technetium-tc-99m-lidofenin and Cholecystitis

Topics: Adult; Bile Ducts; Cholecystitis; Cholelithiasis; Cholestasis, Extrahepatic; Cholestasis, Intrahepatic; Common Bile Duct Diseases; Cysts; Hepatitis; Humans; Imino Acids; Infant, Newborn; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Tomography, X-Ray Computed; Ultrasonography

Topics: Acute Disease; Cholecystitis; Cholelithiasis; Humans; Imino Acids; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Ultrasonography

Topics: Abdomen, Acute; Acute Disease; Cholecystitis; Female; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Lidofenin; Ultrasonography

Acute cholecystitis is a relatively common clinical entity characterized histopathologically by obstruction of the cystic duct due to either edema or stone or both. Thorough clinical assessment and selection of the appropriate diagnostic tests are crucial in making an early diagnosis before surgical treatment. Many diagnostic tests are available for imaging the gallbladder. Hepatobiliary imaging using technetium Tc 99m IDA is the test of choice to either exclude or confirm the diagnosis of acute cholecystitis and it carries a discriminating power greater than that of cholecystography or ultrasonography. In most patients the exclusion of the diagnosis of acute cholecystitis can be made as early as 30 minutes and the confirmation within three hours. The confirmation of acute cholecystitis by radionuclide imaging obviates the need for either cholecystography or ultrasonography.

Topics: Acute Disease; Cholecystectomy; Cholecystitis; Cholecystography; Cholelithiasis; Costs and Cost Analysis; Diagnosis, Differential; Evaluation Studies as Topic; Gallbladder; Humans; Imino Acids; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Ultrasonography

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: Acute Disease; Adult; Bile Duct Diseases; Bile Ducts; Child; Cholecystitis; Cholecystokinin; Cholestasis, Extrahepatic; Cystic Duct; Humans; Imino Acids; Iodine Radioisotopes; Radionuclide Imaging; Rose Bengal; Technetium; Technetium Tc 99m Lidofenin

Patients with the clinical diagnosis of acute cholecystitis were studied with intravenous cholecystography and cholescintigraphy. The two examinations alternated in a random order. The final diagnosis was ascertained by surgery in most patients. Either cholecystography or cholescintigraphy could be used in the diagnostics of patients with suspected acute cholecystitis. The methods have about the same accuracy. However, cholescintigraphy is performed more easily and more rapidly than intravenous cholecystography.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Cholecystitis; Contrast Media; Female; Humans; Imino Acids; Infusions, Intravenous; Ioglycamic Acid; Male; Middle Aged; Organotechnetium Compounds; Radiography; Radionuclide Imaging; Technetium Tc 99m Lidofenin

Tc-99m HIDA cholescintigraphy is the diagnostic procedure of choice for acute cholecystitis. Acute cholecystitis is associated in vast majority of the cases with cystic duct obstruction. The demonstration of presence (cystic duct patency) or absence (cystic duct obstruction) of visualization of the gallbladder on cholescintigraphy is critical to the diagnosis of acute cholecystitis. The visualization of the gallbladder rules out acute cholecystitis in most of the cases. Although, in most cases, determination of visualization or nonvisualization of gallbladder is straight forward, occasionally it can be challenging. We describe a patient with suspected acute cholecystitis, in whom an unusual appearance of the gallbladder on hepatobiliary scintigraphy was clarified with SPECT/CT, an approach that is rarely used in Tc-99m HIDA cholescintigraphy.

