technetium-tc-99m-lidofenin and Cholestasis

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

Bronchobiliary fistula (BBF) represents a rare but severe complication in patients affected by liver metastases. Although a clinical suspicion can arise when specific clinical signs, in particular biliptysis, are present, conventional imaging modalities often fail to confirm the diagnosis. We present a case of a patient affected by colon cancer with liver metastases previously treated with partial right-sided hepatectomy and multiple thermo-ablative treatments combined with chemotherapy, who manifested a septic fever associated with productive cough and biliptysis. Diagnosis of BBF was confirmed only by hepatobiliary scintigraphy with (99m)Tc-heptoiminodiacetic acid.

Topics: Aged; Bile; Biliary Fistula; Bronchial Fistula; Cautery; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis; Colonic Neoplasms; Combined Modality Therapy; Drainage; Duodenum; Escherichia coli Infections; Female; Fever; Hepatectomy; Humans; Jaundice, Obstructive; Liver Neoplasms; Radionuclide Imaging; Stents; Technetium Tc 99m Lidofenin; Tomography, X-Ray Computed

Disturbances in the sphincter of Oddi (SO) function may prevent normal bile flow and thus enhance the probability of common bile duct stone (CBDS) formation. We have previously shown increased prevalence of diagnosed hypothyroidism in CBDS patients, thyroxine (T(4)) -induced inhibition of the SO contractility both in animal and in human experiments ex vivo, and reduced bile flow to duodenum in hypothyroid rats. The aim of the present study was to investigate human biliary dynamics in relation to altered thyroid gland function.. Eight female patients, 1 with diagnosed untreated hypothyroidism and 7 with total thyroidectomy performed due to thyroid cancer, were studied in hypothyroid stage and again after thyroxine replacement therapy in euthyroid stage, with quantitative (99m)Tc HIDA cholescintigraphy (QC), biliary ultrasonography, and serum determinations. Each patient served as her own control in the 2 stages of the study.. In QC, maximal uptake of (99m)Tc HIDA was not changed in hypothyroidism compared to euthyroidism. The first appearance of radioactivity to large bile ducts at the hepatic hilum remained unchanged in the 2 stages of the study. Hepatic clearance of (99m)Tc HIDA was decreased at 45 minutes (28% [11-38] vs 50% [33-54]; P =.028; median and range) and at 60 minutes (55% [28-80] vs 69% [61-79]; P =.028; median and range) and hilum-duodenal transit time increased by 31% compared to euthyroid stage. In US no changes were seen in gall bladder or bile ducts in the 2 stages of the study. Serum hypercholesterolemia was observed in the hypothyroid stage.. We conclude that hypothyroidism may result in delayed emptying of the biliary tract, as studied with QC. In addition to the changes in bile composition and excretion rate suggested before to take place in hypothyroidism, according to the present study changes in biliary emptying also may be included in the probable causes for the increased prevalence of CBDS in hypothyroidism. This may be due to the absence of the prorelaxing effect of thyroxine on SO, which we have shown before to exist ex vivo.

Topics: Adult; Aged; Bile; Cholestasis; Female; Gallstones; Humans; Hypothyroidism; Incidence; Middle Aged; Prevalence; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Lidofenin; Thyrotropin; Thyroxine; Time Factors

This paper illustrates the role of 99m-Technetium(Tc) diethyl-iminodiacetic acid (EHIDA) hepatobiliary scintigraphy in a patient who developed obstructive jaundice as a result of afferent loop syndrome, which is a rare occurrence. The computed tomographic (CT) and ultrasonographic findings are also described.

Topics: Cholestasis; Diagnosis, Differential; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Lidofenin; Tomography, X-Ray Computed

To assess the role of Tc-99m IDA cholescintigraphy in diagnosing bile leakage and bile obstruction after laparoscopic cholecystectomy, 51 studies were performed in 51 patients on the first postoperative day. Two different radioactive bile acid analogs were used, Tc-99m HIDA and Tc-99m trimethylbromo IDA. Scintigraphic findings were correlated with the clinical conditions. Results of seven out of 51 cholescintigrams were abnormal, showing accumulations of activity in the right paracolic gutter. Of these seven patients, only three had clinical symptoms consisting of more than normal postoperative abdominal pain and peritoneal irritation. The other four patients had minimal abnormal accumulation in the right paracolic gutter and showed no clinical signs postoperatively. Complete common bile duct obstruction or other bile duct-related complications, except for bile leakage, were not observed. Cholescintigraphy is feasible for the early detection of bile leakage and bile flow obstruction after laparoscopic cholecystectomy in patients with increased postoperative abdominal discomfort.

