technetium-tc-99m-mebrofenin and Biliary-Tract-Diseases

A study was undertaken to check the feasibility of measuring the hepatic extraction fraction (HEF) and excretion T-1/2 values as an integral part of hepatobiliary imaging with technetium-99m-mebrofenin in health and disease. In 18 controls subjects, the HEF was 100% and the T-1/2 excretion mean +/- s.e. value was 15.23 +/- 1.4 min. The mean appearance times of the common bile duct (CBD), gallbladder (GB), and small intestine were 15.8 +/- 1.52, 20.2 +/- 2.7, and 23.8 +/- 3.08 min, respectively. Rising serum bilirubin in patients decreased HEF and increased T-1/2 excretion value resulting in delayed appearance of CBD, GB, and small intestine. In control subjects and patients with bilirubin less than 5 mg%, T-1/2 excretion values at 30, 40, and 50 min were similar to those values calculated using the entire 60 min of data, suggesting that the hepatic phase study time could be reduced to 30-40 min and still use the normal reference values established for 60 min. In patients with bilirubin greater than 5 mg%, the data collection duration should be continued for 60 min.

Topics: Aniline Compounds; Biliary Tract; Biliary Tract Diseases; Bilirubin; Female; Glycine; Humans; Imino Acids; Liver; Liver Diseases; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Reference Values; Time Factors

The patient is a 44-year-old woman with Crohn's disease, who presented to the ED with abdominal pain. Initial imaging by CT and US showed mild biliary tree dilatation, mild gallbladder distension, and pericholecystic fluid. The cystic and common bile ducts were patent without bile leak on cholescintigraphy. The next day, MRCP revealed free fluid extending from the gallbladder fossa to the right lower quadrant. Subsequently, a repeat cholescintigraphy was performed which was positive for bile leak. This case highlights the use of multiple imaging modalities in assessing abdominal pain, pre-and post-biliary leak.

Topics: Adult; Aniline Compounds; Biliary Tract Diseases; Female; Glycine; Humans; Imino Acids; Multimodal Imaging; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The management of patients with symptoms consistent with biliary tract disease but without evidence of cholelithiasis is difficult. This study was undertaken to test the value of cholescintigraphy in predicting the success of cholecystectomy in patients with acalculous biliary tract disorders.. A prospective study was carried out on 73 patients presenting with recurrent upper quadrant pain without documented evidence of gallstones on ultrasound. Fatty meal-cholescintigraphy was performed on all patients and the gallbladder ejection fraction was calculated. Laparoscopic cholecystectomy was performed in patients with ejection fractions of <40%, followed by histopathological analysis and assessment of symptomatic improvement.. There were 43 men and 30 women with a mean age of 33.4 years. Forty-one patients had abnormal ejection fractions. All except one patient had a laparoscopic cholecystectomy. The pathological diagnosis of chronic cholecystitis was made in 33 patients and acute on chronic cholecystitis documented in four patients. Five patients had cholesterolosis and two of these had associated chronic cholecystitis. All except three patients had complete relief of symptoms post-operatively with a mean follow-up of 10 months.. Modified cholescintigraphy is a useful test for predicting which patients with acalculous biliary tract disease benefit from a cholecystectomy.

Topics: Adult; Aged; Aniline Compounds; Biliary Tract Diseases; Cholecystectomy, Laparoscopic; Female; Glycine; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Prospective Studies; Radiopharmaceuticals

Nonoperative management of blunt liver trauma may delay diagnosis of related biliary complications leading to delayed surgical intervention and related morbidity. The aim of this study was to see whether technetium (tc) 99 trimethylbromo-im-indolacetic acid (TBIDA) nuclear scan would allow noninvasive early diagnosis of bile leak and pre-emptive management.. Retrospective analysis of the patient records and radiologic investigations of 7 patients admitted between April 1998 and December 2000 with "major" blunt liver trauma (parenchymal fracture of less than 4 cm on computed tomography [CT] scan or involving porta hepatis) and various types of biliary complications. Patients with or without early TBIDA diagnosis were compared.. There were 7 patients. The first 2 patients were treated conventionally without TBIDA, and late diagnosis was associated with further related problems (sepsis, life-threatening hemorrhage in both cases) and prolonged hospital stay. The subsequent 5 consecutive patients benefited from early diagnosis (TBIDA scan, 2 to 4 days after trauma), and preemptive management was done (tailored to each case). There was no further or related morbidity. All 7 patients currently are alive and well.. A TBIDA nuclear medicine scan was efficient in providing an early diagnosis of biliary leakage, thus, allowing adequate preemptive management. In turn, this may have helped avoid related added morbidity compared with cases of late diagnosis. Early TBIDA scan should be performed routinely when the initial CT scan confirms liver trauma graded as "major."

Topics: Adolescent; Aniline Compounds; Bile Ducts; Biliary Tract Diseases; Child; Glycine; Humans; Imino Acids; Liver; Male; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Time Factors; Tomography, X-Ray Computed; Wounds, Nonpenetrating

Intrabiliary rupture is the most common complication of hepatic hydatid cyst yet it is unusual, occurring in only 3-17% of cases. The diagnosis is rarely difficult on ultrasound and CT when typical radiological features are present. In rare cases of complete evacuation, when characteristic findings of hydatid cyst are absent or when there is no evidence of the previous existence of liver hydatid cyst, the diagnosis may be difficult. In difficult cases, MRI, MRCP, ERCP and (99)Tc(m)-mebrofenin hepatobiliary scintigraphy are employed. We present a rare case of surgical obstructive jaundice due to rupture of a liver hydatid cyst into the biliary tract and gall bladder, with complete evacuation of its contents leading to misdiagnosis on CT and ultrasound. MRCP and (99)Tc(m)-mebrofenin hepatobiliary scintigraphy were able to establish a firm pre-operative diagnosis.