Topics: Aged; Cholecystitis; Cholecystography; Gallbladder; Humans; Male; Technetium Tc 99m Lidofenin; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Topics: Abdominal Pain; Acute Disease; Adult; Cholecystitis; Female; Humans; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Lidofenin

This study was designed to retrospectively determine recent clinical trends of initial radiological evaluation in patients pathologically proven to have acute cholecystitis (AC) and to assess the methodology that led to its diagnosis. Over a 28-month period, the medical records and imaging studies of 117 consecutive patients who had pathologically confirmed AC were retrospectively analyzed. The sensitivities of ultrasound (US) and hepatobiliary 99mTc-iminodiacetic acid (HIDA) were computed. The false-negative scans were retrospectively reviewed by a blinded radiologist to determine the limitations and advantages of each modality. The 117 patients were grouped into six categories based on the type of imaging examination they underwent prior to cholecystectomy: initial US evaluation only (n=80, 68.4%), initial US followed by HIDA (n=17, 14.5%), initial HIDA only (n=2, 1.7%), initial HIDA followed by US (n=3, 2.6%), initial CT (n=5, 4.3%), and no imaging evaluation (n=10, 8.6%). HIDA scan had a calculated sensitivity of 90.9% (20 true-positive, 2 false-negative) while US had a sensitivity of 62% (62 true-positive, 38 false-negative). Current practice in the initial radiological evaluation of acute cholecystitis remains outdated. The vast majority of patients in our study group were initially worked up using US, although HIDA scan has been shown to have greater sensitivity for the diagnosis of acute cholecystitis.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Child; Cholecystitis; Female; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Lidofenin; Ultrasonography

AIDS patients are susceptible to opportunistic gastrointestinal infections including ascending cholangitis and cholecystitis, especially if CD4 count is < 200. Incidence of acalculous cholecystitis has not been reported previously.. We aim to evaluate the incidence of acalculous cholecystitis in AIDS patients and to identify causative organisms and mortality rate following cholecystectomy.. We reviewed the files of 46 patients in order to meet the objectives of this study.. CD4 counts were < 200 in 31 patients and > 200 in 15 patients. HIDA imaging was performed in 31 patients; in 8, the CD4 count was > 200 and all had calculous cholecystitis. The gallbladder was visualized in 3 patients for a sensitivity of 63% and no organisms were found in the gallbladder specimens. In 23 patients, the CD4 count was < 200; the gallbladder was visualized in 5 patients for a HIDA sensitivity of 78%; 16 (52%) had acalculous cholecystitis; and 15 had calculous cholecystitis. In acalculous cholecystitis, Cryptosporidium was found in six cases, cytomegalovirus (CMV) in six cases, and fungus, yeast, tuberculosis, and mycobacterium avium intracellular each in one case. The thirty day mortality rate was 18%; 5 of 28 who underwent open cholecystectomy died within 30 days, 4 of them with a CD4 count < 200. There was no mortality in the 26 patients who underwent laparoscopic cholecystectomy.. (1) Because of the high incidence of 52% of acalculous cholecystitis in AIDS patients with a CD4 count < 200, we recommend using intravenous cholecystokinin if the gallbladder is visualized on hepatobiliary scintigraphy in order to determine gallbladder ejection fraction and exclude acalculous cholecystitis. (2) Laparoscopic rather than open cholecystectomy should be the surgical procedure of choice in AIDS patients especially if the CD4 count is < 200.

Topics: Acquired Immunodeficiency Syndrome; Acute Disease; AIDS-Related Opportunistic Infections; CD4 Lymphocyte Count; Cholecystectomy; Cholecystitis; Cholelithiasis; Gallbladder; Humans; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Lidofenin

Topics: Acute Disease; Cholecystitis; Cholelithiasis; Gangrene; Humans; Imino Acids; Liver; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Lidofenin; Ultrasonography

Pharmacological intervention with either cholecystokinin-8 (CCK-8) or morphine during 99mTc- hepatoiminodiacetic acid (HIDA) cholescintigraphy is required primarily for the assessment of the diseases affecting the gallbladder, the common bile duct, or the sphincter of Oddi. For imaging, the patient should be prepared by an overnight fast, or with 4 hours of minimum fast. Pre-emptying with CCK-8 is probably undesirable and should either be avoided or one should wait for at least 4 hours after CCK-8 to begin the 99mTc-HIDA study to achieve higher specificity of the test for acute cholecystitis. When he gallbladder is not observed by 60 mins in a clinical setting of acute cholecystitis, a dose of 0.04 mg/kg of morphine is administered intravenously and imaging continued for an additional 30 mins. Nonvisualization of the gallbladder by 90 mins with morphine in an appropriate clinical setting is diagnostic for acute cholecystitis. When the gallbladder is not observed by 60 min but is seen with morphine administered after 60 mins, a positive diagnosis of abnormal gallbladder function can be made. When the gallbladder is observed in a clinical setting of biliary pain or chronic calculous or acalculous cholecystitis, CCK-8 at a dose rate of 3.3 ng/kg/min is infused intravenously for 3 mins (10 ng/kg/3 min) for the measurement of the ejection fraction. An ejection fraction value of less than 35% is indicative of calculous or acalculous chronic cholecystitis. The gallbladder emptying is directly related to the total number of cholecystokinin receptors in the smooth muscle. The ejection fraction can be controlled to any desired level simply by controlling the dose rate or the duration of infusion of CCK-8. Morphine and other opiate metabolites circulate for many hours in blood and act on the sphincter of Oddi and decrease the gallbladder ejection fraction. Careful drug history, especially that of opiates, is very critical in all subjects with a low ejection fraction before assigning an abnormality to the gallbladder motor function.

Topics: Acute Disease; Bile; Biliary Tract; Cholecystitis; Cholecystokinin; Gallbladder Emptying; Humans; Imino Acids; Morphine; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Lidofenin

Intravenous radionuclide cholescintigraphy (IVRC) provides a very specific picture for choledochal cysts. However, the clinical significance of the non-visualization of the gall-bladder (GB) activity in these cases is unclear. In this study, we reviewed 27 patients with choledochal cysts who underwent IVRC within 7 days prior to operation and correlated the GB findings on IVRC with the histopathological results. In 18 of the 27 patients (66.7%), there was non-visualization of the GB at 4 h post injection. Among these, two had histopathological features of acute cholecystitis (AC), 11 had chronic cholecystitis (CC), and five had normal GBs. In the other nine patients with visualization of the GB, there were five cases of CC and four normal GBs. If we apply the finding of non-visualization of the GB at 4 h post injection as the criterion for the diagnosis of AC, the diagnostic accuracy was only 40.7% (11/27). We concluded that: (1) GB disease (AC and CC) was common (66.7%: 7.4% and 59.3% respectively) in choledochal cyst patients. (2) Non-visualization of the GB on IVRC did not necessarily indicate AC in choledochal cyst cases, and the diagnostic accuracy was low. (3) GB disease is not the only cause of GB non-visualization on IVRC. A huge choledochal cyst causing a mass or reservoir effect may be a cause of GB compression and result in non-visualization of the GB.

Topics: Child; Cholecystitis; Choledochal Cyst; Female; Gallbladder; Humans; Imino Acids; Male; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Disofenin; Technetium Tc 99m Lidofenin; Time Factors

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

Cholescintigraphy with morphine augmentation is used routinely to expedite the differential diagnosis of acute from chronic cholecystitis. A patient with hepatic dysfunction and an allergy to morphine received intravenous meperidine in conjunction with cholescintigraphy. The gallbladder was not visualized 30 minutes after administration of the drug. However, the activity accumulated in the initial photon deficient gallbladder at 4 hours after meperidine administration (6.5 hours after radiopharmaceutical administration). These findings may be explained in part by prolongation of meperidine bioavailability because of impairment of hepatic function.

Topics: Acute Disease; Cholecystitis; Chronic Disease; Diagnosis, Differential; Drug Hypersensitivity; Gallbladder; Humans; Imino Acids; Male; Meperidine; Middle Aged; Morphine; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Lidofenin; Time Factors

Topics: Acute Disease; Cholecystitis; Gallbladder; Humans; Imino Acids; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Lidofenin

The authors report a case of a patient with acute acalculous cholecystitis whose cholescintigram was negative, but showed a pericholecystic photopenic halo. The diagnosis was confirmed by an In-111 WBC scan and histopathology.

Topics: Cholecystitis; Cholelithiasis; False Negative Reactions; Female; Humans; Imino Acids; Indium Radioisotopes; Leukocytes; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Lidofenin

This selective retrospective study was undertaken to establish whether the gallbladder contraction (ejection fraction) calculated during cholescintigraphy correlates with the histopathologic changes in the surgical specimen. The medical records of 243 patients who underwent hepatobiliary scintigraphy were reviewed. Of these, 215 patients had cholecystokinin cholescintigraphy and 100 went on to cholecystectomy. The original histologic slides from 67 gallbladders were available and reviewed by a pathologist who graded each specimen based on presence and severity of changes associated with "chronic" cholecystitis. There was no significant correlation between the severity of histopathologic change and cholecystokinin-induced gallbladder emptying.

Topics: Adult; Aged; Cholecystectomy; Cholecystitis; Female; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Lidofenin

We studied emergency hepatobiliary scintigraphy in the 43 patients to rule out acute cholecystitis. After injection of 185-222 MBq (5-6 mCi) of 99mTc-EHIDA or 99mTc-HIDA, serial static scintigraphic images were obtained up to 7 hours in maximum. Of 43 patients in this study, 20 had a normal scan and finally in all of them cholecystitis was ruled out. Of the 43 patients, 14 had an abnormal scan (nonvisualized gall bladder). In 10 of them the diagnosis of acute cholecystitis was confirmed after emergency cholecystectomy. The other 9 patients of 43 had an incomplete scan mainly due to liver dysfunction. Four of them had acute cholecystitis in the cholecystectomy. These results indicate that acute cholecystitis can be excluded by the findings of gall bladder visualization in hepatobiliary scintigram. We concluded that emergency hepatobiliary scintigraphy is very useful to rule out acute cholecystitis.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Biliary Tract; Cholecystitis; Emergencies; Female; Gallbladder; Humans; Imino Acids; Liver; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Diethyl-iminodiacetic Acid; Technetium Tc 99m Lidofenin

Topics: Acute Disease; Aged; Cholecystectomy; Cholecystitis; Confusion; Diagnosis, Differential; Humans; Hypothermia; Imino Acids; Male; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Lidofenin; Thrombocytopenia; Ultrasonography

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Cholangiography; Cholecystitis; Female; Humans; Imino Acids; Male; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Lidofenin; Ultrasonography

Topics: Adult; Cholecystectomy; Cholecystitis; Cholelithiasis; Chronic Disease; Humans; Imino Acids; Liver; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Lidofenin

The article describes results of using dynamic hepatobiliary scintigraphy in 43 young patients with chronic calculous cholecystitis. High informative value of the method for diagnosis of morpho-functional changes in the organs of the hepatobiliary system is shown, hyperbilirubinemia included. More than in half of the patients alterations of the absorptive-excretory functions of the liver and motor function of the gallbladder were revealed. Their direct relationship with the duration of the disease and degree of the inflammatory process in the biliary tract is established.

Topics: Adult; Biliary Tract; Cholecystitis; Cholelithiasis; Chronic Disease; Evaluation Studies as Topic; Female; Humans; Imino Acids; Iodipamide; Liver; Male; Radiography; Technetium; Technetium Tc 99m Lidofenin; Tomography, Emission-Computed

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

Fifty-four patients with suspected acute cholecystitis underwent 99mTc HIDA cholescintigraphy, ultrasonography and oral cholecystography. The correct diagnosis was reached in 49 patients by cholescintigraphy (91%) in 35 (65%) by ultrasonography and in 45 (83%) by oral cholecystography. 99mTc HIDA cholescintigraphy provides a rapid accurate diagnosis with minimal discomfort to the patient and is the investigation of choice for patients with symptoms of acute gallbladder disease, particularly if early cholecystectomy is to be considered.

Topics: Acute Disease; Cholecystitis; Cholecystography; Cholelithiasis; False Positive Reactions; Gallbladder Diseases; Humans; Imino Acids; Technetium; Technetium Tc 99m Lidofenin; Ultrasonography

The motor activity of the gall bladder was studied using cholescintigraphy with 99m Tc-HIDA in 57 patients with chronic cholecystitis and chronic hepatitis and in 9 controls. A comparative analysis of the curves activity-time based upon the elements of images of the external contour and the entire zone of the gall bladder, made it possible to reveal differences in the type of reaction of the gall bladder to the use of cholagogic stimulators (cholecystokinin i.v. and cholagogic breakfast). A method of the processing of the results made it possible to determine the number of contraction phases of the gall bladder during its emptying as well as the true latent period and the period of primary reactions of the biliferous apparatus after taking a food stimulus.

Topics: Cholagogues and Choleretics; Cholecystitis; Cholecystokinin; Gallbladder; Hepatitis; Humans; Imino Acids; Peristalsis; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

The benefit of early surgery for patients with acute cholecystitis is now accepted but rapid accurate pre-operative diagnosis is important and the single best investigation has not yet been clearly established. All 47 patients with suspected acute cholecystitis admitted to a district general hospital during a 6 month period underwent ultrasonic examination and scintigraphy with HIDA within 48 h of admission. In 23 patients acute cholecystitis was proven. Ultrasound correctly diagnosed this in 21 patients but in 2, changes attributed to chronic cholecystitis only were detected. Two false positive ultrasound results also occurred, one in a patient with adenomyomatosis and acute pancreatitis, the other in a case of duodenitis. HIDA scan was diagnostic in 19 patients but in the remaining 4 the presence of abnormal liver function tests accounted for non-visualization of the biliary tree (a non-diagnostic result). In the absence of jaundice a HIDA scan is the more specific test for confirming acute cholecystitis.

Topics: Acute Disease; Cholecystectomy; Cholecystitis; Humans; Imino Acids; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Time Factors; Ultrasonography

Two patients presenting with right upper abdominal colicky pain, jaundice, and fever had a hepatobiliary scan using Tc 99m HIDA. The scan was suggestive of acute cholecystitis and a space occupying lesion in the liver. On operation, liver echinococcosis, located in the right lobe rupturing into the biliary ductal system, was found. Intraoperative cholangiography revealed filling defects in the main biliary ducts. Exploration of the common bile duct disclosed daughter cysts and cystic debris. Acute cholecystitis or stones were not found. We conclude that in patients with a clinical picture and HIDA scanning compatible with acute cholecystitis and a space occupying lesion in the liver, the diagnosis of hydatid cyst of the liver which has ruptured into the biliary tract should be considered.

Topics: Acute Disease; Aged; Bile Duct Diseases; Bile Ducts; Cholecystitis; Diagnosis, Differential; Echinococcosis, Hepatic; Humans; Imino Acids; Liver; Male; Middle Aged; Radionuclide Imaging; Rupture, Spontaneous; Technetium; Technetium Tc 99m Lidofenin

Topics: Cholecystitis; Female; Hematoma; Humans; Imino Acids; Liver Abscess; Liver Diseases; Liver Neoplasms; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

The value of infusion cholecystography 99mTc HIDA cholescintigraphy and ultrasonography was compared in 51 patients presenting with a clinical diagnosis of acute cholecystitis. Of the 35 patients with proven gallbladder disease, the presence of gallstones was correctly predicted in 31 (88 per cent) by infusion cholecystography, 32 (90 per cent) by 99mTc HIDA cholescintigraphy and 27 (77 per cent) by ultrasonography. There were no false positive investigations. Infusion cholecystography may be of particular interest to surgeons with no ready access to isotope scanning techniques.

