technetium-tc-99m-lidofenin and Constriction--Pathologic

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

In order to assess the patency and function of biliary-enteric anastomoses performed in our Department of Surgery, 21 patients entered the following study, provided an informed consent was obtained. All the patients were affected by benign biliary tract diseases and underwent either Roux-en-Y hepaticojejunostomy (11 cases), or side-to-side choledochoduodenostomy (10 cases). The 21 patients were evaluated with Tc-99m-HIDA scanning at intervals of 20 days-36 months after the surgical procedure (mean 14 months). The images were obtained after intravenous injection of the radioactive medium (5 mCi) and the scans were taken at 1 min (1 frame/s), 3 min (1 frame/10 s), and 56 min (1 frame/2 min). THe data were analyzed by a Digital PDP 11/34 Computer System. This method allowed us to assess each individual patient for the patency of the anastomosis and, by computer analysis, to build up a profile of the timing of the passage of the radioactive medium through the anastomosis, a delayed passage across the anastomosis was always pathological. In conclusion, the 99m-Tc-HIDA scanning used in our study for long-term follow-up of biliary-enteric anastomoses is reliable and allows an assessment of prognosis.

Topics: Alkaline Phosphatase; Anastomosis, Roux-en-Y; Bile Ducts; Choledochostomy; Constriction, Pathologic; Hepatic Duct, Common; Humans; Imino Acids; Intestine, Small; Jejunostomy; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Lidofenin; Time Factors

Repair of iatrogenic biliary stricture was carried out in 38 patients of whom five are now dead, three causally related. Thirty-one patients were followed up between August 1983 and March 1984 (mean time since repair 7.9 years). Fifty reparative operations were carried out, six patients first having a temporary end fistula performed. Cholangiography during cholecystectomy had been performed in only eight patients (21 per cent). All but one patient had gastroscopy and barium meal examination and the incidence of duodenal ulceration was 6.7 per cent and of oesophageal varices 5.6 per cent. Liver biopsies taken during the first reparative operation were normal in 5 per cent, obstructive in 65 per cent and cirrhotic in 30 per cent. Intra-operative cultures were mainly coliforms (66.7 per cent). Liver function tests were normal in 19 (61.3 per cent) but there was no correlation between abnormal values and clinical status. Twenty-nine patients (93.5 per cent) are now completely well. 99mTc HIDA scans, liver ultrasonography, intravenous cholangiography and BSP excretion were of limited value in planning further surgery. The most useful investigation before reoperation was transhepatic cholangiography.

Topics: Adult; Aged; Bile Ducts; Biliary Fistula; Child; Cholangiography; Cholecystectomy; Constriction, Pathologic; Female; Follow-Up Studies; Humans; Iatrogenic Disease; Imino Acids; Intraoperative Complications; Liver Function Tests; Male; Middle Aged; Reoperation; Technetium; Technetium Tc 99m Lidofenin; Time Factors; Ultrasonography

The diagnosis of papillary stenosis, occasionally seen after cholecystectomy, is confirmed by endoscopic retrograde cholangiopancreatography (ERCP), which demonstrates delayed emptying of contrast material into the duodenum for more than 45 minutes. The authors assessed 2,6-dimethyl phenyl carbamoyl methyl iminodiacetic acid labelled with technetium-99m (99mTc HIDA) as a less invasive procedure in these circumstances by comparing it with the findings from ERCP. Twenty-six patients who had pain after cholecystectomy were studied by continuous 1-hour scintigraphy after injection of 99mTc HIDA. Biliary flow was estimated by measuring uptake and clearance of the entire liver and common bile duct. Volunteers who had no pain after cholecystectomy served as controls. Of the 26 study patients, all 99mTc HIDA scan findings were within the control range in 11. Of these, 10 had normal biliary drainage confirmed by ERCP. The one patient with delayed drainage did not improve after endoscopic sphincterotomy. Two patients demonstrated pooling of 99mTc HIDA in cystic dilatations of the biliary tree, while the other 13 patients had obstruction of the distal common bile duct and impaired flow demonstrated on the 99mTc HIDA scan. All 13 of these patients had papillary stenosis proven by ERCP. The authors conclude that 99mTc HIDA scanning is a valuable, minimally invasive method of diagnosing papillary stenosis.

Topics: Ampulla of Vater; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy; Common Bile Duct Diseases; Constriction, Pathologic; Humans; Imino Acids; Pain, Postoperative; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin