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This study aimed to evaluate the ratio of glomerular filtration rate (GFR) from 99mTc-diethylenetriamine-pentaacetic acid dynamic renal scan (GFRSCAN) to estimated GFR (eGFR) as a predictor of renal function improvement in patients with azotemia. A retrospective review of medical records was conducted to identify consecutive patients with newly discovered or aggravated azotemia who underwent 99mTc-diethylenetriamine-pentaacetic acid renal scan. Significant renal function improvement was defined as ≥100% and ≥10 mL/min improvement of eGFR at 12 weeks compared to eGFR on the day of renal scan (eGFR0). The GFRSCAN/eGFR0 ratio was evaluated as a predictor of significant renal function improvement using logistic regression and receiver operating characteristic (ROC) curve analyses. Added value of the GFRSCAN/eGFR0 ratio in the prediction of significant renal function improvement were demonstrated by adjusting for best clinical predictor variables. The eligibility criteria were met by 224 patients, among whom 22 patients (9.8%) showed significant renal function improvement. The odds ratios of the GFRSCAN/eGFR0 ratio for predicting significant renal function improvement were 1.76 (95% confidence interval [CI]: 1.26–2.45, P

A 1-year 5-month-old male patient had a history of recurrent cough and pneumonia, which required antibiotics and bronchodilators. CT suggested the possibility of congenital tracheobiliary fistula. However, a diagnosis could not be made based on CT alone. A Tc-EHIDA hepatobiliary scintigraphy was then performed, which led to a definite diagnosis of tracheobiliary fistula.

Cholecystokinin-cholescintigraphy (CCK-HIDA) is commonly performed to evaluate patients with upper abdominal pain thought to be biliary in origin and with a normal gallbladder on abdominal ultrasonography. The nomenclature of this disease entity, based on the finding of an abnormally low gallbladder ejection fraction (GBEF) on the CCK-HIDA examination, varies in the literature and has been known as biliary dyskinesia, gallbladder dyskinesia, functional gallbladder disorder, chronic acalculous cholecystitis, and chronic acalculous biliary dysfunction, just to name a few. For the purposes of this review, we will use the term gallbladder dyskinesia because this is the term most referenced in the surgical literature. Cholecystectomy is commonly recommended as the treatment of choice in these patients. 1 Although used commonly in today’s clinical surgical practice, the CCK-HIDA testing methodology, test interpretation, patient selection, and controversies surrounding long-term treatment outcomes pertaining to surgical intervention for gallbladder dyskinesia are controversial and poorly understood by many practicing clinicians. This review details the controversies surrounding the testing methodology, the method of determining normal vs abnormal CCK-HIDA values, and the data both supporting and questioning its clinical use to select patients for cholecystectomy based on the current available literature. In addition, evidence-based recommendations for the use of CCK-HIDA in clinical practice are presented.

High-dose radiation therapy (RT) for intrahepatic cancer is limited by the development of liver injury. This study investigated whether regional hepatic function assessed before and during the course of RT using 99mTc-labeled iminodiacetic acid (IDA) single photon emission computed tomography (SPECT) could predict regional liver function reserve after RT.Fourteen patients treated with RT for intrahepatic cancers underwent dynamic 99mTc-IDA SPECT scans before RT, during, and 1 month after completion of RT. Indocyanine green (ICG) tests, a measure of overall liver function, were performed within 1 day of each scan. Three-dimensional volumetric hepatic extraction fraction (HEF) images of the liver were estimated by deconvolution analysis. After coregistration of the CT/SPECT and the treatment planning CT, HEF dose-response functions during and after RT were generated. The volumetric mean of the HEFs in the whole liver was correlated with ICG clearance time. Three models, dose, priori, and adaptive models, were developed using multivariate linear regression to assess whether the regional HEFs measured before and during RT helped predict regional hepatic function after RT.The mean of the volumetric liver HEFs was significantly correlated with ICG clearance half-life time (r=-0.80, P.0001), for all time points. Linear correlations between local doses and regional HEFs 1 month after RT were significant in 12 patients. In the priori model, regional HEF after RT was predicted by the planned dose and regional HEF assessed before RT (R=0.71, P.0001). In the adaptive model, regional HEF after RT was predicted by regional HEF reassessed during RT and the remaining planned local dose (R=0.83, P.0001).99mTc-IDA SPECT obtained during RT could be used to assess regional hepatic function and helped predict post-RT regional liver function reserve. This could support individualized adaptive radiation treatment strategies to maximize tumor control and minimize the risk of liver damage.

Since the early 1980s interventions have been used in conjunction with (99m)Tc-iminodiacetic acid (IDA) radiopharmaceuticals in many different clinical situations, eg, to prepare the patient for the study, to reduce the time of a study, to improve its diagnostic accuracy, and to make diagnoses not otherwise possible. Interventions all have underlying physiological rationales. Some of these interventions are as simple as having the patient fast before the study or eat a meal with high fat content. However, most are pharmacologic interventions, eg, morphine sulfate, cholecystokinin, and phenobarbital. Although these are probably the most common interventions used today, numerous other interventions have been used during the years and likely will be in the future. Interventions have aided in the diagnosis of acute cholecystitis, chronic cholecystitis, biliary obstruction, and sphincter of Oddi dysfunction. This review will discuss in detail the interventions commonly is use today and in somewhat less detail many that have been successfully used on an investigational basis and may have some larger role in the future.

The significance of hepatobiliary scintigraphy (HBS) for hepatic graft function assessment was established mostly on retrospective studies and was not widely recognized due to the lack of quantitative data and variation in accuracy. This prospective study was performed to investigate the effectiveness of quantitative HBS for assessing hepatocyte dysfunction and biliary complication in liver transplant recipients. In 57 recipients who had undergone orthotopic liver transplantation, a total of 67 dynamic 99mTc-EHIDA scans were performed and quantitative parameters including the hepatocyte extraction fraction (HEF), time to maximum hepatic radioactivity (Tmax), and time for peak activity to decrease by 50% (T1/2) were calculated. The scintigraphic results based on the 3 parameters were compared against the final diagnosis. A ROC curve analysis was carried out to identify the cutoff value of Tmax for diagnosis of biliary stricture. Correlation between the parameters of postoperative HBS and conventional biochemical liver function indices were also analyzed. Quantitative 99mTc-EHIDA HBS had an overall sensitivity of 94.12% (16/17), specificity of 93.33% (42/45), and diagnostic accuracy of 93.55% (58/62) for detecting hepatocyte dysfunction and biliary complication in liver transplant recipients. The recommended cutoff value of Tmax for diagnosis of post-transplant biliary stricture was set at 15.75 min with a sensitivity of 100.0% and a specificity of 94.0%. The scintigraphic parameters (HEF, Tmax) were statistically significantly associated with the conventional liver function parameters. Quantitative 99mTc-EHIDA HBS offers a noninvasive imaging modality with high sensitivity and specificity to diagnose hepatocyte dysfunction as well as distinguish between patients with or without biliary stricture following liver transplantation. Furthermore, HEF and Tmax values obtained from dynamic HBS show good correlation with conventional liver function parameters.

