technetium-tc-99m-mebrofenin and Chronic-Disease

A redundant collateral network between the intestinal arteries is present at all times. In case of ischaemia in the gastrointestinal tract, the collateral blood supply can develop further, thus accommodating the demand for oxygen even in the presence of significant stenosis or occlusion of the intestinal arteries without clinical symptoms of intestinal ischaemia. Symptoms of ischemia develop when the genuine and collateral blood supply no longer can accommodate the need for oxygen. Atherosclerosis is the most common cause of obliteration in the intestinal arteries. In chronic intestinal ischaemia (CII), the fasting splanchnic blood flow (SBF) is sufficient, but the postprandial increase in SBF is inadequate and abdominal pain will therefore develop in relation to food intake causing the patient to eat smaller meals at larger intervals with a resulting weight loss. Traditionally, the CII-diagnosis has exclusively been based upon morphology (angiography) of the intestinal arteries; however, substantial discrepancies between CII-symptoms and the presence of atherosclerosis/stenosis in the intestinal arteries have been described repeatedly in the literature impeding the diagnosis of CII. This PhD thesis explores a method to determine the total SBF and its potential use as a diagnostic tool in patients suspected to suffer from CII. The SBF can be measured using a continuous infusion of a tracer and catheterisation of a hepatic vein and an artery. By measuring the SBF before and after a standard meal it is possible to assess the ability or inability to enhance the SBF and thereby diagnosing CII. In Study I, measurement of SBF was tested against angiography in a group of patients suspected to suffer from CII due to pain and weight loss. A very good agreement between the postprandial increase in SBF and angiography was found. The method was validated against a well-established method independent of the hepatic extraction of tracer using pAH in a porcine model (study II). An excellent agreement was found between the two methods for the measurement of SBF. In the same set-up metabolism and recirculation in the intestines of the 99mTechnetium labelled tracer was rejected based on the consistency between the portal and arterial contents of tracer. Based on this study we concluded that an arterial blood sample can be used instead of a portal blood sample, making the method applicable to patients. In study III, 20 healthy volunteers and 29 patients with weight loss and

Topics: Angiography; Aniline Compounds; Animals; Anthropometry; Chronic Disease; Fasting; Glycine; Humans; Imino Acids; Intestinal Diseases; Ischemia; Organotechnetium Compounds; Oxygen Consumption; p-Aminohippuric Acid; Postprandial Period; Radiopharmaceuticals; Splanchnic Circulation; Swine

The diagnosis chronic intestinal ischaemia (CII) is based on the clinical symptoms postprandial pain and weight loss combined with abnormal findings during angiography. Despite the well-known poor correlation between symptoms and morphology, physiological tests are rarely performed.. It is possible to measure the total splanchnic blood flow (SBF) before and after a test meal, and the results supply additional information to the morphologic investigations. To date, no papers have addressed the impact of morphologic changes of the mesenteric arteries on the SBF.. Forty-six consecutive patients suspected of CII were investigated. The routine investigation included angiography and measurements of the SBF before and after a test meal. Measurements of the total SBF were performed using the 'Fick principle'. (99m)Technetium-labelled Mebrofenin was used as a tracer. Digital subtraction angiography was performed.. Agreement between SBF and angiography was found in 44 of 46 patients. Mean baseline SBF for all patients was 985 ml/min, total range (525-1932) and within the reported normal range. The mean postprandial increase in SBF was 480 mL min(-1) (-130 to 1353), thus 36 patients were categorized as normal by both angiography and SBF, eight patients were abnormal by both methods and two patients had abnormal SBF but normal angiography.. In this cohort, SBF detects CII with sensitivity of 1.0, and specificity of 0.95. SBF supplies additional information in patients with convincing symptoms and normal angiography. In these patients, the affection of the intestinal arteries may be too distant or too subtle to be visualized on angiography.

Topics: Adult; Aged; Aged, 80 and over; Angiography; Aniline Compounds; Blood Flow Velocity; Chronic Disease; Cohort Studies; Female; Follow-Up Studies; Glycine; Humans; Imino Acids; Intestines; Ischemia; Male; Mesenteric Arteries; Middle Aged; Organotechnetium Compounds; Oxygen Consumption; Radionuclide Imaging; Sensitivity and Specificity; Splanchnic Circulation

With recent advances in liver imaging, the estimation of liver concentrations is now possible following the injection of hepatobiliary contrast agents and radiotracers. However, how these images are generated remains partially unknown. Most experiments that would be helpful to increase this understanding cannot be performed

Topics: Aniline Compounds; Animals; ATP-Binding Cassette Transporters; Bile Canaliculi; Biological Transport; Chronic Disease; Glycine; Hepatocytes; Imino Acids; Liver; Liver Cirrhosis, Biliary; Magnetic Resonance Imaging; Meglumine; Organometallic Compounds; Organotechnetium Compounds; Perfusion; Rats; Temperature; Tissue Distribution

Afferent loop syndrome is caused by intermittent mechanical obstruction of the afferent loop of a gastrojejunostomy and may present early as an acute type or late as a chronic type. The authors describe two patients who were examined for a history of bilious vomiting after gastrojejunostomy, and who were thought to have afferent loop syndrome (chronic type) based on clinical findings. Results of routine investigations, such as upper gastrointestinal endoscopy, and ultrasonography were inconclusive. Findings from the barium meal follow-through studies were normal in the first patient and revealed a dilated duodenum in the second patient. Tc-99m bromotriethyl-iminodiacetic acid has been used to identify afferent loop obstruction as represented in these studies.

Topics: Adult; Afferent Loop Syndrome; Aged; Aniline Compounds; Barium Sulfate; Bile Ducts, Intrahepatic; Chronic Disease; Contrast Media; Duodenum; Endoscopy, Gastrointestinal; Glycine; Humans; Imino Acids; Male; Organotechnetium Compounds; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Ultrasonography

We retrospectively reviewed the medical records of 107 patients in two community hospitals who had undergone cholecystokinin-stimulated cholescintigraphy with ejection fraction to determine whether this test is reliable in identifying patients whose symptoms will improve following cholecystectomy. Patients with cholelithiasis or incomplete medical records and patients who could not be interviewed were excluded from the study. Forty-two of 58 study patients (72%) had an abnormal ejection fraction (defined as 35% or less); 27 of 42 patients (64%) underwent cholecystectomy. Twenty-six of 27 (96%) reported lessening of or resolution of symptoms following cholecystectomy. Sixty-seven per cent of the surgical specimens from the 27 patients demonstrated chronic cholecystitis. Fifteen of 42 patients (36%) with abnormal ejection fractions did not undergo cholecystectomy; 12 of 15 (80%) also reported lessening or resolution of symptoms. Of the 16 of 58 patients with a normal ejection fraction, 2 underwent cholecystectomy and reported resolution of symptoms. Five of 14 (36%) with normal ejection fractions who did not undergo cholecystectomy reported improvement. In this series, most patients with an abnormal ejection fraction had lessening of symptoms regardless of whether they underwent cholecystectomy.

Topics: Adult; Aniline Compounds; Case-Control Studies; Cholecystectomy; Cholecystitis; Chronic Disease; Female; Gallbladder; Gallbladder Emptying; Glycine; Humans; Imino Acids; Logistic Models; Male; Middle Aged; Organotechnetium Compounds; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sincalide

This study investigated the value of morphine-augmentation in patients who demonstrated gallbladder nonvisualization with a pericholecystic rim sign at 1 hr, a cholescintigraphic pattern considered highly predictive of acute cholecystitis.. Retrospectively, 170 consecutive morphine-augmented cholescintigrams were analyzed for the presence of a pericholecystic rim sign, marked or mild, associated with gallbladder nonvisualization at 1 hr (before morphine); those with a pericholecystic rim sign were further evaluated for persistent gallbladder nonvisualization versus gallbladder visualization after morphine. Scintigraphic interpretations were correlated with surgical pathology or clinical diagnosis.. Before morphine, 43/170 (25%) patients demonstrated gallbladder nonvisualization with a pericholecystic rim sign. Since only 31 had acute cholecystitis, a diagnosis based solely on that scintigraphic pattern would have resulted in 12 false-positives. After morphine, gallbladder visualization correctly excluded acute cholecystitis in seven; a single false-negative was encountered; five false-positives remained. Morphine-augmentation improved the positive predictive value from 72% (gallbladder nonvisualization with pericholecystic rim sign before morphine) to 86% (gallbladder nonvisualization after morphine). Of 24 patients with marked pericholecystic rim signs, 21 had acute cholecystitis. Of 31 with acute cholecystitis, however, 10 (32%) had a mild pericholecystic rim sign.. Morphine-augmented cholescintigraphy optimizes the diagnosis of acute cholecystitis in patients with the suggestive, but not pathognomonic, cholescintigraphic pattern at 1 hr of gallbladder nonvisualization with a pericholecystic rim sign, regardless of its intensity.