Topics: Acute Disease; Cholecystitis; Cholecystography; Cholelithiasis; Contrast Media; Gallbladder Diseases; Humans; Imino Acids; Iodobenzoates; Ioglycamic Acid; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Ultrasonography

The authors note high significance of results of echocholescintigraphy in diagnosis of acute and chronic calculous cholecystitis. Preoperative echographic diagnosis of destructive changes in the gall bladder wall was shown to be possible.

Topics: Adult; Aged; Cholecystitis; Cholelithiasis; False Negative Reactions; Female; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Ultrasonography

During a two year period, 1981 to 1982, 21 of 262 patients undergoing cholecystectomy had acalculous cholecystitis. The majority of these patients had chronic disease, and more than 50 per cent of them were in the older age group and had other chronic medical problems. The signs and symptoms are similar to that of calculous cholecystitis, although the cause is unclear. However, the patient with these complaints deserves thorough evaluation in order to rule out other disorders of the upper part of the gastrointestinal tract, because cholecystectomy for chronic acalculous cholecystitis will relieve the symptoms in more than 80 per cent of the patients. Acalculous cholecystitis is a true organic problem which, if diagnosed accurately, can be effectively treated with cholecystectomy.

Topics: Cholangiography; Cholecystectomy; Cholecystitis; Chronic Disease; Female; Follow-Up Studies; Humans; Imino Acids; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Time Factors; Ultrasonography

Topics: Acute Disease; Bayes Theorem; Cholecystitis; Humans; Imino Acids; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Ultrasonography

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: Acute Disease; Adult; Aged; Cholecystitis; Female; Gallbladder; Humans; Imino Acids; Liver; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

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

In five of seven patients with acute pancreatitis, Tc-99m HIDA scintigraphy failed to visualize the gallbladder. In all five patients the gallbladder was later found to be normal and in three of them normal filling was obtained at a repeat examination performed after the attack had subsided. Transient nonvisualization of the gallbladder in acute pancreatitis is probably due to disturbed motility of the biliary tree.

Topics: Acute Disease; Adult; Biliary Tract; Cholecystitis; Diagnosis, Differential; Gallbladder; Humans; Imino Acids; Male; Pancreatitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Time Factors

Radionuclide hepatobiliary imaging (HIDA scanning), a pathophysiologic modality, has become the diagnostic method of choice for suspected acute cholecystitis. The diagnosis is made quickly with this technic, which is simple, safe, and accurate. It is in widespread use and will soon be available for small community hospitals as well as large metropolitan and university centers. Ultrasound, though an excellent anatomic modality for diagnosing cholelithiasis, does not demonstrate the status of the cystic duct, information essential to the diagnosis of acute cholecystitis.

Topics: Acute Disease; Cholecystitis; Cholelithiasis; Cystic Duct; Evaluation Studies as Topic; Gallbladder; Humans; Imino Acids; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Ultrasonography

Using computer-assisted scintillation camera imaging bile duct dynamics was studied in 28 patients with a nonvisualizing gallbladder due to acute cholecystitis. Postoperative repeat studies were carried out in 8 of the 28 patients. In half of the studies three accumulations of activity were evident on the 60 added 1-min views. These three accumulations were interpreted as corresponding to the biliary tree. An explanation for the separation of the activity into three depots, is proposed. Analysis of the time-activity curves of the accumulations showed an irregular exchange of activity, suggesting intracholedochal movements of bile. Passage of bile from the common duct into the duodenum was observed 1-7 times during the 1-h studies. In most studies the bulk of the activity was caught by an antegrade peristaltic wave as soon as it left the duct. The activity was then transported rapidly in a medial direction. This finding suggests that relaxation of the sphincter occurs in phase with duodenal peristalsis.