The purpose of this study was to investigate the postprandial gallbladder motility of cirrhotic patients using cholescintigraphy by technetium-99m-ethylhydroiminodiacetic acid ((99m)Tc-EHIDA).Sixty two cirrhotic patients (Child-Pugh A: 28 patients; Child-Pugh B: 21 and Child-Pugh C: 13 patients) and 24 normal subjects were included in this study. All patients underwent cholescintigraphy. Mean gallbladder ejection fraction (GBEF) and mean ejection period (EP) were acquired by the region of interest method. In order to evaluate gallbladder contractility of cirrhotic patients, their mean GBEF and EP were compared with the same tests of normal subjects using an independent sample t test.The mean GBEF of cirrhotic patients was lower and their mean ER was longer than that of normal subjects. The means of GBEF and EP of cirrhotic patients were different among different Child-Pugh grade groups. All these differences showed statistical significance.This study suggests that post prandial cholescintigraphy by (99m)Tc EHIDA demonstrated slower gallbladder motility in cirrhotic patients. The ejection period of cholescintigraphy by (99m)Tc-EHIDA can be used as an index of abnormal gallbladder motility.

Background and Aim: The role of juxtapapillary diverticulum ( JPD) in biliary stone formation is controversial. This study was designed to understand the relationship between the size of JPD, hepatic clearance and recurrent bile duct stones in patients after endoscopic sphincterotomy. Methods: Five hundred and twenty patients with choledocholithiasis who had received endoscopic sphincterotomy were enrolled. They were divided into three groups: group A (n = 268) without diverticula; group B (n = 156) with small diverticula; and group C (n = 96) with large diverticula. All patients were regularly followed with interviews, liver function test and sonogram to detect the recurrent bile duct stones. Quantitative cholescintigraphy was performed in 176 cholecystectomized patients to evaluate the hepatic clearance. Sphincter of Oddi manometry was performed to exclude incomplete sphincterotomy if quantitative cholescintigraphy was abnormal. Results: After 9–111 months of follow-up, 76 patients had recurrent bile duct stones. There was a significant higher bile duct stone recurrence in group C than in group A (P

Aim: The aim of the present study was to develop a new pharmacologic method during hepatobiliary scintigraphy by which patients with functional and organic forms of gallbladder (GB) dysfunction can be differentiated. Methods: Quantitative hepatobiliary scintigraphy (QHBS) was performed on 31 patients with impaired GB motility selected by cerulein-augmented ultrasonography. Nineteen patients had acalculous biliary pain (ABP) and suspected GB dyskinesia, 6 patients had celiac disease, and 6 patients had type II diabetes mellitus. Sixty minutes after the isotope administration, 1 ng/bwkg/min cerulein (CCK 1 0 ) was infused for 10 minutes, and then from the 90th minute, an equivalent dose of CCK 1 0 was infused in the presence of 0.5 mg sublingual glyceryl trinitrate (GTN) in 12 or placebo in 7 consecutive patients. The GB ejection fraction (GBEF) was calculated repeatedly in time periods from 60 to 90 and from 90 to 120 minutes. Results: In the majority of patients with ABP and suspected GB dyskinesia, CCK 1 0 and GTN coadministration normalized the previously impaired GB-emptying. When the cumulative results of all 12 patients were calculated, we demonstrated significant differences (P = 0.003) in the GBEF between the first (CCK 1 0 ) versus the second (CCK 1 0 plus GTN) stimuli: 19 ′ 11% versus 40 ′ 17%, respectively. In contrast, in 12 patients with celiac sprue and diabetes mellitus, no differences in the GBEF were detected when the first (CCK 1 0 alone) versus the second (CCK 1 0 plus GTN) stimuli was compared: 21 ′ 10% versus 22 ′ 13%, respectively. Finally, placebo and CCK 1 0 coadministration in 7 consecutive patients with ABP and suspected GB dyskinesia did not influence the GBEF as compared with CCK 1 0 alone: 13 ′ 9% versus 15 ′ 10%, respectively. Conclusion: GTN and CCK 1 0 coadministration induces a significant improvement of the GBEF in patients with GB dyskinesia. The application of this new pharmacologic test during QHBS permitted the noninvasive separation of those patients with secondary impaired GB-emptying as a result of GB dyskinesia from those with primary forms of GB hypokinesia.

Objective Somatostatin acts at different sites in the human gastrointestinal tract and generally inhibits the release and effects of many gastrointestinal hormones and neuropeptides. Together with its long-acting analogue octreotide, somatostatin is widely used in the treatment of hormone-producing tumours, variceal bleeding, etc., but multi-centre trials have failed to prove a beneficial effect in the treatment of acute pancreatitis or in the prevention of post-ERCP pancreatitis (pancreatitis following endoscopic retrograde cholangiopancreatography). The aim of the present work was to study the effects of somatostatin and octreotide on the human sphincter of Oddi by means of quantitative hepatobiliary scintigraphy (QHBS). Method Fifteen cholecystectomized patients were enrolled in the study, six in the somatostatin group and nine in the octreotide group. QHBS was performed initially with a standard protocol (baseline data), then repeated after 0.1 mg octreotide or a 250 microg bolus + 250 microg/h somatostatin administration. In the 60th min of QHBS, 0.5 mg glyceryl trinitrate (GTN) was administered sublingually. Results QHBS demonstrated that both somatostatin and octreotide caused a marked impairment in the bile flow: the half-time of excretion (T1/2) over the common bile duct was significantly prolonged compared with baseline data (somatostatin group: common bile duct T1/2 180 min versus 59.7+/-31 min; octreotide group: common bile duct T1/2 140.9+/-60.5 min versus 30.7+/-11.7 min). Glyceryl trinitrate administration accelerated the transpapillary bile flow, with significant decreases in the elevated T1/2 in both groups. Conclusion Increased transpapillary flow induced by glyceryl trinitrate may be beneficial in the treatment of acute or post-ERCP pancreatitis.

Background/Purpose: Impaired gallbladder emptying has been identified as a cause of chronic abdominal pain in adults. This study aims to define a pediatric population with functional abnormalities of gallbladder contractility and to assess clinical outcome after cholecystectomy. Methods: Children and adolescents (n = 42) with abdominal complaints underwent gallbladder emptying studies, measured by either ultrasonography or scintigraphy with intravenous cholecystokinin (CCK). On ultrasound studies, gallbladder volume was measured before injection and 15 minutes after injection. Measures of gallbladder emptying by scintigraphy were taken at least 30 minutes after CCK injection. A study was classified as abnormal for contractility less than 50%. Cholecystectomy was performed and outcomes were evaluated during office visits and by telephone interview. Results: Abdominal pain and fatty food intolerance were the predominant symptoms. Patients were treated by open (n = 2) or laparoscopic (n = 40) cholecystectomy. In 20 cases the gallbladder showed chronic inflammation on pathology. Response to surgical therapy was excellent in 41 patients (mean follow-up, 20.4 months). Conclusions: Children and adolescents with persistent abdominal pain should undergo functional assessment of gallbladder contractility. Patients with abnormal gallbladder contractility benefit from cholecystectomy.