Topics: Acute Disease; Aniline Compounds; Case-Control Studies; Cholecystitis; Chronic Disease; False Positive Reactions; Female; Gallbladder; Glycine; Humans; Imino Acids; Liver; Male; Middle Aged; Morphine; Organotechnetium Compounds; Predictive Value of Tests; Radionuclide Imaging; Retrospective Studies; Time Factors

Morphine intervention in cholescintigraphy decreases imaging time to diagnose acute cholecystitis. Not infrequently we observe duodenogastric reflux during scintigraphy with and without morphine intervention. To evaluate occurrence of duodenogastric reflux related to morphine, we reviewed 55 patients who underwent cholescintigraphy with (32) and without (23) morphine intervention. Morphine was injected when there was bowel activity with non-visualization of the gallbladder at 60 min. Duodenogastric reflux was identified by the appearance of activity in the area just below or immediately adjacent to the tip of the left hepatic lobe laterally. Among 32 patients with morphine intervention, 19 had acute cholecystitis and 13 chronic cholecystitis. Eleven of 19 (58%) with acute cholecystitis had duodenogastric reflux and 6 of 13 (46%) had duodenogastric reflux in chronic cholecystitis. The total of duodenogastric reflux in the group with morphine injection was 53%. Two patients' duodenogastric reflux occurred before morphine injection and was more apparent after morphine was given. In the without morphine group, 3 had acute cholecystitis and 20 had chronic cholecystitis; 2 (one acute and one chronic cholecystitis) of these 23 (9%) had duodenogastric reflux. Our results indicate: (1) occurrence of DG reflux in morphine augmented cholescintigraphy is not significantly different in cholecystitis from that in chronic cholecystitis; (2) duodenogastric reflux in morphine augmentation occurs significantly more often than without morphine intervention (p < 0.001). We conclude that cholescintigraphy with morphine enhances duodenogastric reflux. The degree of duodenogastric reflux in the acute cholecystitis patients has been more severe than in the chronic cholecystitis patients.

Topics: Acute Disease; Aniline Compounds; Cholecystitis; Chronic Disease; Duodenogastric Reflux; Evaluation Studies as Topic; Gallbladder; Glycine; Humans; Imino Acids; Morphine; Organotechnetium Compounds; Radionuclide Imaging

During the first hour of cholescintigraphy, both the gallbladder and small bowel are visualized in the majority of normal subjects and patients with chronic cholecystitis. Usually, radioactive bile flows initially into the gallbladder followed by passage into the small bowel. To determine whether a reversed sequence of bile flow (i.e., small bowel followed by gallbladder) could serve as an indicator of chronic cholecystitis, 141 hepatobiliary scans were reviewed retrospectively with attention to the relative order of gallbladder and small bowel appearance during the first hour. The scintigraphic findings were correlated with results from real-time gallbladder ultrasonography in all 141 patients and gallbladder histopathology in a subset of 35 (25%). The specificity of a reversed sequence for chronic cholecystitis was 79% using ultrasonography and 100% for histopathology. This phenomenon likely reflects altered biliary flow dynamics secondary to recurrent inflammation and fibrosis. In patients referred for possible biliary tract disease, visualization of the gallbladder after the small bowel appears to predict chronic cholecystitis.

Topics: Aniline Compounds; Bile; Cholecystitis; Chronic Disease; Female; Gallbladder; Glycine; Humans; Imino Acids; Intestine, Small; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Time Factors; Ultrasonography