Topics: Bile Ducts; Cholecystitis; Computers; Humans; Imino Acids; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Hepatobiliary scintigraphy with the 99mTc-labeled iminodiacetic acid derivatives has been shown to be useful in the evaluation of biliary tract diseases, especially for the diagnosis of acute cholecystitis. Little emphasis has been placed on the importance of the hepatic parenchymal image that occurs early in the imaging sequence. To determine what information can be obtained from the hepatic parenchymal image, a comparison was carried out of sulfur colloid and iminodiacetic acid images in 50 patients with focal defects. In 46 of 50 patients, the number and position of lesions on the two studies were similar, while in four patients the images were discordant. In addition to being very similar in lesion detection, the iminodiacetic acid scans also allowed more specificity in the later imaging (biliary phase) in 13 cases. The value of iminodiacetic acid derivatives in the evaluation of some biliary tract disorders has been established; considerable value can also be obtained by close inspection of the hepatic parenchymal image as well.

Topics: Adult; Bile Duct Diseases; Bile Ducts; Cholecystitis; Female; Humans; Imino Acids; Liver; Liver Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Lidofenin; Technetium Tc 99m Sulfur Colloid; Time Factors

Topics: Aged; Cholecystitis; Diagnostic Errors; Diverticulum; Duodenal Diseases; Female; Gallbladder; Humans; Imino Acids; 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: Acute Disease; Cholecystitis; Diagnosis, Differential; Humans; Imino Acids; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Topics: Acute Disease; Adolescent; Adult; Aged; Cholecystitis; Diagnosis, Differential; Female; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Ultrasonography

Topics: Adult; Aged; Cholecystitis; Cholelithiasis; Chronic Disease; Female; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Radiography; Technetium; Technetium Tc 99m Lidofenin; Tomography, Emission-Computed

Cholescintigraphy with 99m-Tc labeled iminodiacetic acid (IDA) derivatives has proved to be extremely reliable in the evaluation of suspected acute cholecystitis. The major diagnostic feature of the study is the presence (cystic duct patency) or absence (cystic duct obstruction) of gallbladder visualization. Secondary findings include degree and rate of liver uptake, visualization and caliber of the intrahepatic and common bile ducts, and the presence of intestinal activity as well as rapidity of biliary tract-to-bowel transit of the radiotracer. Various combinations of these secondary parameters result in a spectrum of cholescintigraphic patterns which can assist in determining the cause of the patient's acute clinical problem.

Topics: Acute Disease; Cholecystitis; Humans; Imino Acids; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Lidofenin

Topics: Adult; Bile Ducts; Cholecystitis; Diagnosis, Differential; Humans; Imino Acids; Male; Pancreatic Cyst; Pancreatic Pseudocyst; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

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

Topics: Acute Disease; Cholecystitis; Cholelithiasis; Gallbladder; Humans; Imino Acids; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Ultrasonography

An unusual case of malignant degeneration of a choledochal cyst is presented. The presence of acute cholecystitis with the cystic duct originating from the cyst as well as the subsequent obstruction of the cyst-jejunal surgical anastomosis was readily detected with Tc-99m-dimethyl-iminodiacetic (Tc-99m-HIDA) cholescintigraphy.

Topics: Adult; Cholecystitis; Common Bile Duct; Common Bile Duct Diseases; Cysts; Female; Gallbladder; Humans; Imino Acids; Jejunum; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Sixty patients were evaluated for acute abdominal pain using technetium-99m PIPIDA hepatobiliary imaging. The sensitivity of the test was 90.6 percent in all patients and the accuracy was 93.3 percent. In the evaluation of acutely ill patients with right upper quadrant pain, fever, nausea and vomiting, hepatobiliary imaging with PIPIDA is the preferred test for diagnosing acute cholecystitis. If the test is positive, disease of the gallbladder and probably acute cholecystitis are present. Early operation can proceed if desirable. If the test is negative and the bilirubin level is less than 5.0 mg/dl, acute cholecystitis is not present. In such cases conservative treatment is appropriate, and follow-up tests should be performed to evaluate the possibility of chronic cholecystitis. When the bilirubin level exceeds 5.0 mg/dl, the test is often indeterminate.

