Bile Ducts; Biliary Tract Diseases; Child; Child, Preschool; Humans; Imino Acids; Infant; Infant, Newborn; Liver Diseases; Radionuclide Imaging; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid; Technetium Tc 99m Lidofenin

Topics: Adult; Aged; Biliary Tract; Biliary Tract Diseases; Evaluation Studies as Topic; Female; Humans; Imino Acids; Liver; Liver Diseases; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Topics: Animals; Bile; Biliary Tract; Biliary Tract Diseases; Imino Acids; Jejunum; Prostaglandins E; Prostaglandins E, Synthetic; Radionuclide Imaging; Rats; Technetium; Technetium Tc 99m Lidofenin

Endoscopic retrograde cholangiography (ERCP), the most advanced of the gastrointestinal endoscopic procedures, provides both specific diagnostic information pertaining to diseases of the biliary tract and pancreas and definitive therapy available only with this modality. ERCP is safe and accurate, establishing a primary diagnosis in 80% of cases and, in experienced hands, cannulation is successful in 98%. In addition to cholangiography, pancreatography has been a significant achievement providing accurate diagnostic yield through direct cannulation and opacification of the pancreatic duct while permitting collection of secretions for cytological evaluation and chemical analyses. The therapeutic extension of ERCP, endoscopic papillotomy (EPT), is successful in 94% of cases in the treatment of common bile duct stones and papillary stenosis, providing comparable results to surgical procedures while reducing morbidity, mortality and convalescence. Because of the accuracy and safety of these procedures, they should be considered early in suspected diseases of the biliary tract and pancreas so that the clinician can establish a specific diagnosis and provide definitive therapy.

Topics: Biliary Tract Diseases; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy; Cholestasis, Extrahepatic; Cholestasis, Intrahepatic; Gallbladder Diseases; Humans; Imino Acids; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Postoperative Complications; Technetium; Technetium Tc 99m Lidofenin

99Tcm-labelled HIDA administered intravenously is promptly taken up by the liver and excreted into the bile duct and gallbladder. In this study the use of this agent in hepatoscintigraphy was evaluated. Thirty patients with a variety of hepatobiliary pathology were studied. After an overnight fast 2 mCi of 99Tcm HIDA were given intravenously and the patient was scanned continuously for 1 h. A rapid outline of the liver and biliary tract was usually obtained and the T 1/2 of the tracer in the blood stream was 20 min. In total obstructive jaundice, isotope was excreted through the renal tract without visualization of the liver. Hepatoscintigraphy was compared with conventional radiographs and ultrasonography in 19 patients presenting an emergencies with suspected hepatobiliary disease and was found to be comparable to the latter modes of investigation. In the jaundiced patients hepatoscintigraphy was inferior to percutaneous transhepatic cholangiography and to ultrasonography. No adverse side effects have followed the use of the radiopharmaceutical.

Topics: Adolescent; Biliary Tract; Biliary Tract Diseases; Cholangiography; Cholestasis; Evaluation Studies as Topic; Female; Humans; Imino Acids; Liver; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Ultrasonography

Topics: Biliary Tract; Biliary Tract Diseases; Humans; Imino Acids; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Topics: Adult; Aged; Biliary Tract; Biliary Tract Diseases; Evaluation Studies as Topic; Female; Humans; Imino Acids; Liver; Liver Diseases; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin