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Biliary tract cholescintigraphy using Technetium-99m-labeled disofenin

1982; Elsevier BV; Volume: 32; Issue: 3 Linguagem: Inglês

10.1016/0022-4804(82)90091-9

1095-8673

Nathaniel M. Matolo, Robert C. Stadalnik,

Pediatric Hepatobiliary Diseases and Treatments

Abstract Technetium-99m-labeled disofenin is a new iminodiacetic acid analog for imaging the biliary tract and the gallbladder. Biliary cholescintigraphy with 99mTc-disofenin was performed on 148 patients referred for evaluation of hepatobiliary tract disease. Four millicuries was administered intravenously to nonjaundiced patients and 7 mCi to jaundiced patients. Scintigraphy was performed on patients in supine position and was accomplished via a large-field-of-view camera with a low-energy, all-purpose collimator. Technetium-99m-labeled disofenin rapidly cleared the blood which permitted excellent images of the biliary system with minimal interference from renal activity in only 11% of the patients. Of the 34 patients confirmed operatively and histologically to have acute cholecystitis, 32 had positive 99mTc-disofenin cholescintigram, a sensitivity rate of 94%. Only 2 of the 8 patients with chronic cholecystitis had positive scan with nonvisualization of the gallbladder. This is not surprising, since scintigraphic study may be normal in patients with chronic cholecystitis if the cystic duct is patent. A normal biliary tract was detected in 63% of our jaundiced patients ( 25 40 ), thus excluding biliary tract disease. Radioactivity was definitely identified in the gastrointestinal tract when the serum bilirubin level was as high as 27.3 mg/100 ml, thus differentiating hepatocellular disease from complete extrahepatic biliary tract obstruction. However, in 6 patients (15%), 99mTc-disofenin cholescintigram could not differentiate between liver disease and biliary tract obstruction. It is concluded that 99mTc-disofenin has rapid blood clearance, which permits satisfactory images of the biliary system in a variety of hepatobiliary diseases encountered in routine clinical practice. It is particularly sensitive in the diagnosis of acute cholecystitis.