Topics: Abdomen, Acute; Adolescent; Adult; Aged; Bile Ducts; Cholecystitis; Female; Humans; Imino Acids; Liver; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Changes in the radiological diagnosis of gallbladder disease are occurring at a remarkable rate. In this symposium, several recognized authorities place the various diagnostic modalities and their interrelation in modern perspective. The present and future roles of oral cholecystography and intravenous cholangiography, the radiological diagnosis of chronic acalculous cholecystitis, and the use of ultrasonography and cholescintigraphy are analyzed.

Topics: Acute Disease; Cholangiography; Cholecystitis; Cholecystography; Cholecystokinin; Chronic Disease; Gallbladder Diseases; Humans; Imino Acids; Radionuclide Imaging; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid; Technetium Tc 99m Lidofenin; Tomography, X-Ray Computed; Ultrasonography

Topics: Acute Disease; Biliary Tract; Cholecystitis; Cholecystography; Cholelithiasis; Humans; Imino Acids; Liver Function Tests; Pancreatitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Topics: Cholecystitis; Humans; Imino Acids; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

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

A prospective comparative study was made of 99mTc-HIDA cholescintigraphy and 24-h infusion cholecystography for the diagnosis of acute cholecystitis. The material comprised 50 patients. Non-visualization of the gallbladder was regarded as a positive result and as indicative of acute cholecystitis. The final diagnoses were made at operation (36 patients), by additional examinations (9 patients), by a typical clinical course (3 patients), and at autopsy (2 patients). The predictive value of a positive and a negative cholescintigraphy was 92.6% and 95.7%, respectively. The predictive value of a positive and a negative infusion cholecystography was 78.6% and 81.8%, respectively. There was no statistically significant difference between the results of the two tests. The 99mTc-HIDA cholescintigraphy was easier and quicker to perform than the cholecystography, and likewise the scintigrams were easier to assess than the infusion cholecystograms. The diagnostic certainty of cholescintigraphy was found to be high, and the test is recommended in patients suspected of having acute cholecystitis.

Topics: Acute Disease; Adult; Aged; Cholecystitis; Cholecystography; Female; Humans; Imino Acids; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Technetium-99m dimethyl iminodiacetic acid cholescintigraphy has contributed significantly to the diagnosis of acute and chronic biliary tract disorders. Yet attention should also be focused on the other structures visualized during the blood pool, hepatocyte, renal excretory, and intestinal phases of the study. Nonbiliary pathology was detected in 42 of 294 patients (14.3%) studied for suspected acute cholecystitis. The serendipitous detection of previously unsuspected abnormalities assisted in directing further work-up from suspected biliary disease and towards the real source of the patient's acute problem in 28 cases (9.5%).

Topics: Acute Disease; Adult; Appendicitis; Cholecystitis; Diagnosis, Differential; Heart; Heart Diseases; Humans; Imino Acids; Intestinal Diseases; Intestines; Kidney; Kidney Diseases; Liver; Liver Diseases; Perfusion; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

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

A newer approach to the early diagnosis of acute biliary tract disease is review. Ninety-two patients were evaluated with a new hepatobiliary agent (H.I.D.A/P.I.P.D.A.) for the presence of cystic duct obstruction. Seven patients with suspected acute gall bladder disease were dropped from the study for the lack of pathologic confirmation of the diagnosis. Forty-four of the remaining 85 patients were subsequently operated on and found to have acute cholecystitis. Forty-three of the 44 had cystic duct obstruction demonstrated on H.I.D.A. Scan (one false negative). An additional 23 patients underwent cholecystectomy for chronic disease. In this group, the gallbladder scan was only 43% (10/23) accurate in correctly identifying disease. Eighteen patients with nonbiliary disease had normal scans. The accuracy of ultrasonography and the scan are also compared in a smaller subgroup of 53 patients who had both studies.

Topics: Acute Disease; Adolescent; Adult; Aged; Cholecystitis; Cholestasis, Extrahepatic; Cystic Duct; Female; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Ultrasonography

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