Objective: Extra corporeal shock wave lithotripsy is a promising and effective therapy mode in the nonsurgical therapy of gallstones. This prospective study was conducted to investigate the effects of ESWL on hepatocellular function, using quantitative hepatobiliary scintigraphy, serum aminotransferase, alkaline phosphatase (ALP), amylase (AML), and direct and indirect bilirubin levels. Methods: The study consisted of 22 patients with ultrasonographically documented gallstones. Hepatobiliary scintigraphy was applied to all patients before ESWL and biochemical tests were performed. Scintigraphy and biochemical tests were repeated in 16 patients 24 h, in seven patients 72 h, and in six patients 1 wk after ESWL. The hepatic extraction fraction (HEF) was calculated using deconvolution analysis of scintigraphic data. Results: All patients’ pre-ESWL biochemical tests and HEF values were within the normal range. The 24- and 72-h post-ESWL aminotransferase, ALP, and AML levels and HEF values were significantly different from pre-ESWL values (p < 0.05). After 1 wk this difference disappeared. Decreased HEF values were observed in 50% of patients 24 h, in 71.7% of patients 72 h, and in 16.6% of patients 1 wk after ESWL. A direct relationship was also observed between the number of shocks applied and the degree of impairment in HEF values. Conclusion: Transient hepatocellular dysfunction, which usually occurs after ESWL, can be demonstrated and monitored using quantitative hepatobiliary scintigraphy.

Aim The aim of this study was to evaluate our institutional experience with single-photon emission computed tomography/computed tomography (SPECT/CT) hepatobiliary imaging as a problem-solving tool in the workup of suspected acute cholecystitis. Methods We queried our radiology information system database for cases in which SPECT/CT had been performed as part of the routine hepatobiliary technetium Tc 99m iminodiacetic acid studies done for the evaluation of acute cholecystitis. Fifty-three consecutive patients who had SPECT/CT after planar imaging were included. This cohort represents cases that were considered problematic by the initial interpreting physician on the basis of planar images. The planar and SPECT/CT images were retrospectively reviewed independently and separately by 2 experienced nuclear medicine specialists who evaluated the planar images for visualization of the gallbladder on a binary scale (yes or no) and rated their level of confidence on an ordinal scale(unsure, somewhat sure, and sure). Results Single-photon emission CT/CT would have led to change in the management for interpreter 1 in a total of 23 cases (41%), with change from normal to abnormal scan findings (28%) and from abnormal to normal scan findings (13%). Similarly, SPECT/CT would have led to change in the management for interpreter 2 in a total of 23 cases (43%), with change from normal to abnormal scan findings (13%) and from abnormal to normal scan findings (30%). Conclusions Although planar hepatobiliary scanning is usually sensitive and specific, there are occasionally problematic cases. In our experience, we found that the addition of SPECT/CT improved the interobserver agreement and may change management in patients with superimposed bowel activity and/or unusual gallbladder anatomy that can confound the planar interpretation.

A newborn female was hospitalized due to metabolic acidosis and conjugated hyperbilirubinaemia. Extrahepatic biliary atresia (EHBA) was suspected why a (99m)Tc-mebrofenin cholescintigraphy was performed. It showed poor hepatocyte tracer uptake and no drainage to the gut. The hepatocyte dysfunction was caused by an obstructing adrenal gland neuroblastoma later visualised by ultrasound and MRI. The cholescintigraphy is a non-invasive modality to exclude or confirm the suspicion of EHBA. Furthermore neonatal conjugated hyperbilirubinaemia demands the use of a multimodality imaging strategy for differential diagnosis to EHBA.

The partition coefficients (log P) of theoretically possible alkyliodinated iminodiacetic acid (IDA) derivatives and commercial IDA derivatives were calculated using two computer programs: ChemSketch Log P and ChemOffice Ultra. Newly synthesized ligands (DIETHYLIODIDA and DIISOPROPYLIODIDA) with the highest calculated log P were labeled with technetium-99m. The biodistribution and the influence of bilirubin on their biokinetics were investigated in rats and compared to corresponding results for commercial Tc-99m-BROMIDA. Log P of Tc-99m-complexes of synthesized ligands were determined experimentally as well as the protein binding. In comparison to Tc-99m-BROMIDA, Tc-99m-DIETHYLIODIDA has: (a) better biliary excretion (2.76 +/- 0.15%ID/g versus 1.83 +/- 0.10%ID/g); (b) faster hepatic clearance (2.90 +/- 0.21%ID/g versus 7.47 +/- 0.70%ID/g) and decreased biliary excretion (for 14% versus 22%) in conditions of hyperbilirubinemia after 15 min. It is proved that Tc-99m-DIISOPROPYLIODIDA has a prolonged hepatic transit time and decreased biliary excretion. (c) 2012 Elsevier Ltd. All rights reserved.

Change in gallbladder function may occur in patients with an intact gallbladder after endoscopic sphincterotomy (EST). This study was designed to evaluate the factors influencing gallbladder filling after EST and the correlation between gallbladder function and stone recurrence.Sixty Chinese patients with symptomatic choledocholithiasis and an intact gallbladder received EST to clear the bile ducts. They were further investigated with sphincter of Oddi manometry (SOM), quantitative cholescintigraphy (QC), and long-term clinical follow-up.Fifty-six of the 60 patients in the study group were confirmed to have a loss of sphincteric function by SOM. QC showed normal gallbladder filling in 35 of these patients and delayed or non-filling in 21 patients. A significantly higher incidence of normal gallbladder filling occurred in patients with juxtapapillary diverticulum than in those without (P0.02), but preexisting cholecystolithiasis had no effect on it. During the follow-up period (median, 32 months: range, 9-54 months) 10 of 56 patients developed recurrent choledocholithiasis. There was no correlation between the status of gallbladder filling, preexisting cholecystolithiasis, and recurrent stones, but 9 of the 10 patients with recurrent stones had a juxtapapillary diverticulum. Repeated endoscopic treatment was satisfactory in eight patients, and only two patients received cholecystectomy.EST does not alter gallbladder function in most patients. Juxtapapillary diverticulum may facilitate gallbladder filling after EST, but it is also a possible factor for recurrent choledocholithiasis.

The aim is to compare the radionuclide (DC) and ultrasonographic (US) method in the assessment of gallbladder (GB) motility.The study was performed in 15 controls (C), 10 patients with acute cholecystitis (AC), 20 patients with chronic acalculous cholecystitis (CAC), 26 patients with chronic cholecystitis with calculosis (CCC) as well as in 15 patients with GB dyskinesia (D). GB emptying period (EP), ejection fraction (EF) and ejection rate (ER) were estimated with dynamic cholescintigraphy (DC) and US.The DC and US finding in the patients with AC was typical in all the patients, i.e. GB was not visualized at all on DC, while on US, stone was visible in the cystic duct. There were significant differences (p0.05) between the EF and ER values obtained between C and the three groups of patients CAC, CCC and D, using both methods. However, there were no significant differences in EF, EP and ER values among CAC, CCC and D (p0.05). There was also high correlation between the results obtained with both methods in all the groups of patients studied.The results obtained by both methods are valuable for the assessment of GB motility. Although there are no significant differences and there is a high correlation between the values, radionuclide method is more precise, because it can register motility continuously.

A 4-year-old child referred for acute jaundice following percutaneous needle biopsy of the liver underwent hepatobiliary scintigraphy. Although all conventional liver tests suggested preservation of hepatocyte function, the tracer uptake in the liver appeared dramatically reduced at scintigraphy and the blood pool activity did not decrease significantly until the end of the study. Visualization of the bile ducts indicated, however, that the tracer was taken up by the hepatocyte and further excreted into the biliary tree. There was no tracer pooling in the biliary tree although no bowel activity was observed, even on delayed images. The association of persistent blood pool activity, bile duct visualization without tracer pooling, and nonvisualization of the bowel was caused by a continuous recirculation of the tracer from the biliary tree into the bloodstream. The presence of a biliovenous fistula was further proven by percutaneous transhepatic cholangiography performed 24 h later. Since 1975, only 16 cases of bilhemia have been reported. To the best of our knowledge the scintigraphic pattern of this rare but life-threatening complication has not previously been reported.

Duodenogastric (D-G) reflux is commonly associated with peptic ulcer disease and chronic gastritis. To determine D-G reflux in association with each disease entity, we studied 43 chronic gastritis patients and 21 peptic ulcer patients with cholescintigraphy. Scoring (0 to 3+) was judged by the amount of Tc-99m diethylacetanitanilido-IDA (EHIDA) in the stomach. In the chronic gastritis group, 5, 16, 10, and 12 patients scored 3+, 2+, 1+, and 0, respectively. In the peptic ulcer disease group 6, 2, and 13 patients scored 2+, 1+, and 0, respectively. Thirty-nine of the 64 patients (60.9%) were positive for D-G reflux. D-G reflux occurred in 31 of 43 (72.09%) of chronic gastritis patients and in 8 of 21 (38.1%) patients with peptic ulcer disease. D-G reflux was significantly higher in the chronic gastritis group (P = 0.0009). Chronic gastritis patients were more likely to have more marked D-G reflux than peptic ulcer disease (P = 0.048). The authors conclude that cholescintigraphy is noninvasive and objectively demonstrates D-G reflux in chronic gastritis and peptic ulcer disease and that chronic gastritis is more closely associated with D-G reflux than peptic ulcer disease.

The radiopharmaceuticals (RF) EHIDA, DTPA and MAG-3 (labeled by 99mTc), commonly used in dynamic liver/kidney scintigraphy, are distributed in intravascular (i.v.) and extravascular (e.v.) spaces, as they are simultaneously cleared from the blood passing through their target organ (liver/kidney). The drop in concentration of these RF in blood is therefore determined by distribution as well as by clearance up to the time of equilibrium. From that time only the rate of decrease of RF in blood expresses the “true” (liver/kidney) clearance and this clearance parameter is a clinically reliable index of the function of the target organ. 1. (A) The method of analysis of the clearance curve obtained from the heart region has been reported; the method is based on a physiological approach with respect to the distribution processes of the RF in the organism. Apart from the main important parameter, T (clear) (half-time of the “pure” clearance of the resp. RF from its distribution space), two further parameters are obtained: T (distr.) (half-time of the e.v. distribution of the RF) and END (distr.) (end of this distribution). 2. (B) The results of 218 patients examined using 99mTc-EHIDA, 192 using DTPA and 65 using MAG-3 have been statistically processed. The mutual correlation of all parameters [T (distr.), END (distr.), T (clear)] within each group of patients as well as the differences of corresponding parameters between the groups of patients are studied. The main purpose of the work was to obtain the reliable clearance parameters of the RF with extravascular distribution for routine clinical practice. The second purpose was to contribute to the knowledge regarding the distribution processes of these compounds in their distribution spaces.

The aim of this study was to investigate the value of technetium etifenin injection (99mTc-EHIDA) hepatobiliary scintigraphy in combination with determination of bilirubin from duodenal drainage in differential diagnosis between infantile hepatitis syndrome and biliary atresia. 99mTc-EHIDA hepatobiliary scintigraphy in combination with duodenal fluid examination was used for evaluation in 84 infants with persistent infantile jaundice. For diagnosing biliary atresia, the sensitivity and specificity of scintigraphy were 100% and 74.5%, respectively; the sensitivity and specificity of scintigraphy in combination with duodenal fluid examination were 100% and 100%, respectively. In conclusion, hepatobiliary scintigraphy, which is a noninvasive, safe, valuable examination method, in combination with examination of duodenal fluid, is of value for the differential diagnosis between infantile hepatitis syndrome and biliary atresia.

The purpose of this study is to evaluate the diagnostic value of the following tests in the assessment of patients with chronic liver disease (CLD) and cholestatic syndrome (CS): (1) aminopyrine breath test, measuring 14CO2 excretion in the expired air, (2) peripheral clearance of [99mTc]EHIDA, and (3) postprandial levels of glycocholic acid (GCA) and glycochenodeoxycholic acid (GCDCA). The results indicate that: (1) 14CO2 2-hr excretion rate is a specific and sensitive marker of liver function, with good correlation with postprandial bile acid levels, [99mTc]EHIDA retention, and the conventional tests of serum albumin and prothrombin time. (2) Peripheral clearance and retention of [99mTc]EHIDA increased in both groups of CLD and CS vs controls, but it does not discriminate between the two. (3) Postprandial bile acids were elevated in CLD, particularly those of GCDCA, whereas GCA levels were significantly elevated in CS compared with CLD. This may be due to increased synthesis and entry into the blood. (4) The combination of [14C]aminopyrine breath test and postprandial levels of GCDCA enhance the diagnostic value, specificity, and sensitivity in the assessment of patients with CLD.

