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

The purpose of the study was to determine the distribution of excreted bile during cholestatic periods and in remission in patients with progressive familial intrahepatic cholestasis (PFIC) after surgery with partial external biliary diversion (PEBD), using hepatobiliary scintigraphy.. Using intravenously administered technetium Tc 99m-labeled mebrofenin, the distribution of bile during periods of biochemical cholestasis and in remission was investigated in patients with PFIC operated with PEBD. Stomal bile, urine, and feces from the patients were collected during 24 hours after administration of technetium Tc 99m-labeled mebrofenin; and the fractions of remaining radioactivity in the 3 compartments and the remaining isotopic activity in the body were quantified using scintigraphy.. Nine patients (4 boys and 5 girls) were studied. The median age was 13 (range, 5-24) years, and they had been operated with PEBD at a median time of 10 (range, 4-14) years before entering the study. Thirteen scintigraphic examinations were analyzed: 8 during noncholestatic remission (n = 7 patients) and 5 during cholestasis (n = 3 patients). The patients studied during remission discharged a significantly larger fraction of isotopic activity through the stoma (median, 90% vs 22%; P < .05) and a significantly lower fraction through the urine (median, 2.5% vs 15%; P < .05) compared with the patients studied during cholestasis.. Hepatobiliary scintigraphy could detect substantial differences in the output of bile. Further studies are needed to determine whether these differences may explain the mechanism of the PEBD operation or merely are secondary to the degree of cholestasis.

Topics: Adolescent; Adult; Aniline Compounds; Bile; Bile Acids and Salts; Bile Ducts; Biliary Tract; Bilirubin; Child; Child, Preschool; Cholestasis, Intrahepatic; Dietary Fats; Feces; Female; Glycine; Humans; Imino Acids; Liver; Male; Organotechnetium Compounds; Postoperative Complications; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Surgical Stomas

Topics: Adult; Aniline Compounds; Cholangiography; Cholecystectomy; Choledochostomy; Cholestasis, Intrahepatic; Constriction, Pathologic; Female; Glycine; Humans; Imino Acids; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals

Topics: Aniline Compounds; Bile Ducts, Intrahepatic; Cholestasis, Extrahepatic; Cholestasis, Intrahepatic; Cysts; Female; Glycine; Humans; Imino Acids; Jaundice; Liver; Liver Diseases; Middle Aged; Organotechnetium Compounds; Polycystic Kidney Diseases; Radionuclide Imaging; Radiopharmaceuticals

Technetium-99m mebrofenin hepatobillary excretory patterns were assessed in 36 infants with hyperbilirubinemia. Phenobarbital was administered to 22 patients before imaging. Final diagnoses included: intrahepatic cholestasis (14 patients), neonatal hepatitis (nine patients), biliary atresia (eight patients), alpha-1-antitrypsin deficiency (two patients), Alagille's syndrome (two patients), and cystic fibrosis (one patient). No patient with biliary atresia showed bowel activity by 24 hours. Of the 28 infants without biliary atresia, 23 (82%) had bowel activity visualized by 6-8 hours and 26 (90%) had bowel activity by 24 hours. Two had no bowel activity at 24 hours: one had cystic fibrosis and one had neonatal hepatitis. Of the 26 patients with bowel visualization, the time to visualize bowel did not differ between patient groups with and without phenobarbital induction. All of the patients with hepatitis, including those with marked dysfunction, showed good hepatic uptake. Mebrofenin scintigraphy is an important imaging technique in the diagnostic evaluation of infants with hyperbilrubinemia. In addition to biliary atresia, intrahepatic cholestasis due to cystic fibrosis and severe neonatal hepatitis may also cause bowel nonvisualization up to 24 hours. The results of this study suggest phenobarbital induction may not be needed when Tc-99m mebrofenin scintigraphy is used for the assessment of infantile jaundice.

Topics: Aniline Compounds; Biliary Atresia; Cholestasis, Intrahepatic; Female; Glycine; Hepatitis; Humans; Imino Acids; Infant; Infant, Newborn; Jaundice, Neonatal; Liver; Male; Organotechnetium Compounds; Phenobarbital; Radionuclide Imaging; Time Factors; Ultrasonography

A patient with cystic fibrosis and a previous cholecystectomy, underwent Tc-99m mebrofenin scintigraphy to rule out hepatobiliary disease. The scan revealed multiple focal collections of radiopharmaceutical within the liver parenchyma. This unusual pattern of multiple focal parenchymal activity may be specific for patients with cystic fibrosis. This is the first time this unusual pattern has been confirmed at autopsy.

