technetium-tc-99m-lidofenin and Liver-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: Biliary Tract; Colloids; Gallbladder; Gallium Radioisotopes; Humans; Imino Acids; Iodine Radioisotopes; Liver; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Organotechnetium Compounds; Radionuclide Imaging; Rose Bengal; Sulfur; Technetium; Technetium Tc 99m Lidofenin; Technetium Tc 99m Sulfur Colloid

The function of polygonal liver cells can be estimated by using liver specific dyes such as labelled BSP or bengalrosa and labelled X-ray contrast media. Various methods are available: clearance with blood counting or external monitoring, whole body clearance and retention measurement. These tests are of value for following the course of liver diseases. Blood flow measurements either with labelled colloids or 133 Xe are mainly used for scientific purposes. Portosystemic shunts can be detected by injection of labelled microspheres in the spleen and lung monitoring or scanning. With the dynamic scintigraphy portosystemic shunts can be visualized ( radionuclide splenoportography). The measurement of the praecordial appearance time after rectal instillation of 133 Xe permits the functional evaluation of a surgical portosystemic shunt. Dynamic scintigraphy makes possible the estimation of the arterial part of liver blood flow after i.v. injection of 99m Tc and this together with the radionuclide splenoportography allows the assessment of disturbed blood flow in patients with portal hypertension. I. v. applied parathyroid hormone increases the arterial hepatic blood flow. Preliminary results indicate that patients with portal hypertension and a good response to parathyroid hormone seem to have a good prognosis after shunt operation. The determination of red cell survival with 51 Cr is helpful in the differential diagnosis of jaundice. The specificity of liver scanning with labelled colloids for malignant diseases can be reasonably increased by additional 67 Ga-scintigraphy. In the diagnosis of hepatoma with both colloid and Galliumscan and the evaluation of alpha-fetoprotein a 90% accuracy can be achieved. The hepatobiliary transport can easily be visualized with 99m Tc labelled IDA-compounds and also in patients with severe jaundice where the X-ray cholangiopathy is impossible. This examination is indicated in patients with bile duct observations (also intrahepatic), after cholecystectomy, for the differential diagnosis of jaundice, for the demonstration of refluxes etc. The most important radioimmunological in vitro methods for the investigation of liver diseases are only briefly described.

Topics: alpha-Fetoproteins; Bile Acids and Salts; Ferritins; Gallium Radioisotopes; Hepatic Artery; Hepatitis A; Hepatitis B; Humans; Imino Acids; Liver; Liver Circulation; Liver Cirrhosis; Liver Diseases; Liver Function Tests; Liver Neoplasms; Portasystemic Shunt, Surgical; Portography; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Xenon Radioisotopes

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

To evaluate the characterisation of liver lesions using power Doppler sonography before and after intravenous injection of the ultrasound contrast agent Levovist.. 39 patients with 41 liver lesions (10 haemangiomas, 2 focal nodular hyperplasias (FNH), 2 focal fatty infiltrations, 1 echinococcal lesion, 11 hepatocellular carcinomas, 14 metastases and one cholangiocarcinoma) were evaluated prospectively. Power Doppler images before and after intravenous injection of the ultrasound contrast agent Levovist were analysed by two radiologists and one gastroeterologist, who subjectively classified the distribution (peripheral, central, diffuse) and amount (none, minimal, moderate and strong) of flow pattern in each sonographic examination. Histological verification was obtained in all liver lesions, except in haemangiomas, where MR imaging and in one FNH where scintigraphy was regarded as sufficient proof.. On the whole, power Doppler sonography after contrast injection was superior to unenhanced power Doppler-sonography in 20 liver lesions and equal in 7. After contrast injection, previously visible flow was enhanced in 14 patients, in 6 lesions flow was detected, which was not seen before in the power mode. Moderate or strong flow signals were detected before contrast injection in 8/26, post contrast injection in 18/26 malignant tumours. Contrawise, 13/15 benign lesions did show any or only minimal flow signals before and 10/15 after contrast injection.. Intratumoural flow signals favour a malignant tumour. The absence of flow signals is a frequent finding in benign lesions but does not rule out malignancy.

Topics: Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Echinococcosis, Hepatic; Fatty Liver; Hemangioma; Humans; Hyperplasia; Liver; Liver Diseases; Liver Neoplasms; Polysaccharides; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Technetium Tc 99m Lidofenin; Ultrasonography, Doppler

Topics: Female; Humans; Hyperplasia; Imino Acids; Liver; Liver Diseases; Middle Aged; Organotechnetium Compounds; Portal Vein; Radionuclide Imaging; Technetium Tc 99m Lidofenin; Thrombocythemia, Essential; Thrombosis

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

Topics: Adult; Antipyrine; Circadian Rhythm; Contrast Media; Female; Humans; Imino Acids; Liver; Liver Diseases; Male; Metabolic Clearance Rate; Middle Aged; Organotechnetium Compounds; Propranolol; 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

Technetium-99m HIDA hepatic lobar distribution and retention ratios were developed to evaluate patients with intrahepatic lithiasis. The data of 57 cases were analyzed. Results reveal a highly significant difference in these ratios between the patients and normal individuals. They are simple, objective, and easily obtainable. Thus, the determination of these ratios may replace [99mTc]HIDA sequential scintiphotography, which is qualitative and time consuming, for screening intrahepatic lithiasis.