A 45-minute infusion of an octapeptide of cholecystokinin (Kinevac; Squibb Diagnostics, New Brunswick, NJ) was used to measure the gallbladder ejection fraction during cholescintigraphy in 40 normal volunteers. Cholecystokinin cholescintigraphy was shown to be a reproducible test. The maximum mean gallbladder ejection fraction occurred 15 minutes after cholecystokinin infusion and was 74.5% +/- 1.9% (mean +/- SEM). A gallbladder ejection fraction greater than 40% (mean -3SD) was arbitrarily defined to be normal. The gallbladder ejection fraction test was then used to identify patients with acalculous biliary symptoms who may respond to cholecystectomy. A total of 103 patients was tested; 21 had abnormal gallbladder ejection fractions and were randomized into two groups, cholecystectomy or no operation. These patients were followed up symptomatically at 3-month intervals for 13-54 months (mean, 34 months). Of the 11 patients who underwent cholecystectomy, 10 (91%) lost their symptoms and 1 improved. Of the 10 patients in the group that did not undergo surgery, all continued to be symptomatic, 2 of whom requested cholecystectomy after 13 and 24 months, respectively. Of the 13 gallbladders obtained from surgery, 12 showed evidence of chronic cholecystitis, muscle hypertrophy, and/or narrowed cystic duct. A normal gallbladder ejection fraction was recorded in 82 patients, and further treatment was left to the discretion of their referring clinician. On follow-up, 50 patients were asymptomatic and 10 were symptomatic without specific treatment of the biliary tract; 14 underwent cholecystectomy, 8 of whom were asymptomatic. Pathological abnormalities were recorded in 6 of the removed gallbladders. It is concluded that the gallbladder ejection fraction obtained after a 45-minute infusion of cholecystokinin during cholescintigraphy is a reproducible measure of gallbladder emptying, and that cholecystectomy alleviates the biliary-type pain of patients with a reduced gallbladder ejection fraction.

To establish a three-dimentional liver function evaluation system using 99mTc-diethyl iminodiacetic acid (99mTc-EHIDA) scintigraphy based on single photon emission computed tomography (SPECT).Totally 16 patients with liver lesions were divided into cirrhosis group and non-cirrhosis group. SPECT was performed 2 days before operation and 5 days after operation. Serum liver functions were examined on the same day of scintigraphy. SPECT images of areas of interest of heart and liver were aquired. Time of the peak of EHIDA density in liver (Tpeak), five-minutes heart liver index (HLI5), blood clearance index (HH15), receptor index (LHL15), and the predictive values were calculated.Tpeak was not significantly different between two groups, while HLI5, HH15, and LHL15 were significantly different (P = 0.033, P = 0.001, and P = 0.005). HLI, and LHL15 were significantly correlated with preoperative total protein and prealbumin levels (P = 0.003, P = 0.015, P = 0.022, P = 0.038) and post-operative prealbumin (P = 0.037, P = 0.042). The predictive values of HLI5 and LHL15 correlated well with postoperative HLI5 and LHL15 (r = 0.675, P = 0.016; r = 0.629, P = 0.028).The three-dimentional liver function evaluation system using 99mTc-EHIDA based on liver SPECT may facilitate the further studies of risks of liver surgery.

We have reviewed the experience of our institution and the literature concerning the use of hepatobiliary scintigraphy for the diagnosis of acute cholecystitis. The aim of this study was to assess whether the hepatobiliary scintigraphic finding of initial gallbladder visualization within 30 min is a more reliable criterion for excluding acute cholecystitis than gallbladder visualization within 1 h after tracer injection. In our institution's consecutive series, 113 of 211 hepatobiliary studies had gallbladder visualization within 1 h. Gallbladder visualization time in this group had a log normal distribution, with gallbladder visualization occurring within 30 min in 107 of 113 (95%). Gallbladder visualization occurred between 31 and 60 min in only 6 (5%); nevertheless, our one false negative study came from this small subgroup of patient studies (P = 0.05). Review of the literature (1645 patients with iminodiacetic acid [99mTc-IDA] derivative studies) revealed 6 further timed false negative results with gallbladder visualization within 1 h. Of these studies, in 4 (67%) the gallbladder was visualized between 31 and 60 min and in only 2 before 30 min. One of these latter 2 patients had a rare anatomy. Analysis of the pooled institutional and literature data gave an estimated false negative rate of 21 % if the gallbladder was visualized between 31 and 60 min. This was significantly higher (P < 0.001) than the 0.5% false negative rate when the gallbladder was seen prior to 30 min, but similar to the false negative rate of 16% reported by Weissmann et al. for studies with initial visualization after 1 h. Therefore, gallbladder visualization is strong evidence against acute cholecystitis only if it occurs within 30 min after tracer injection.

The aim of the study is evaluation of hepatocellular function, as well as morphology and patency of the biliary three of the liver transplants by dynamic hepatobiliary scintigraphy. The study was performed in 10 controls and 10 patients after orthotopic transplantation (up to two years). Sixty minutes dynamic acquisition (1 frame/min) was performed with scintillation camera after injection of 360 MBq 99mTc-diethyl- IDA. Hepatobiliary scintigrams were analysed for morphology, and parenchymal and hepatobiliary TA curves were generated and analysed as regard to the time to maximal acitivity (Tmax) and the time to half of maximum acitivity (T1/2). Uptake of the radiopharmaceutical was slightly but not significantly delayed (Tmax=18.5 +/- 2.9 min) in comparison to the controls (Tmax=14.2 +/- 3.4min), while excretion was significantly prolonged (T1/2=59.5 +/- 12.1 min) than physiological (Tmax=34.2 +/- 4.1min). Intrahepatic bile flow was nonsignificantly prolonged (Tmax=31.3 +/- 3.7 min) in comparison to the controls (Tmax=25.7 +/- 3.5 min) while extrahepatic one is high significantly prolonged (T1/2=89.0 +/- 14.3 min) than physiological (T1/2 =45.0 +/- 7.2 min). Biliary phase of hepatobiliary scintigraphy showed increased accumulation of radiopharmaceutical in the left (n=1) or right (n=2) hepatic duct. Radionuclide methods are noninvasive, and apear to be sensitive and valuable for the monitoring of liver transplants.

Heterotopic auxiliary liver transplantation (HALT) with portal vein arterialization (PVA) was proposed in acute hepatic failure (AHF). However, clinical results of PVA are controversial because of lacking standardized flow-regulation. In rats, we examined HALT with flow-regulated PVA in AHF. Group A: HALT with flow-regulated PVA and 85% resection of the native liver to induce AHF [acute experiments (n = 8), killing after 7 days (n = 8) and after 6 weeks (n = 11)]. Group B: 85% liver-resection (n = 10). The average blood-flow in the arterialized portal vein in HALT achieved normal values (1.7 +/- 0.4 ml/min/g liver-weight). After reperfusion, the diameters of the sinusoids (6.4 +/- 0.6 microm), the postsinusoidal venules (31.1 +/- 3.3 microm) and the intersinusoidal distance (17.9+/-0.7 microm) also achieved normal values. The functional sinusoidal density amounted to 335 +/- 48/cm. The 6-week survival was nine of 11 with excellent liver function (Quick's value: 110% +/- 7.8%). The hepatobiliary radioisotope scanning with (99mTc) ethyl hepatic iminodiacetic acid (EHIDA) showed no significant differences between the native livers and grafts. The hepatocellular morphology was regular, apart from low-grade necroses in two grafts. The grafts' sinusoidal endothelial cells did not show any morphological changes. In group B, however, all rats died from AHF within 6 days. HALT with flow-regulated PVA achieved good results regarding microcirculation, morphology and function and can reliably bridge AHF.

Hepatobiliary scintigraphy of infants being examined for persistant neonatal jaundice is best carried out using mebrofenin, a 99m Tc-labeled IDA derivative. This article summarizes the most frequently occurring etiologies of persisting neonatal jaundice and the diagnostic work-up of this condition. Perinatal obliteration of extrahepatic bile ducts requires immediate surgery, whereas other causes of persisting jaundice may be treated medically and/or conservatively.

99mTc-phosphate and 99mTc-IDA complexes, made by the addition of 99mTcO4- to the kits, have been applied to bone and gallbladder imaging respectively, for many years. In this paper, an effort to label DPD and EHIDA with [99mTc(CO)3(H2O)3]+ was carried out.DPD and EHIDA were synthesised and prepared in kit form in INS "Vinca". A carbonyl labelling agent Isolink (Mallinckrodt Medical B.V.) and a carbonyl precursor (NCRS Demokritos) were applied. The samples of each compound were added to a vial containing 99mTc-carbonyl precursor, in which original pH (10/11) was neutralised to a pH of around 5.5 or 7.5, the same one as the pH of the investigated compounds. After heating, the reaction products were analysed by HPLC equipped with UV and g-detector, with TEAP 0.05 M, methanol and water as solvent. The biological evaluation of 99m99mTc(I)-coordinated compounds, as well as 99mTc-DPD and 99mTc-EHIDA complexes, involved a bio distribution examination on Wistar rats.The results have shown that hydrophilic organometallic [99mTc(CO)3(H2O)3]+ precursor facilitates the formation of Tc (I) complexes with these ligands, based on the tricarbonyltechnetium (I) core. The changes in structure of DPD and EHIDA labelled molecules influenced biological behaviour: 99Tc(CO)3 -DPD did not accumulate in bone (1% of the complex was found in the femur), while 99Tc(CO)3-EHIDA has shown slower billiary excretion and faster filtration through the kidneys.The results of the labelling of DPD and EHIDA with [99mTc(CO)3(H2O)3]+ and their chemical and biological behaviour, in comparison with the same one for 99mTc-DPD and 99mTc-EHIDA, confirmed that different oxidation states of technetium make the formation of a variety of complexes with quite different behaviour possible.

The aim of the study was the evaluation of the perfusion, morphology and biliary three patency of liver transplants employing two radionuclide methods.The study was performed on 10 controls and 10 patients after an orthotopic transplantation (up to two years). "First pass" dynamic acquisition was performed with a scintillation camera, after a bolus injection of 360 MBq 99mTc-diethyl- IDA, (60 frames/60s), continued by a 59 minute (1 frame/min) slower dynamic study. From the liver and kidney activity during the "first pass" study, the hepatic perfusion index (HPI) was calculated using slope-analysis. Hepatobiliary scintigrams obtained during second phase of the study were analyzed for morphology, and parenchymal and hepatobiliary TA curves were generated and analyzed according to the time to maximal activity (Tmax) and the time to half of maximum activity (T/2).In comparison to the controls (HPI, X = 0.64.5 +/- 0.05%) portal perfusion had slightly (X = 0.68 +/- 0.04%), but not significantly (p0.05) increased. In 3 patients, the biliary phase of hepatobiliary scintigraphy showed an increased accumulation of the radiopharmaceutical in the left (n = 1) or right (n = 2) hepatic duct. The uptake of the radiopharmaceutical (Tmax, X = 18.5 +/- 2.9 min) was slightly, but not significantly (p0.05) delayed in comparison to the controls (X = 14.2 +/- 3.4 min), while excretion was significantly (p0.05) prolonged (X = 59.5 +/- 12.1 min) (X = 34.2 +/- 4.1 min). Intrahepatic bile flow was insignificantly (p0.05) prolonged (X = 31.3 +/- 3.7 min) in comparison to the controls (X = 25.7 +/- 3.5 min) while extrahepatic bile flow was high, significantly (p0.01) prolonged (X = 89.0 +/- 14.3 min) than physiological one (X = 45.0 +/- 7.2 min).Radionuclide methods are noninvasive, sensitive and valuable in monitoring liver transplants.

A 10-year-old girl with Rotor's syndrome was studied using Tc-99m di-isopropyl-iminodiacetic acid cholescintigraphy. The findings showed slow hepatic uptake, persistent cardiac blood pool radioactivity, and prominent renal excretion. The contribution of cholescintigraphy and pathophysiology will be discussed via a literature review.

The aim of the present study was to evaluate the influence of the exogenous nitric oxide donor glyceryl trinitrate on cerulein-induced gallbladder contraction in patients with acalculous biliary pain. Quantitative hepatobiliary scintigraphy was performed on 33 patients. From the 60th min cerulein (1 ng/kg body wt/min for 10 min intravenous) then from the 90th min the same dose of cerulein plus glyceryl trinitrate (0.5 mg sublingually) (21 patients) or placebo (12 patients) were administered and the gallbladder ejection fraction was measured repeatedly. After the first dose of caerulein, the gallbladder ejection fraction was less than 35% in 23 of 33 patients (nonresponders), while it was more than 35% in the remaining 10 patients (responders). After the second dose of cerulein in 16 nonresponder patients glyceryl trinitrate administration significantly increased the previously impaired gallbladder ejection fraction while in 7 nonresponder patients placebo administration had no effect. In conclusion, normalization of the gallbladder ejection fraction in the majority of patients following glyceryl trinitrate administration suggests that impairment of gallbladder emptying is caused by a functional motility disorder rather than any organic disease.

The distinctive features of cystic duct syndrome are acalculous biliary pain (ABP) with impaired gallbladder (GB) filling, emptying, or both. The mechanism of ABP pain has been explained in theory by exaggerated GB contraction, which was intended to overcome a functional cystic duct obstruction or GB dyskinesia. However, no human data lend support to this pathomechanism. The authors present new scintigraphic features suggestive of functional cystic duct obstruction in humans.

