Technetium-99m-Diethyl-IDA Cholescintigraphy in the Differential Diagnosis of Jaundice

Abstract

Cholescintigraphy with ^99mTc-diethyl-IDA was performed on 50 jaundiced and 11 control patients. The examination was recorded by a gamma-camera on Polaroid film and transferred to a computerized image-processing system. In total extrahepatic obstruction no tracer was recorded in the biliary tract or the intestine. In partial extrahepatic obstruction the tracer was not recorded in the intestine before 25 min, and its appearance in the biliary tract was delayed beyond 20 min in 8 out of the 10 cases. The retained tracer in the common bile duct made it easily visible in all cases. In nonobstructive conditions, the appearance time of the tracer in the biliary tract was ≤ 15 min in 27 out of the 33 cases, and retention in the common bile duct was observed in only 1 of these cases. Time-activity curves were computed from the background, the liver, and the common bile duct. The background clearance of the tracer in controls was 4.8–8.4%/min and in the jaundiced patients 0.3–6.9%/min. No liver uptake of the tracer was recorded in 15 out of the 19 cases of total extrahepatic obstruction and in one case of hepatocellular disease. In the other cases, the mean transit times were calculated from the liver curves, and the point of maximum activity was observed from the 25 common bile duct curves obtained. The mean transit times in controls were 13–60 min, in hepatocellular diseases 26–173 min, in intrahepatic cholestasis 32–164 min, in partial extrahepatic obstruction 56–255 min, and in the four cases of tracer uptake with total extrahepatic obstruction 93–306 min. Maximum activity in the common bile duct was not reached before 45 min in partial extrahepatic obstruction, but it was attained in 12–42 min in nonobstructive conditions.

Key-words:

• Biliary tract
• jaundice
• radionuclide imaging