Topics: Calculi; Humans; Imino Acids; Liver; Liver Diseases; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Time Factors

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

Topics: Calculi; Humans; Imino Acids; Liver; Liver Diseases; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Technology, Radiologic

Topics: Calculi; Humans; Image Enhancement; Imino Acids; Liver Diseases; Probability; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Technology, Radiologic

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

Posttraumatic intrahepatic biliary cysts or bilomas were once thought to be rare. With increased use of sonography and 99mTc-HIDA cholescintigraphy, this entity will probably be detected more often. Preoperative sonographic diagnosis of posttraumatic biloma was made in five patients. A well circumscribed, anechoic hepatic lesion with excellent distal sonic enhancement strongly suggests the diagnosis. Cholescintigraphy especially using delayed scans or percutaneous aspiration, can confirm the diagnosis.

Topics: Adult; Bile; Cysts; Humans; Imino Acids; Liver; Liver Diseases; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Ultrasonography

Fifty-two patients were studied with various diseases affecting liver parenchyma. Any disorders of bile transport were excluded on the basis of dynamic liver scintigraphy using intravenously injected N/2,4-dimethyl acetanilido/iminodiacetate 99mTc complex (HEPIDA). The activity concentration of 99mTc-HEPIDA in plasma was measured from 5 through 60 min post injection. Clearance of the substance (ClB) was calculated from blood plasma disappearance curves and compared with results of 13 laboratory tests used conventionally for assessment of damage of the liver and its functional capacity; age and body weight was also included in the analysis. Statistical relations were studied using linear regression analysis of two variables, multiple regression analysis as well as multidimensional analysis of variance. It was demonstrated that 99mTc-HEPIDA clearance is a simple, accurate and repeatable measure of liver parenchyma damage. In males, values of ClB above 245 ml. min-1/1.73 m2 exclude hepatic damage with high probability; values below 195 ml.min-1/1.73 m2 indicate evident impairment of liver parenchyma function.

Topics: Adolescent; Adult; Aged; Chemical and Drug Induced Liver Injury; Humans; Imino Acids; Liver Cirrhosis; Liver Diseases; Male; Middle Aged; Occupational Diseases; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Vinyl Chloride

Topics: Aged; Biliary Tract; Hematoma; Humans; Imino Acids; Liver Diseases; Male; 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

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 merit of concomitant hepatic imaging with Tc-99m-sulfur colloid (SC) and Tc-99m-HIDA was examined in 40 patients with abnormal liver function tests. The studies were performed sequentially within a 2 to 5 day interval with 5 mCi each of SC or HIDA. Routine static images in all cases, and dynamic studies with HIDA in 15 patients, were graded and compared with the liver function tests and clinical diagnoses. Of the 40 patients, the images with SC showed an abnormality in 22 while HIDA images were abnormal in 38. Thirteen of 21 patients with hepatocellular diseases showed an abnormality of the SC images, and 20 of the same 21 patients had abnormal HIDA images. Abnormal HIDA images were more closely related to abnormal liver function tests. These results suggest that alterations of hepatic function reflected by abnormal liver function tests are better demonstrated with hepatobiliary imaging agents than with reticuloendothelial imaging agents, while either type of imaging agents will detect focal anatomic lesions.

Topics: Humans; Imino Acids; Liver Diseases; Liver Function Tests; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Lidofenin; Technetium Tc 99m Sulfur Colloid

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

Topics: Biliary Tract; Cysts; Female; Humans; Imino Acids; Liver Diseases; Middle Aged; 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

Topics: Adolescent; Adult; Aged; Biliary Tract Diseases; Computers; Humans; Imino Acids; Liver Diseases; 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

Radiation dose from Tc-99m HIDA has been calculated for normal subjects and for patients with various hepatobiliary diseases classified into four groups based on serum bilirubin level. The calculation was performed on biokinetic radioactivity data from blood, urine, liver, gallbladder, and intestines, using a biological approach that included a catenary model of the digestive organs. For normal subjects the critical organs were the gallbladder and the upper and lower large intestine, with doses of 910, 300, 200 mrad/mCi, respectively. The bone marrow, ovaries, and testes received 24, 62, and 4 mrad/mCi. For Group 4 patients with severe hepatobiliary disease (bilirubin greater than 10 mg/dl), the critical organs were the kidney, urinary bladder, and gallbladder, with doses of 130, 110, and 100 mrad/mCi. The bone marrow, ovaries, and testes received 9, 13, and 6 mrad/mCi. Thus the critical organs and overall radiation doses to organs change between health and disease.

Topics: Bilirubin; Humans; Imino Acids; Liver Diseases; Models, Biological; Radiation Dosage; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Tissue Distribution

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: Bile Duct Diseases; Bile Ducts, Intrahepatic; Computers; Humans; Imino Acids; Liver; Liver Diseases; Radionuclide Imaging; Subtraction Technique; 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: Bile Acids and Salts; Bile Ducts; Bilirubin; Humans; Imino Acids; Kinetics; Liver Diseases; Liver Function Tests; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

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

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