A 21 -year-old man, who had an operation for an amebic abscess of the liver 6 months earlier, had fever and was experiencing dyspnea and chest pain. His chest radiograph revealed pleural effusion at the right lung base. A diagnostic thoracentesis was performed and a drainage tube placed. The gross appearance and laboratory analysis of the pleural effusion suggested a biliary fistula associated with his previous operation. A hepatobiliary scan, performed with 5 mCi of Tc-99m EHIDA (Etifenin), demonstrated the presence of a pleuro-biliary fistula, which was then confirmed by a retrograde radionuclide fistulogram and an endoscopic retrograde cholangiograph. Computed tomography and ultrasonography were nondiagnostic

Transcatheter arterial embolization is the treatment of choice for inoperable hepatocellular carcinoma. Gallbladder infarction following transcatheter arterial embolization has been reported, therefore, the gallbladder functions were studied using the quantitative Tc-99m DISIDA cholescintigraphy in the present study.The gallbladder functions which were presented as the filling fraction and the ejection fraction in 24 patients with hepatoma before and after transcatheter arterial embolization. The patients were separated into two groups. Group 1: 12 patients received precystic artery transcatheter arterial embolization and group 2: 12 patients received postcystic artery transcatheter arterial embolization.After transcatheter arterial embolization, significantly decreased both gallbladder functions of filling fraction (61.2 +/- 7.4% and 48.3 +/- 6.5%) and ejection fraction (47.8 +/- 6.0% and 36.5 +/- 5.3%) were found in group 1 patients. However, no significant change of filling fraction (59.0 +/- 5.0% and 58.8 +/- 7.4%) and ejection fraction (49.9 +/- 2.4% and 49.3 +/- 5.7%) in group 2 patients.Impaired gallbladder functions were common in hepatoma patients who received precystic artery transcatheter arterial embolization, and Tc-99m DISIDA cholescintigraphy may be useful for evaluating the gallbladder functions in hepatoma patients who received transcatheter arterial embolization.

Acute cholecystitis is an uncommon disease in childhood. Few cases in patients under 10 years of age have been found in literature. An eight-year old male patient with no history of interest who had acute acalculous cholecystitis was reported. Ultrasonographic and isotopic studies led to the diagnosis and control of the patient's evolution.

Sphincter of Oddi dysfunction is an underdiagnosed but important clinical condition. It should be considered in the differential diagnosis of biliary pain when the gallbladder sonogram shows no evidence of gallbladder disease. Hepatobiliary scanning (Tc-99m dimethyl iminodiacetic acid) may provide valuable information in the evaluation of these patients and may be helpful in monitoring response to treatment.

Unenhanced helical computerized tomography (UHCT) has recently evolved as an accurate imaging modality for determination of the presence or absence of ureterolithiasis in patients with acute flank pain. Functional renal scintigraphy is considered the gold standard for urinary tract obstruction. The objective of this study was to correlate the secondary signs of urinary obstruction on UHCT with findings of functional renal scintigraphy. UHCT was performed in 30 patients admitted to the emergency room with acute flank pain. All patients had a calcified urinary stone identified on UHCT. The location of each urinary stone was classified as ureteral or in the ureterovesical junction. The presence of secondary CT signs of ureteral obstruction was determined for each patient. After oral or intravenous hydration, a technetium-99m diethylene triamine penta-acetic acid renal scan was performed in all patients within 12 h of the CT scan. Follow-up delayed scintigraphic images were obtained at 2 h and 24 h in patients with evidence of ureteral obstruction. The sensitivity, specificity and predictive values of each possible combination of CT findings were determined by comparison with the scintigraphic results. The distal ureter was the most common location for a calculus on UHCT, followed in frequency by the ureterovesical junction, proximal ureter and mid-ureter. The renograms showed high-grade, unilateral obstruction in 12 patients, indeterminate scans in five patients and normal renograms in 13 patients. The sensitivities and specificities of individual CT findings ranged from 50% to 75% and from 8% to 69%, respectively. Perinephric stranding gave the highest positive predictive value (PPV) for obstruction (69% including indeterminate renograms). None of the individual CT findings showed a statistically significant correlation with scintigraphic findings. A combination of one or two positive CT findings had a PPV of only 25% for obstruction. A combination of three or four positive CT findings gave a PPV of 70% for obstruction. Our preliminary study shows that secondary CT signs of ureterolithiasis correlate poorly with the scintigraphic findings and that they do not permit evaluation of the functional status of obstructed kidneys. Even a combination of the most frequent CT findings has a low predictive value, i.e. does not allow a decision to be made as to the most suitable treatment. Therefore, renal scintigraphy should be performed in conjunction with UHCT in all patients with ureteral calculi.

A 2-year-old child underwent liver transplant and was referred for postsurgical abdominal pain. Hepatobiliary scintigraphy with Tc-99m iminodiacetic acid (IDA) was performed and with the help of 24-hour delayed images, the diagnosis of biliary leak at the site of anastomosis was made possible. This case report confirms the value of delayed images to facilitate the diagnosis in unequivocal situations and reminds us of the usefulness of this noninvasive method, especially in pediatrics.

A case of Caroli's disease is presented and the findings of various imaging modalities are discussed with emphasis on the role of Technetium 99mTc diethyl-iminodiacetic acid scan in reaching the final diagnosis. The 'beaded' appearance of the dilated intrahepatic ducts seen in this scan is believed to be pathognomonic for this condition.

The main purposes of this study were to investigate the best parameter for describing gallbladder emptying and whether gallbladder bile emptying should be induced with a bolus injection or continuous infusion of cholecystokinin-octapeptide (CCK-8).Gallbladder emptying was measured by dynamic cholescintigraphy. Twelve healthy subjects and six patients with gallstones were examined twice with CCK-8 infusion cholescintigraphy, 0.3 ng CCK-8 kg per min for 60 min under identical circumstances. Another six healthy subjects randomly received bolus injection (0.04 microgram/kg) and infusion of CCK-8 (0.3 ng/kg per min for 60 min), respectively, during cholescintigraphy on two separate occasions. The choice of bolus dose was based on recommendations from the CCK-8 manufacturer. The infusion dose was chosen to produce plasma CCK concentrations similar to postprandial plasma CCK levels.A parameter of gallbladder emptying, mean ejection fraction (EF), was defined as 100% minus the area under the time-activity curve normalized to 100% and divided by the time interval from maximum to minimum counts per minute. This parameter proved superior to the well known parameters, EFmax. and EF30, in regard to reproducibility in healthy subjects. The slope of the regression line for the mean EF was 0.998 and the intercept value approximately 0% (p = 0.0001). The mean coefficient of variation was 4%. Apart from a higher mean coefficient of variation, similar reproducibility results were seen in the six patients. The measurements of EF30 in healthy subjects scattered more widely around the mean compared to the mean EF and EFmax, which indicates poorer ability to separate normal from abnormal gallbladder emptying. Intravenous bolus injection of CCK-8 resulted in incomplete gallbladder emptying with a mean EF value of 16% (s.d. 9%; range 7%-32%) compared to 49% (s.d. 7%; range 37%-57%) following CCK-8 infusion (p = 0.004). Abdominal discomfort was observed in all subjects after administration of the bolus injection, whereas no complaints were reported during infusion.Mean EF is the best parameter for describing gallbladder emptying. Moreover, slow infusion of a physiological dose of CCK-8 is preferable to induce gallbladder emptying because it results in more complete emptying and has no side effects.

The diagnostic efficacy of time-activity curves (TAC) and common bile duct dynamics (CBDD) derived from quantitative cholescintigraphy (QC) was assessed in patients with suspected sphincter of Oddi dysfunction (SOD). Quantitative cholescintigraphy was performed on 34 cholecystectomized individuals with suspected SOD and 26 asymptomatic controls. Each patient with suspected SOD underwent endoscopic retrograde cholangiography and sphincter of Oddi manometry (SOM). After exclusion of eight patients because of failure of manometry, the final diagnoses of the remaining 26 patients were taken as the gold standard by which to determine the detectability of TAC and CBDD. The sensitivity of TAC reached 68.8%. Common bile duct dynamics showed equal sensitivity but was more specific than TAC. The sensitivity improved to 87.5% when TAC and CBDD were combined. We conclude that non-invasive QC provides good sensitivity and specificity in evaluating cholecystectomized patients with suspected SOD.

This study was designed to investigate the reproducibility of the results obtained from 99mTc-dimethyliminodiacetic acid (99mTc-EHIDA) cholescintigraphy, when used as a method of estimating gallbladder emptying.In a random controlled fashion, the reproducibility of scintigraphic gallbladder emptying studies was assessed in 30 subjects, of whom six were normal, four had duodenal ulcers and the remaining 20 had undergone antiulcer gastric surgery. In fasting subjects, who 30 min later drank 250 ml of fresh milk, 2 mCi of 99mTc-EHIDA was intravenously injected. Liver and gallbladder areas were scanned for 60 sec and then every 5 min for 1 hr. The study was repeated in all subjects within 2-5 wk. From the gallbladder emptying curves, the duration of the lag phase (time from milk ingestion to actual start of emptying), the ejection fraction of emptying (peak to least activity in the gallbladder), the time by which maximal emptying was achieved and the pattern of gallbladder emptying were calculated.Two subjects were excluded from the study because their gallbladders did not fill. Lag phase duration was well reproduced in duplicate studies (r = 0.87), as was ejection fraction (r = 0.84). The time by which maximal emptying was achieved was not sufficiently reproduced. The normal pattern of emptying (exponential function) was reproduced in all controls, subjects with duodenal ulcers and patients after antiulcer surgery that did not involve duodenal exclusion. The abnormal pattern of emptying, characterized by refilling, was reproduced in five of the seven patients with gastric surgery that mainly involved duodenal exclusion.Scintigraphy with 99mTc-EHIDA to assess gallbladder motility is a method with satisfactory reproducibility of both parametric variables and patterns of emptying.

Cholecystokinin hepatobiliary (CCK-HIDA) scintigraphy is used to triage patients with chronic abdominal pain and suspected gall-bladder dysfunction. This study evaluates the predictive value of CCK-HIDA for clinical outcome after surgical and medical therapy. Fifty-six patients (45 females), mean age 43 +/- 9 years, with otherwise normal investigations, including normal ultrasound, fasted for more than 8h and then had 70MBq technetium-99m-EHIDA injected. One and a half hours later 15 ng/kg CCK was infused over 45 min. Seventy minutes dynamic imaging commenced 5 min prior to infusion. An abnormal gall-bladder ejection fraction (GBEF) was defined as < 50%. Patients were treated medically, or by cholecystectomy, depending on the surgeon's overall assessment, including results of the CCK-HIDA study. Patient status was then obtained in 51/56 patients at least 3 months after the scan or at least 1 month after surgery. All surgical specimens were reviewed independently for pathological changes of chronic acalculous cholecystitis. Of the 11 patients with an abnormal gall-bladder ejection fraction, nine (82%) underwent cholecystectomy, all of whom achieved total symptomatic cure, while two patients underwent other therapy, both of whom remained symptomatically unchanged. Of the 40 patients whose gall-bladder ejection fraction was normal, only five (12.5%) underwent cholecystectomy, of whom four were cured and one partially improved at follow up. Of the 35 patients with a normal gall-bladder ejection fraction and who underwent forms of therapy other than cholecystectomy, nine were cured symptomatically, 13 improved, 10 remained unchanged and three were symptomatically worse at follow up.(ABSTRACT TRUNCATED AT 250 WORDS)

We used [99mTc]EHIDA hepatobiliary scintigraphy to determine whether both hepatic bile secretion and gallbladder contractility are suppressed in acromegalic patients receiving long-term treatment with the somatostatin analogue octreotide. We studied three groups of patients: group 1, untreated patients; group 2, average dose of octreotide 500 +/- 100 micrograms/day for 33 +/- 4 months; and group 3, 1000 +/- 200 micrograms/day for 33 +/- 4 months. Images were taken at specified time intervals during the 120-min period following injection of EHIDA. After a single injection of octreotide, group 1 patients demonstrated delayed visualization of the radioisotope in the liver, gallbladder, and duodenum. At the end of long-term treatment, group 2 patients showed a delay in appearance of maximal radioactivity in the gallbladder. Two weeks following discontinuation of octreotide, this parameter had decreased significantly (P < 0.001). In group 3, visualization of the liver, gallbladder, and duodenum were prolonged, with delayed visualization of the gallbladder persisting two weeks after withdrawal (P < 0.005). These results indicate that gallbladder contractility is decreased after a single injection of octreotide and that during chronic octreotide therapy the rate of bile secretion is reduced. Impaired gallbladder contractility normalizes more rapidly after discontinuation of octreotide in patients receiving low doses of the analog.

Benign papillary stenosis (BPS) is an uncommon condition, the diagnosis of which is often difficult. In this report cholescintigraphy with technetium-99m diethyl-acetanilido-iminodiacetic acid has been evaluated for the diagnosis of BPS, as well as for assessing the effect of treatment by endoscopic sphincterotomy (ES). In 12 patients with BPS, cholescintigraphy was performed before and after ES and the findings compared with those in ten controls. Time-activity curves from regions over the liver and bowel were generated. A significant difference was found in respect of the time for maximum activity (Tmax) over the liver before and after ES. The time for occurrence of bowel activity (Texcr) also showed significant differences before and after ES. Considering both Tmax and Texcr mean values plus two standard deviations in the control group, all BPS patients would have been detected and there would have been no false-positives among the controls. It is concluded that cholescinitgraphy should be used in the diagnosis of BPS. The method has high sensitivity and should be applied as an early diagnostic procedure to exclude BPS in patients with clinical suspicion of the disorder. The method can also be used for assessment of endoscopic treatment (ES).

Duodenogastric reflux is quantified in ten patients with biliary lithiasis and a functioning gallbladder, before and six months after performing cholecystectomy. The results are compared with those of a control group (n = 10) with similar age and gender, without gastric or hepatobiliary pathologic factors. To evaluate reflux, we used six hour continuous intravenous infusion and subsequent determination in gastric juice of 99mTc-diethyliminodiacetic acid. Our results showed that patients with cholelithiasis have higher reflux rates than those in the control group (p0.001). When comparing patients before and after cholecystectomy, we confirmed that removal of the gallbladder produces a significant increase (p0.001) in reflux rates compared with preoperative values.