Topics: Adult; Aniline Compounds; Bile Ducts, Intrahepatic; Cholestasis, Intrahepatic; Cystic Fibrosis; Dilatation, Pathologic; Fatal Outcome; Female; Glycine; Humans; Imino Acids; Organotechnetium Compounds; Radionuclide Imaging

Hepatobiliary scintigraphy with technetium-99m-mebrofenin including a first-pass study of 60 two-sec images and a functional phase of 40 one-min images was performed in 26 patients (42.5 +/- 12.5 yr) in the early postoperative period (9.1 +/- 4.3 days) after liver grafting. Needle biopsy was carried out within a mean of 0.5 +/- 2.2 days of the scintigraphy study. Considering only rejection and cholestasis, biopsy results were used to classify the patients in three groups: control group I (11 patients) with minimal lesions, group II (9 patients) with moderate histologic modifications, and group III (6 patients) with severe dysfunction showing important structural changes. First-pass time-activity curves were used to calculate arterial (alpha-A) and portal (alpha-P) angles as well as a portal perfusion index. Functional time-activity curves were used to define two blood retention indices (BRI1 and BRI2) and two liver uptake indices (LUI1 and LUI2). Excretion was not quantified.. Simple linear regression analysis showed a significant correlation between portal perfusion index and BRI1 (p < 0.05, r = -0.43) and BRI2 (p = 0.01, r = -0.53). The validity of the histologic classification was assessed by the existence of significantly different (p < 0.05) mean values for alpha-P, portal perfusion index and LUI1 in the three groups. All other indices could distinguish significantly between groups I and II. Furthermore, arterial angle alpha-A allowed differentiation of group II from group III but not group I from group II; on the contrary, LUI2 and BRI1 distinguished group I from group II but not group II from group III.. This study demonstrated a close correlation between early biopsy results and perfusion indices in patients with a liver graft as well as uptake parameters determined by hepatobiliary scintigraphy.

Topics: Adult; Aniline Compounds; Biopsy, Needle; Cholestasis, Intrahepatic; Female; Glycine; Graft Rejection; Humans; Imino Acids; Linear Models; Liver; Liver Transplantation; Male; Organotechnetium Compounds; Postoperative Complications; Radionuclide Imaging; Time Factors

Previous results from tests on a limited number of patients suggested that the combination of relatively normal hepatocyte clearance, prolonged parenchymal transit time, and eventual passage of radiotracer into the intestine or gallbladder without evidence of biliary tract dilatation were relatively specific for intrahepatic cholestasis. We reevaluated the specificity of cholescintigraphy for the diagnosis of intrahepatic cholestasis in an unselected group of patients from a general hospital. Sixteen patients had the cholescintigraphic findings of intrahepatic cholestasis and an established diagnosis of biliary tract dilatation or nondilatation by ultrasound, ERCP, or intraoperative cholangiography. Using 6 mm as the upper limits of normal for the diameter of the common hepatic duct by ultrasonography resulted in a specificity of 63% (10 correct out of 16); using 6 mm plus 1 mm for for every decade over 60 years of age gave a specificity of 75% (12 correct out of 16); and using the more liberal criterion of 8 mm as the upper limits of normal increased the specificity to 81% (13 out of 16). The data suggest that cholescintigraphy alone is unreliable in differentiating intrahepatic cholestasis from extrahepatic obstruction, even when the obstruction is partial and radiotracer eventually passes through the extrahepatic biliary tract.

Topics: Aniline Compounds; Bile Ducts; Cholestasis, Extrahepatic; Cholestasis, Intrahepatic; Evaluation Studies as Topic; Female; Gallbladder; Glycine; Humans; Imino Acids; Liver; Male; Middle Aged; Organotechnetium Compounds; Premedication; Radionuclide Imaging; Sensitivity and Specificity; Sincalide; Technetium Tc 99m Disofenin