technetium-tc-99m-sulfur-colloid and Biliary-Tract-Diseases

The interaction between the various noninvasive and invasive imaging modalities used to evaluate the liver, biliary tract, and pancreas is demonstrated in this article. By understanding this interaction and correlating noninvasive studies, the clinician will avoid diagnostic redundancy and the need for invasive testing may be reduced.

Topics: Adenocarcinoma; Biliary Tract Diseases; Biopsy, Needle; Cholangiography; Cholecystectomy; Cholelithiasis; Cholestasis; Diagnosis, Differential; Hepatectomy; Humans; Liver; Liver Diseases; Liver Neoplasms; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Radionuclide Imaging; Spleen; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

Radionuclide techniques are currently used to fully evaluate many congenital and acquired abnormalities of the gastrointestinal tract of children. Frequently, the anatomic and functional data provided by the nuclear examination are definitive. In the study of many disease entities, tracer techniques have replaced more cumbersome or invasive procedures. Although the radiopharmaceuticals and instrumentation are similar as applied to both children and adults, the uniqueness of children and their disease entities requires special consideration when performing and interpreting their studies. In this review, the principle radionuclide examinations used in the evaluation of pediatric gastrointestinal disorders are detailed and examples are illustrated.

Topics: Bile Ducts, Intrahepatic; Biliary Tract; Biliary Tract Diseases; Child; Common Bile Duct Diseases; Computers; Cysts; Gastroesophageal Reflux; Gastrointestinal Diseases; Humans; Infant, Newborn; Jaundice, Neonatal; Liver; Liver Diseases; Meckel Diverticulum; Postoperative Care; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Controversy exists over the relation between gallbladder dysfunction and the propensity for duodenogastric reflux. To evaluate this, Tc-99m DISIDA hepatobiliary imaging studies in 120 patients were reviewed, excluding patients who had had cholecystectomy or subtotal gastrectomy before scintigraphy. Serial images were obtained at 5, 10, 15, 30, 45, and 60 minutes and up to 24 hours, if indicated, after intravenous injection of 5-10 mCi of Tc-99m DISIDA. Normally, the liver, bile ducts, gallbladder, common bile duct, and bowel are visualized sequentially. Reversal of the normal sequence of gallbladder (GB) and bowel visualization indicates GB dysfunction; nonvisualization of the GB reflects cystic duct obstruction or absent GB function. Duodenogastric reflux is identified by radiotracer localized in the area just below or immediately adjacent to the tip of the left hepatic lobe. The intragastric location of the tracer may be verified by oral administration of 300 uCi of Tc-99m sulfur colloid. Twenty-nine patients had duodenogastric reflux between 10 and 60 minutes after injection. Of the 29 patients, 22 had a nonvisualized gallbladder, four had reversal of appearance of GB and bowel activity, and three had a normal study. GB dysfunction or nonfunction is more frequently demonstrated when duodenogastric reflux is present than with normal gallbladder function (P less than 0.001). In conclusion, gallbladder malfunction is closely associated with duodenogastric reflux, an abnormality that may be diagnosed noninvasively by Tc-99m DISIDA hepatobiliary scintigraphy.

Topics: Adult; Aged; Aged, 80 and over; Bile Reflux; Biliary Tract Diseases; Gallbladder Diseases; Humans; Imino Acids; Male; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid

The postoperative diagnostic imaging examinations of 44 children who underwent 59 orthotopic liver transplantations were reviewed. The imaging modalities used for the evaluation of suspected complications include plain roentgenography, ultrasonography (US), computed tomography (CT), nuclear scintigraphy, arteriography, percutaneous and operative cholangiography, and endoscopic retrograde cholangiopancreatography. The main postoperative complications included ischemia, thrombosis (hepatic artery and portal vein), infarction, obstruction or leakage of the biliary anastomosis, hepatic and perihepatic infection, and allograft rejection. US, the most frequently used abdominal imaging modality, was best suited for detection of biliary duct dilatation, fluid collections in or around the transplanted liver, and hepatic arterial, inferior vena caval, and portal vein thrombosis. CT was especially helpful in corroborating findings of infection and in locating abscesses. Technetium 99m sulfur colloid (early- and late-phase imaging) provided a sensitive, although nonspecific, means of assessing allograft vascularization and morphology. Angiography showed vascularity most clearly, and cholangiography was the most useful in the assessment of bile duct patency. A diagnostic imaging algorithm is proposed for evaluation of suspected complications.

Topics: Adolescent; Angiography; Biliary Tract Diseases; Child; Child, Preschool; Cholangiography; Cholangiopancreatography, Endoscopic Retrograde; Female; Graft Rejection; Humans; Infant; Liver; Liver Transplantation; Male; Postoperative Care; Postoperative Complications; Radionuclide Imaging; Retrospective Studies; Surgical Wound Infection; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

Topics: Biliary Tract Diseases; Diagnosis, Differential; False Positive Reactions; Humans; Imino Acids; Liver; Liver Neoplasms; Radionuclide Imaging; Rhenium; Sulfur; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid; Technetium Tc 99m Sulfur Colloid