Topics: Aniline Compounds; Biliary Tract Diseases; Diagnosis, Differential; Echinococcosis, Hepatic; Gallbladder Neoplasms; Glycine; Humans; Imino Acids; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Organotechnetium Compounds; Rupture, Spontaneous; Tomography, X-Ray Computed

Biliary complications are a significant cause of morbidity and death after orthotopic liver transplantation (OLT). This study was a prospective evaluation of endoscopic retrograde cholangiography (ERC) and hepatobiliary scintigraphy (HBS), using 99mTc Mebrofenin, to detect early biliary complications following OLT.. One hundred consecutive patients who had OLT with a biliary duct-to-duct anastomosis were studied. Of these, 67 had both ERC and HBS performed within 30 days of OLT. Sensitivity, specificity and diagnostic accuracy of HBS in identifying biliary leak or stricture was calculated.. Of the 67 cholangiographies performed 45 were normal. In 22 patients there was radiological evidence of a leak (n = 14) or stricture (n = 8) which required further intervention in nine and four patients respectively. The sensitivity and specificity of scintigraphy for the detection of biliary leak after transplantation was 50 and 79 per cent and for biliary stricture 62 and 64 per cent respectively. No patient with normal scintigraphy required biliary intervention. Only six of 14 patients with biliary leaks and two of 20 with strictures suggested by scintigraphy required intervention. If both ERC and HBS reported leak or stricture, the intervention rate was considerably higher at five of seven leaks and two of five strictures.. This study suggests that scintigraphy is a useful screening test for biliary complications after OLT, ERC is only necessary if HBS is abnormal.

Topics: Adolescent; Adult; Aged; Aniline Compounds; Biliary Tract Diseases; Child; Cholangiography; Endoscopy, Gastrointestinal; Female; Glycine; Humans; Imino Acids; Liver Transplantation; Male; Middle Aged; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity

Topics: Adult; Aniline Compounds; Biliary Tract; Biliary Tract Diseases; Child; Glycine; Humans; Imino Acids; Liver; Liver Diseases; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Disofenin

Twelve patients with biliary colic had no evidence of gallstones but underwent cholecystokinin-augmented hepatobiliary scintigraphy that revealed gallbladder ejection fractions of less than 35%. All 12 patients underwent cholecystectomy. Biliary colic was relieved in all patients at a mean postoperative follow-up of 2.5 years. The biliary colic in these patients was probably caused by abnormal gallbladder emptying, itself apparently produced by either cystic duct obstruction or abnormal motility. Biliary abnormality was seen at operation in most patients, and all patients had abnormalities of the gallbladder or cystic duct seen grossly or histologically. These abnormalities included cystic duct stenosis or adhesions, chronic inflammation, and cholesterolosis.

Topics: Adult; Aged; Aniline Compounds; Biliary Tract Diseases; Cholecystectomy; Colic; Female; Follow-Up Studies; Gallbladder; Glycine; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sincalide; Technetium Tc 99m Disofenin

Fifty-five hepatobiliary scintigraphic studies using 99mTc-Mebrofenin were performed in 52 orthotopic liver transplant patients to evaluate suspected biliary complications, namely biliary extravasation and extrahepatic obstruction. Final diagnosis was made by analysis of the clinical course and other procedures. Three out of three studies of biliary leak and four out of five studies of biliary obstruction were detected. There were no false positives in either complication. The sensitivity, specificity and accuracy were 100, 100, 100% for ectravasation and 80, 100, 98% for obstruction, respectively. Hepatobiliary scintigraphy appears to be an accurate means of detecting biliary leak and obstruction associated with the transplanted liver.

Topics: Adolescent; Adult; Aged; Aniline Compounds; Biliary Tract Diseases; Child; Female; Glycine; Humans; Imino Acids; Liver Transplantation; Male; Middle Aged; Organotechnetium Compounds; Postoperative Complications; Radionuclide Imaging

Six healthy individuals and six patients with a wide range of hepatobiliary function abnormalities were studied with Tc-99m-trimethylbromo-IDA; all normal subjects and four of the six patients were also studied with Tc-99m-diisopropyl-IDA. Visual evaluation of analog images demonstrated a greater liver-to-kidney ratio for Tc-99m-trimethylbromo-IDA (p less than 0.01). Sampling for radiopharmaceutical in urine at three hours following injection demonstrated that Tc-99m-trimethylbromo-IDA had a lower renal excretion rate than Tc-99m-diisopropyl-IDA regardless of whether hepatocyte function was normal or abnormal (p less than 0.01). There were no significant differences between the two radiopharmaceuticals in hepatocyte extraction efficiency or hepatic parenchymal transit time. It is concluded that the lower rate of renal excretion and, therefore, greater hepatocyte specificity of Tc-99m-trimethylbromo-IDA justifies expanded clinical trials and may make it the radiopharmaceutical of choice for hepatobiliary imaging.

Topics: Adult; Aniline Compounds; Biliary Tract; Biliary Tract Diseases; Drug Evaluation; Glycine; Humans; Imino Acids; Liver; Liver Diseases; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin