Quantitative cholescintigraphy in the assessment of choledochoduodenal bile flow

Cicala, Michele; Scopinaro, Francesco; Corazziari, Enrico; Vignoni, Alberto; Viscardi, Andrea; Habib, F. I.; Torsoli, A

doi:10.1016/0016-5085(91)90289-w

Cited by 49 publications

(22 citation statements)

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“…15 However, QC is not sensitive enough to diVerentiate between organic and functional disorders of the biliary tract, especially in patients with a dilated bile duct. 18 In the present study, organic obstruction of the biliary tract may be excluded by cholangiography soon after EST, normal liver function before QC, and low sphincteric basal pressure on sphincter of Oddi manometry. The abnormal time-activity curve of the QC observed for some patients in this study therefore suggests impaired emptying of the biliary tract.…”

Section: Discussionmentioning

confidence: 59%

Prediction of recurrent choledocholithiasis by quantitative cholescintigraphy in patients after endoscopic sphincterotomy

1995

Gastroenterology

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Background-Endoscopic sphincterotomy (EST) is widely used for the removal of stones from the bile duct, but stones recur in about one fifth of patients. Aims-To investigate hepatic clearance by quantitative cholescintigraphy (QC) in patients after EST and to discern the relationship between biliary emptying and stone recurrence. Methods-One hundred and forty nine patients who had EST and clearance of the bile duct for choledocholithiasis were selected. All patients were confirmed to have complete EST by sphincter of Oddi manometry and underwent QC soon after normalisation of liver function. Regular clinical follow up was performed for each patient. Results-During a mean 36 month follow up, 22 (14.8%) patients developed recurrent stones in the bile duct. Irrespective of the status of the gall bladder, patients with recurrent stones had a slower hepatic clearance of radioisotope during QC compared with patients without stone recurrence, but only the diVerences in cholecystectomised patients had statistical significance. After carrying out multivariate analysis, one parameter of QC, percentage clearance of maximal count at 45 minutes, was found to be the only significant factor for stone recurrence. All recurrent stones in the common bile duct were successfully removed at endoscopy. Conclusion-Slower hepatic clearance as shown by QC is an important factor responsible for stone recurrence after sphincter ablation.

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Section: Discussionmentioning

confidence: 59%

Prediction of recurrent choledocholithiasis by quantitative cholescintigraphy in patients after endoscopic sphincterotomy

1995

Gastroenterology

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“…Elevated basal sphincter pressure detected on sphincter-of-Oddi manometry was the gold standard. The investigation showed that both radionuclide quantitative techniques were inferior to manometry (76). There have been criticisms of the investigation, one of these being that the authors used protocols different from the initially described methods-for example, a 60-min infusion of sincalide rather than 3 or 10 min.…”

Section: Sphincter-of-oddi Dysfunctionmentioning

confidence: 94%

Hepatobiliary Scintigraphy in 2014

Ziessman

2014

J Nucl Med

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CE Credit: For CE credit, you can access the test for this article, as well as additional JNMT CE tests, online at https://www.snmmilearningcenter.org. Complete the test online no later than December 2017. Your online test will be scored immediately. You may make 3 attempts to pass the test and must answer 80% of the questions correctly to receive 1.0 CEH (Continuing Education Hour) credit. SNMMI members will have their CEH credit added to their VOICE transcript automatically; nonmembers will be able to print out a CE certificate upon successfully completing the test. The online test is free to SNMMI members; nonmembers must pay $15.00 by credit card when logging onto the website to take the test. Participants who have already taken the exam using JNM and passed cannot retake the exam.Cholescintigraphy with 99m Tc-hepatobiliary radiopharmaceuticals has been an important, clinically useful diagnostic imaging study for almost 4 decades. It continues to be in much clinical demand; however, the indications, methodology, and interpretative criteria have evolved over the years. This review will emphasize state-of-the-art methodology and diagnostic criteria for various clinical indications, including acute cholecystitis, chronic acalculous gallbladder disease, high-grade and partial biliary obstruction, and the postcholecystectomy pain syndrome, including sphincter-of-Oddi dysfunction and biliary atresia. The review will also emphasize the use of diagnostic pharmacologic interventions, particularly sincalide. Now almost 4 decades old, 99m Tc cholescintigraphy continues to be a radionuclide imaging study in much clinical demand. Its strength lies in the fact that the diagnostic information provided defines pathophysiology rather than anatomy.123 I-and 123 I-rose bengal were the first clinically useful cholescintigraphic agents; however, image quality was relatively poor (Fig. 1). 99m Tc-hepatobiliary radiopharmaceuticals began to be widely used by the early 1980s.The discovery of 99m Tc-hepatobiliary (HIDA) radiopharmaceuticals was by chance. During investigation for a cardiac imaging radiopharmaceutical, it was found that 99m Tclabeled lidocaine was not a good cardiac imaging agent but cleared through the hepatobiliary system. With chemical modification, 99m Tc-HIDA imaging agents were born. Loberg et al. reported on this in 1976 (1). Its structure is simply that of 2 lidocaine analogs bichelated to 99m Tc by iminodiacetic acid (IDA) (Fig. 2). HIDA (hepatoiminodiacetic acid) has long been used as a generic term for cholescintigraphy.Modifications of the benzene ring of the lidocaine analogs resulted in an alphabet soup of hepatobiliary radiopharmaceuticals (PIPIDA, BIDA, EIDA, DIDA, DISIDA, etc.), each with different rates of hepatic uptake and clearance. The first 99m Tc-HIDA radiopharmaceutical was approved for clinical use by the Food and Drug Administration in 1982. Dimethyl IDA (lidofenin [Technescan; Mallinckrodt]) was a major advance, but image quality and diagnostic utility were suboptimal in patients with seru...

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“…Because a functional or structural obstacle at the level of the SO would affect bile flow, several attempts have been made to indirectly determine SO dysfunction based on impaired hepatic handling of biliscintigraphic tracers. None of these methods have high diagnostic accuracy, nor have any been shown to be reproducible except the measurement of the hepatic hilum-duodenum transit time in subjects without a gallbladder [51]. In one report prolonged hilum-duodenum transit time assessed by cholescintigraphy (choledochoscintigraphy) has been demonstrated in patients with SO dysfunction and correlated with an abnormal manometric SO basal pressure [51].…”

Section: Bile Ducts and Sphincter Of Oddimentioning

confidence: 97%

“…None of these methods have high diagnostic accuracy, nor have any been shown to be reproducible except the measurement of the hepatic hilum-duodenum transit time in subjects without a gallbladder [51]. In one report prolonged hilum-duodenum transit time assessed by cholescintigraphy (choledochoscintigraphy) has been demonstrated in patients with SO dysfunction and correlated with an abnormal manometric SO basal pressure [51]. In another study this technique predicted the clinical outcome of endoscopic sphincterotomy [52].…”

Section: Bile Ducts and Sphincter Of Oddimentioning

confidence: 98%

Biliary tract imaging

Corazziari

1999

Curr Gastroenterol Rep

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In addition to the detection of gallstones, common bile duct stones, and narrowed and dilated bile ducts, recent advancements in imaging techniques now make it possible to diagnose microlithiasis, pathology of normal-size ducts, and dysfunction of the gallbladder and the sphincter of Oddi (SO). More and more frequently, noninvasive imaging techniques obviate the risk of invasive investigation. These techniques can also take the place of unsuccessful or contraindicated direct cholangiography, and they play an essential role in treatment planning and diagnosis of postoperative complications. Transabdominal ultrasonography (TUS) remains fundamental for initial assessment of the biliary tract. Technical developments make magnetic resonance cholangiopancreatography the most promising diagnostic technique of the biliary tract. Endoscopic ultrasonography (EUS) is most helpful for detection of microlithiasis and evaluation of the ampullary region, the periductal structures, and the regional lymph nodes in neoplastic diseases. Cholescintigraphy is most valuable to assess bile dynamics in the diagnosis of gallbladder and SO dysfunction and in postoperative bile leakage.

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Quantitative cholescintigraphy in the assessment of choledochoduodenal bile flow

Cited by 49 publications

References 10 publications

Prediction of recurrent choledocholithiasis by quantitative cholescintigraphy in patients after endoscopic sphincterotomy

Prediction of recurrent choledocholithiasis by quantitative cholescintigraphy in patients after endoscopic sphincterotomy

Hepatobiliary Scintigraphy in 2014

Biliary tract imaging

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