technetium-tc-99m-lidofenin and Cholestasis--Intrahepatic

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

The efficiency of bile acid conjugation before and during therapy with 600 mg/day of ursodeoxycholic acid was measured in seven adult patients with early chronic cholestatic liver disease (6 with primary biliary cirrhosis; 1 with primary sclerosing cholangitis). Duodenal bile samples were obtained by aspiration and the proportion of unconjugated bile acids was determined using lipophilic anion exchange chromatography to separate bile acid classes, followed by analysis of individual bile acids by gas chromatography-mass spectrometry. The proportion of conjugated bile acids was determined by high-performance liquid chromatography. Use of a (99m)Tc-HIDA recovery marker permitted the absolute mass of unconjugated bile acids in the gallbladder to be calculated. Unconjugated bile acids comprised 0.4% of total biliary bile acids before and 0.2% during ursodeoxycholic acid therapy, indicating highly efficient conjugation of bile acids. During therapy, percentage unconjugated ursodeoxycholic acid significantly increased from (mean +/- S.D.) 13 +/- 13% to 54 +/- 12%; P < 0.002. When the unconjugated and conjugated fractions of bile acids were compared, there was an enrichment in unconjugated fraction for cholic acid and ursodeoxycholic acid and a depletion for chenodeoxycholic acid both in basal condition and during ursodeoxycholic acid therapy, suggesting that hydrophilic bile acids were conjugated less efficiently. During therapy, the conjugation efficiency significantly increased for cholic acid and ursodeoxycholic acid. The pretreatment mass of total unconjugated bile acids in the gallbladder was (mean +/- S.D.) 4.4 +/- 3.2 mumol, and was not significantly changed by ursodeoxycholic acid therapy (6.2 +/- 3.5 mumol). However, ursodeoxycholic acid therapy caused a significant increase in the mass of unconjugated ursodeoxycholic acid. It is concluded that endogenous bile acids and exogenous ursodeoxycholic acid when given at the usual dose are efficiently conjugated in patients with early cholestatic liver disease. Despite showing increased biliary unconjugated ursodeoxycholic acid during its oral administration, our data do not lend support to the occurrence of hypercholeresis due to cholehepatic shunting of bile acids.

Topics: Adult; Bile Acids and Salts; Chenodeoxycholic Acid; Cholestasis, Intrahepatic; Cholic Acid; Cholic Acids; Chromatography, High Pressure Liquid; Deoxycholic Acid; Gallbladder; Gas Chromatography-Mass Spectrometry; Humans; Imino Acids; Organotechnetium Compounds; Technetium Tc 99m Lidofenin; Ursodeoxycholic Acid

An 18-year-old male was evaluated for recurrent attacks of right abdominal pain and intermittent jaundice caused by hydatid cysts of the liver. The case illustrates the value of dynamic functional information provided by Tc-99m-HIDA imaging over noninvasive modalities that demonstrate structural changes, such as ultrasound, computed tomography, and tin colloid liver imaging.

Topics: Adolescent; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis, Intrahepatic; Echinococcosis, Hepatic; Humans; Imino Acids; Male; Organometallic Compounds; Technetium; Technetium Compounds; Technetium Tc 99m Lidofenin; Tin; Tin Compounds; Tomography, X-Ray Computed; Ultrasonography

Atresia and hypoplasia of the bile ducts are the most common congenital biliary anomalies of clinical importance. Surgical correction can help about 10% of these infants. However, surgery should be performed within the first month of life to avoid irreversible liver parenchymal changes. It is difficult to separate the surgical condition, biliary atresia, from conditions in which the trauma of laparotomy should be avoided, such as neonatal hepatitis and other clinically indistinguishable causes of obstructive jaundice. Radionuclide imaging with the 99mTc-labeled N-substituted iminodiacetic acids (HIDA, PIDIDA, DISIDA, etc) have been helpful in the differential diagnosis of biliary atresia.

Topics: Bile Ducts; Cholestasis, Intrahepatic; Diagnosis, Differential; Humans; Imino Acids; Infant, Newborn; Jaundice, Neonatal; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Since hepatobiliary imaging with 99mTc=labeled iminodiacetic acid derivatives (HIDA) allows relatively separate, sequential measurement of hepatocyte clearance, parenchymal transit, and biliary excretion, these agents should be useful in differentiating intrahepatic cholestasis (IC) from other hepatobiliary disorders. We studied 18 patients with clinical evidence of IC in whom the parenchymal transit time was increased disproportionately to any decrease in hepatocyte clearance. In a second group of 14 patients with hepatocyte disease but without clinical evidence of IC, the average parenchymal transit time was increased less in relation to the average decrease in hepatocyte clearance than in the IC group. In 15 patients with extrahepatic biliary obstruction, the average hepatocyte clearance was disproportionately increased, as in IC, but large-duct obstruction was identified by scintigrams, ultrasound, or computed tomography. These preliminary results suggest that IC can be diagnosed with hepatobiliary imaging.

Topics: Adolescent; Adult; Aged; Bile Ducts, Intrahepatic; Child; Child, Preschool; Cholestasis, Extrahepatic; Cholestasis, Intrahepatic; Female; Humans; Imino Acids; Infant; Liver; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

A prospective study was undertaken to compare the diagnostic accuracy of clinical evaluation, ultrasound, computed tomography, and technetium 99m-HIDA or -PIPIDA biliary scans in distinguishing between intrahepatic and extrahepatic jaundice. A final diagnosis was established in each of the 50 patients who completed the study, among whom 29 had intrahepatic cholestasis and 21 had extrahepatic obstruction. In the diagnosis of extrahepatic obstruction, the sensitivities of clinical evaluation, ultrasound, computed tomography, and nuclear medicine biliary scan were 95%, 55%, 63%, and 41%, respectively; the specificities were 76%, 93%, 93%, and 88%; and the overall accuracies were 84%, 78%, 81%, and 68%. These data support the conclusion that when the clinical evaluation is carefully performed, it is the single most effective noninvasive means of detecting extrahepatic biliary obstruction in a jaundiced patient. Although ultrasound, computed tomography, and radionuclide biliary scan are less sensitive, they are highly reliable if they indicate that extrahepatic obstruction is present. A flow chart of invasive and noninvasive approaches for evaluation of the jaundiced patient is presented.

Topics: Adult; Aged; Cholangiography; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis, Extrahepatic; Cholestasis, Intrahepatic; Female; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Tomography, X-Ray Computed; Ultrasonography

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

In a patient with acute obstructive jaundice, cholescintigraphy with technetium-99m-labeled iminodiacetic acid (HIDA) showed uniformly reduced uptake in the left lobe of the liver. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated cholelithiasis and obstruction of the distal hepatic duct. Surgery, and later a T-tube cholangiogram, confirmed the presence of numerous stones in the left intrahepatic and common hepatic ducts. The liver was free of tumor. Intrahepatic segmental ductal obstruction may produce a spectrum of patterns on hepatobiliary imaging ranging from reduced uptake to intrahepatic pooling.

Topics: Aged; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis, Intrahepatic; Humans; Imino Acids; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Segmental biliary obstruction as a result of primary or secondary hepatic malignancy has been reported with increasing frequency. For two representative patients, the clinical and Tc-99m HIDA scintigraphic findings in segmental biliary obstruction are described. The presence of photon-deficient dilated bile ducts in one segment of the biliary tree is highly suggestive of localized biliary obstruction and should be considered in the patient with suspected or proven hepatic malignancy despite the absence of jaundice.

Topics: Adenocarcinoma; Bile Duct Neoplasms; Cholestasis, Intrahepatic; Female; Humans; Imino Acids; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; 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