Topics: Bile Duct Diseases; Cholecystectomy; Cholestasis; Humans; Imino Acids; Laparoscopy; Organotechnetium Compounds; Postoperative Complications; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Lidofenin

The authors employed hepatobiliary scintigraphy (HBS), to study a dynamic state of bile stasis in the common bile duct and bile flow through the papilla of Vater in patients with congenital malformations of the pancreatico-biliary ductal system, such as congenital cystic dilatation of the common bile duct (CCDB) and anomalous arrangement of the pancreatico-biliary ductal system (AAPB). The HBS data were evaluated by a cholestatic index (CI), as an indicator of bile stasis in the common bile duct, and passage time (PT), as an indicator of bile flow through the papilla of Vater. CI was significantly higher in CCDB (3.67 +/- 0.92), in AAPB (2.87 +/- 0.28) and in both CCDB and AAPB with symptoms (2.86 +/- 0.59), compared with patients without CCDB or AAPB (0.96 +/- 0.41). PT was prolonged only in patients with AAPB with/without CCDB (greater than 30 minutes) compared to patients without AAPB (less than 12 minutes). This result suggested that bile stasis in the common bile duct was caused by a pooling of bile in the dilated common bile duct in CCDB, and by a disturbance of bile flow through the papilla of Vater in AAPB.

Topics: Aspartate Aminotransferases; Biliary Tract; Bilirubin; Cholangiopancreatography, Endoscopic Retrograde; Choledochal Cyst; Cholestasis; gamma-Glutamyltransferase; Humans; Imino Acids; Liver; Organotechnetium Compounds; Pancreas; Radionuclide Imaging; Technetium Tc 99m Lidofenin

Topics: Bile; Cholestasis; Humans; Hypertension, Portal; Imino Acids; Liver Circulation; Liver Diseases; Organotechnetium Compounds; Portal System; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Lidofenin

Topics: Cholecystectomy; Cholestasis; Humans; Imino Acids; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Lidofenin

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

Cholescintigraphy after food stimulation was carried out in 40 patients (13 patients with biliary enteric bypass, 14 patients with bile duct stenosis, demonstrated by ERC, 5 patients with endoprothesis and 8 patients with clinically suspected post-cholecystectomy syndrome. Biliary-bowel transit time of one hour or less was considered to be normal. In patients with biliary enteric bypass 11 had a normal transit time; however, one with a concomitant anastomotic leakage, and 2 patients had prolonged transit time and a significant obstruction by the anastomosis. All 14 patients with demonstrated biliary stricture had normal transit time. In 5 patients with endoprothesis, 2 had prolonged transit time in spite of patent endoprothesis. Finally, in the 8 patients with suspected post-cholecystectomy syndrome, 4 had normal sphincter of Oddi manometry and normal transit time, and 4 had abnormal sphincter of Oddi manometry, but only one with prolonged transit time. It is concluded that in patients with biliary enteric bypass (hepatico-jejunostomia) or biliary strictures a biliary-bowel transit time of one hour will be discriminatory between normal and abnormal conditions. This is in contrast to patients with endoprothesis and suspected sphincter of Oddi dysmotility, where a transit time of one hour only will have limited predictive value.

Topics: Adult; Aged; Aged, 80 and over; Bile; Biliary Tract; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis; Eating; Female; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Lidofenin

Bile duct ligated rats (n = 7) have been investigated for 6 months. Two patterns of evolution have been observed: (i) progressive development of cirrhosis and portosystemic shunt (detected by 201Tl per rectal scintigraphy) in three animals, (ii) repermeabilization of the biliary tract in four animals. Despite the small number of animals investigated, the 201Tl per rectal scintigraphy seems to be a good indicator of portosystemic shunt secondary to biliary cirrhosis.

Topics: Administration, Rectal; Animals; Cholestasis; Collateral Circulation; Disease Models, Animal; Imino Acids; Liver Cirrhosis; Organotechnetium Compounds; Portal Vein; Radionuclide Imaging; Rats; Rats, Inbred Strains; Technetium Tc 99m Lidofenin; Thallium; Thallium Radioisotopes; Venae Cavae

In 11 patients with biliary endoprosthesis, hepatobiliary scintigraphy with dimethyliminodiacetic acid (HIDA) was performed 16 times because of an increase in the serum bilirubin level. For the demonstration of dysfunction of the endoprosthesis, this method proved to have the same sensitivity as transhepatic cholangiography, which was performed as control examination. Therefore, hepatobiliary scintigraphy, a noninvasive and well-tolerated examination, can be recommended as a primary diagnostic tool in addition to ultrasonography for assessment of the drainage function of the biliary endoprosthesis.

Topics: Aged; Aged, 80 and over; Bile Ducts, Intrahepatic; Cholestasis; Drainage; Female; Humans; Imino Acids; Male; Middle Aged; Organometallic Compounds; Prostheses and Implants; Prosthesis Failure; Radionuclide Imaging; Technetium Tc 99m Lidofenin

Topics: Aged; Bile Ducts; Cholestasis; Humans; Imino Acids; Liver; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Results obtained using 99mTc HIDA in the follow-up of 17 patients who underwent hepaticojejunal bypass for different indications are examined. Results are also compared to other commonly used procedures such as echography and cholangiography (I.V. or PTC). Preliminary results appear to confirm that cholescintigraphy is an accurate procedure which allows an anterograde and physiologic visualization of the anastomosis.

Topics: Adolescent; Adult; Aged; Bile Ducts, Intrahepatic; Cholestasis; Humans; Imino Acids; Jejunum; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

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: Biliary Tract; Child, Preschool; Cholestasis; Female; Humans; Imino Acids; Infant; Infant, Newborn; Male; Radionuclide Imaging; Syndrome; Technetium; Technetium Tc 99m Lidofenin

99mTc-diethyl-HIDA cholescintigraphy was performed on 24 patients with histologically proven liver disease and on 10 normal adult subjects. Liver mass transport of HIDA was interpreted with the aid of a probabilistic model, assuming that the tracer particles undergo mixed random walks with drifts. The radiohepatograms were thus fitted with a gamma-variate function and the fitting parameters were evaluated as estimates of the severity of the disease. These parameters, together with the transit times, were also used to generate parametric images of liver function. The advantages of this approach are discussed and the following conclusions are drawn: (1) The gamma-fit is highly satisfactory with any type of experimental curve (0.98 less than r less than 1). (2) The parameters derived from the gamma-fit make it possible to objectively assess the extent of liver functional impairment. (3) Parametric imaging of the liver mass transport of HIDA is easily implemented, but still more experience is needed to assess its impact on patient care.

Topics: Bile Ducts; Cholestasis; Hepatitis; Humans; Imino Acids; Kinetics; Liver; Liver Cirrhosis; Liver Diseases; Models, Biological; 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

Twenty-three patients with surgical diversion of the biliary tract were serially studied with ultrasonography and hepatobiliary scintigraphy using 99mTc-HIDA or 99mTc-disofenin. Refluxed biliary air resulted in nondiagnostic sonograms in 14% of cases. Persistent postoperative dilatation was present in five patients (22%). Scintigraphy allowed differentiation of biliary dilatation with obstruction from nonobstructed dilatation. By coordinating the noninvasive imaging results, those patients requiring study using direct injection of contrast material may be selected.

Topics: Adult; Aged; Bile Ducts, Intrahepatic; Biliary Tract; Biliary Tract Surgical Procedures; Cholestasis; Duodenum; Female; Humans; Imino Acids; Jejunum; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Lidofenin; Ultrasonography

A patient with intermittent right upper quadrant abdominal pain thought to represent acute cholecystitis had common bile duct obstruction due to an enlarged right renal pelvis. A Tc-99m-HIDA scan provided the first clue to the diagnosis. The case reinforces the value of cholescintigraphy in diagnosing pathology outside the biliary system.

Topics: Adult; Cholestasis; Common Bile Duct; Female; Gallbladder; Humans; Hydronephrosis; Imino Acids; Kidney Pelvis; Radiography; Radionuclide Imaging; 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

HIDA labelled with 99Tcm is a new hepatobiliary imaging radiopharmaceutical which is selectively taken up by the liver and excreted into the biliary tree; it has been shown to demonstrate the gall bladder in normal subjects. Using a gamma-camera computer system, dynamic liver scans were performed during the first hour on 97 patients who, on the basis of standard investigations and on the findings at surgery, were divided into six groups as follows. 1. Normal. 2. Hepatocellular disease. 3. Biliary obstruction. 4. Chronic gall-bladder disease. 5. Acute gall-bladder disease. 6. Acute abdomen (not due to gall-bladder disease). Pictures were taken and activity-time curves of "regions of interest" were generated from the computer data. From these the presence or absence of a gall-bladder image was easily determined. The gall bladder was visualized in all normals but in none of the patients with acute gall-bladder disease. In the group with an acute abdomen suggestive of acute gall-bladder disease, but subsequently shown to be otherwise, the gall bladder was visualized in all cases. The gall bladder was not visualized in 42% of hepatocellular disease patients, nor in any of those with biliary obstruction, due to poor uptake or poor secretion of the HIDA. In cases of chronic gall-bladder disease, visualization of the gall bladder corresponded with gall-bladder opacification on the oral cholecystogram; in these cases the HIDA scan offers no advantage over the oral cholecystogram. These results suggest that in cases of "acute abdomen" an absent gall bladder image with a normal hepatogram will strongly support the diagnosis of acute gall-bladder disease, and that visualization of the gall bladder excludes such a diagnosis, making the HIDA scan a useful first-line investigation in these patients.

Topics: Abdomen, Acute; Cholestasis; Gallbladder; Gallbladder Diseases; Humans; Imino Acids; Liver Diseases; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Time Factors