• The Korean Journal of Nuclear Medicine
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• v.24 no.2
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• pp.254-259
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• 1990

We examined patients with suspected acute or intermittent biliary obstruction using hepatobiliary scintigraphy, ultrasonography and contrast cholangiography. Of 16 patients with confirmed common bile duct obstruction, sonography and scintigraphy disagreed in 8(50%). Scintigraphy revealed partial or complete common bile duct obstruction in 13 patients (81.3%) and 6 of them had no evidence of dilated biliary trees. It is concluded that disagreement between sonography and scintigraphy is not rare in patients with acute or intermittent biliary obstruction and hepatobiliary scintigraphy is useful in diagnosing obstruction prior to ductal dilatation.

• The Korean Journal of Nuclear Medicine
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• v.31 no.1
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• pp.102-107
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• 1997

Laparoscopic cholecystectorny can be performed safely in most patients with symptomatic cholelithiasis. Preoperative evaluation should assess the potential problems that affect the performance of laparoscopic cholecystectomy. Hepatobiliary scintigraphy or oral cholecystography can assess the gallbladder function and nonvisualization of gallbladder usually indicates acute or severe chronic cholecystitis. The purpose of this study was to evaluate the role of preoperative hepatobiliary scintigraphy or oral cholecystography in predicting the performance of laparoscopic cholecystectorny. The study group consists of 176 patients who underwent both hepatobiliary scintigraphy with Tc-99m DISIDA and oral cholecystography within one month before laparoscopic cholecystectomy. Nonvisualization of gallbladder was defined as persistent nonvisualization of gallbladder until 4 hours on hepatobiliary scintigraphy or 12 hours on oral cholecystography. Among 176 patients, gallbladder was not visualized in 38 patients on hepatobiliary scintigraphy and 41 patients on oral cholecystography. Concordance rate between hepatobiliary scintigraphy and oral cholecystography was 89.2%. The conversion rate to open cholocystectomy was significantly higher in patients with nonvisualization of gallbladder than in patients with gallbladder visualization(15.8% vs 2.9% on hepatobiliary scintigraphy, 12.2% vs 3.7% on oral cholecystography p<0.01 and p<0.05 respectively). The operative complication rate was also significantly higher in patients with nonvisualization of gallbladder (13.2% vs 2.9% on hepatobiliary scintigraphy, 14.6% vs 2.2% on oral cholecystography p<0.01 and p<0.001, respectively). Similarly, operation time was significantly prolonged in patients with nonvisualization of gallbladder ($88.8{\pm}41.9min$ vs $62.5{\pm}23.6min$ on hepatobiliary scintigraphy : p<0.001, $89.4{\pm}41.3$ min vs $61.8{\pm}22.8$ min on oral cholecystography : p<0.001). It is concluded that nonvisualization of gallbladder on hepatobiliary scintigraphy or oral cholecystography is a valuable preoperative clinical risk factor in predicting increased conversion rate to open cholecystectomy, increased operative complication and prolonged operation time.

• The Korean Journal of Nuclear Medicine
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• v.16 no.2
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• pp.71-80
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• 1982

In the present communication, the results will be reported on a clinical study of how well scintigraphic visualization of the hepatobiliary elements and several commonly used clinical liver function tests correlate each other in various diseases oft hepatobiliary system. The demonstrability of the biliary tract, gallbladder (GB) and duodenum was rather closely paralleled to serum bilirubin level and less closely to alkaline phosphatase and rather poorly to SGOT and SGPT. The biliary tree could not be visualized scintigraphically when bilirubin exceeded 10.5mg/dl. The usefulness of Tc-99m EHIDA [N-(2,6-diethylacetanilido) iminodiacetic acid, made by Amersham, England] hepatobiliary scintigraphy (Tc EHIDA HBS) in settling diagnostic controversy and ambiguity raised by oral cholecystography, intravenous cholangiography and ultrasonography in many hepatobiliary diseases is well known. The purpose of this investigation was to semiquantitatively evaluate the scintigraphic demonstrability of the hepatobiliary tract, GB and duodenum following intravenous injection of Tc-99m EHIDA in normal subjects and in patients with a disturbed liver function from various hepatobiliary diseases. The hepatobiliary scintigraphy was performed in 10 normal subjects and 39 patients with various hepatobiliary diseases (Table 1) at the Dept. of Radiology, St. Mary's Hospital Catholic Medical College, Seoul, Korea during 2 years period from September 1979. Scintigraphic examination was started at end of 3 minutes after intravenous injection of Tc-99m EHIDA in the amount of $50{\mu}Ci/kg$ and was continued until after 30 minutes at 5 minutes interval. The imaging was usually terminated when the tracer could be seen in the duodenum. Late scintigrams were obatained at 1 1/2, 3, 4 and 6 hours when reeded. Scintigrams were analyzed in terms of promptness and clarity of visualization of the biliary tree, GB and duodenum and demonstrability of these anatomical landmarks was correlated with the values of liver function tests. The demonstrability of the common hepatic duct, common bile duct, GB and duodenum was closely paralleled to the level of serum bilirubin when it is less than 10.5 mg/dl as shown in figure 1. However when the bilirubin exceeded 10.5 mg/dl the time of visualization between protracted reaching a flat curve or plateau around 10.5 mg/dl. The biliary tract could not be visualized when the bilirubin was higher than 10.5 mg/dl. The correlability between scintigraphic demonstration and serum alkaline phosphatase was less strong and between scintigraphic demonstration and SGOT and SGPT was rather poor. The present clinical study confirmed the usefulness and limitation of Tc-99m EHIDA hepatobiliary scintigraphy in visulizing and diagnosing the biliary system and duodenum when radiogrpahy and ultrasonography failed to provide useful informations. Scintigraphy was very helpful in the diagnosis of neonatal hepatitis, biliary atresia, cholecystitis and extrahepatic biliary obstruction. The hepatobiliary system and duodenum were visualized when serum bilirubin level was less than 10.5 mg/dl, SGOT 135 units, SGPT 114 units and alkaline phosphatase 52.2 KAU.

• The Korean Journal of Nuclear Medicine
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• v.19 no.2
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• pp.25-41
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• 1985

간흡충증은 한국 및 동남아세아에 널리 분포되어 있는 중요한 풍토병의 하나로서 진단은 전통적으로 분변검사에 의존하여 오고 있다. 최근 들어 담관내 간흡충 및 이의 합병증의 진단을 위해 ERCP 및 contrast cholangiogram등이 시도되었으나 실제에 이용하기에는 많은 제약이 있다 하겠다. 저자는 간흡충증에 있어서 최근 소개된 $^{99m}Tc-DISIDA$ hepatobiliary scintigraphy의 진단적 의의를 규명하고자 1982년부터 1983년까지 고신의대 부속 복음병원에서 검진한 간흡충증 환자 90명을 대상으로 하여 $^{99m}Tc-DISIDA$ hepatobiliary scintigraphy와 formalin-ether 원침법에 의한 분변검사를 시행하였다. $^{99m}Tc-DISIDA$ scintigram소견은 간내 담관 bile flow 및 총수담관 bile flow defect, 그리고 간세포기능의 정도에 따라 자료를 분석하였고 그외 합병증의 진단은 병록 기록, 수술 소견, ERCP 등에 의존하여 결론을 얻었다. $^{99m}Tc-DISIDA$ scintigraphy는 특이한 양상의 bile flow dynamics를 나타내었으며 간내 주담관의 intermittent irregular focal bile flow defect 및 tile flow stasis를 나타내고 말초담관의 bile flow defect는 경미하고 60분 내에 담관 bile flow activity의 완전한 배설을 나타내는 경우를 mild pattern, 간내 담관의 심한 irregular bile flow dynamics 및 간내담관의 심한 irregularity (담관내벽의 심한 불규칙성), 총수담관, 간내 주담관 및 말초 담관까지 심하게 irregular bile flow stasis를 나타내며 bile flow activity의 완전 베설이 $60\sim90$분사이 혹은 90분이상까지 인지된 경우를 moderate-severe pattern으로 분류하였다. 1) 분변검사상 간흡충증은 95검사중 70검사(환자 86명중 67명)에서 양성을 보여 분변 충난검사의 양성율은 73.7%였고 음성율은 26.3%였다. 2) $^{99m}Tc-DISIDA$ hepatobiliary scintigraphy는 90명중 70명에서 특이한 Cs-bile flow양성을 보였으며 양성율은 77.8%였으며 음성율은 22.2%였다. 3) $^{99m}Tc-DISIDA$ hepatobiliary scintigram양성율을 나타낸 환자 70명중 11명은 mild pattern, 59명은 moderate-severe pattern을 나타냈으며 그중 21명은 여러가지 간세포 기능 및 담관에 영향을 미치는 질환과 합병했지만 특이한 Cs-bile flow pattern을 dominent하게 나타내었으며 합병된 여러 질환들도 bile flow pattern상 인지 할 수 있었다. 4) $^{99m}Tc-DISIDA$ hepatobiliary scintigram 음성율을 나타낸 환자 20명중 8명은 만성간염, 5명은 간경변증, 3명은 재발성 농양성담관염(recurrent pyogenic cholangitis)과 간내담도의 stricture 및 담관담석증이 합병되었으며 scintigram상 합병증의 pattern을 나타냈고 4명에서는 low CBD obstruction을 나타내었으며 후에 CBD stone, CBD carcinoma, gall bladder Ca.의 porta hepatis 전이 및 clonorchis worms의 cluster에 의한 obstruction이 operation 및 ERCP로서 진단 되었다. 5) $^{99m}Tc-DISIDA$ hepatobiliary scintigraphy pattern은 현재의 자각증상과 관계된 dominent disease를 나타내었으며, 공간 점유병소도 multiple project images를 시행하므로서 쉽게 발견할 수 있었다. 이와 같이 간흡충증에 있어서 $^{99m}Tc-DISIDA$ hepatobiliary scintigram은 환자의 자각증상과 관계된 질환을 규명하는 데 필요한 정보를 얻었을 수 있었으며 간내담관의 damage정도를 규명하는데 필요한 procedure임이 판명되었다.

• The Korean Journal of Nuclear Medicine
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• v.34 no.2
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• pp.154-158
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• 2000

This is a case report of a 5-month-old male who was brought in to hospital for evaluation of jaundice from birth. The baby had a history of ileal atresia operated 2 days after birth. At the age of one month, Tc-99m DISIDA hepatobiliary scintigraphy was performed at other hospital and reported to show good hepatic uptake of the tracer but no uptake in the biliary tree, gall bladder, or intestine for 24 hours post injection. He was judged to have biliary atresia. However, subsequent exploratory laparotomy revealed that the hepatobiliary tree appeared intact and that there was a gall bladder. Additionally, the patient had central aorto-pulmonary shunt for the right ventricular septal defect with pulmonary stenosis of a peripheral type at the age of 4 months. The second hepatobiliary scintigraphy was performed on admission at the age of 5 months, showing a gall bladder but no intestinal uptake up to 24 hours. Retrospectively, the histological specimen of the liver obtained at the exploratory laparotomy was re-evaluated, and by the histological findings coupled with clinical data, arteriohepatic dysplasia (Alagille's syndrome) was diagnosed. In this report, we emphasize the diagnostic limitation of hepatobiliary scintigraphy and the importance of overall clinical and histologic evaluation in a case of Alagille's syndrome.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.3 no.1
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• pp.63-67
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• 2000

Purpose: Biliary atresia, one of the major causes of neonatal cholestais, is an idiopathic, serious disorder, affecting the newborn that results in complete obstruction of biliary tract. Successful reestablishment of bile flow is dependent on early surgical intervention, early diagnosis is imperative. The authors evaluate the utility of Tc-99m-labeled diisoprpyliminodiacetic acid (DISIDA) hepatobiliary scintigraphy in the diagnosis of biliary atresia. Methods: From January, 1995 to August, 1999, total 60 patients with neonatal cholestasis underwent Tc-99m DISIDA hepatobiliary scintigraphy at Asan Medical Center. Results: The undelying causes of neonatal cholestasis were biliary atresia in 14, neonatal hepatitis in 33, intrahepatic bile duct paucity in 9, and total parenteral nutrition induced cholestasis in 4. All patient with biliary atresia were interpreted correctely in DISIDA hepatobiliary scintigraphy, showing 100% sensitivity. Of the 46 patients with neonatal hepatitis and other causes, 37 patients had intestinal radioactivity showing 80% specificity. Conclusion: Visualization of DISIDA in the intestinal tract indicates patency of the biliary ducts and excludes the diagnosis of biliary atresia. But the absence of intestinal excretion on the DISIDA hepatobiliary scintigraphy dose not necessarily indicate biliary atresia.

• Environmental Mutagens and Carcinogens
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• v.21 no.1
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• pp.1-8
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• 2001

We have synthesized $^{99m}$Tc-mercaptoacetyltriglycine (MAG3)-biocytin as a new imaging agent for hepatobiliary scintigraphy. The aim of this study was to evaluate the usefulness of $^{99m}$Tc-MAG3-biocytin scintigraphy in differentiating carbon tetrachloride ( $CCl_4$)-induced hepatotoxicity from $\alpha$-naphthylisothiocyanate (ANIT)-induced cholestasis in mice, which reflecting the differential diagnosis of neonatal jaundice caused by neonatal hepatitis from congenital biliary atresia in humans. Methods: Balb/c mice (female, 20 g, n=4-6) were pretreated with $CCl_4$(0.5 or $1.0m\ell$/kg) and ANIT ($150 or 300 m\ell$/kg) 18 h before scintigraphy. Biochemical and histopathological examinations showed a pattern of typical acute hepatitis (increase of transaminases and hepatocellular necnsis) in $CCl_4$-treated mice and cholestasis (increase of alkaline phosphatase and ${\gamma}$-glutamyltransferase, and biliary hyperplasia) in ANIT-treated mice, respectively, Mice were fasted at least 4 hr prior to the intravenous injection of $^{99m}$Tc-MAG3-biocytin (18.5 MBq/20$\mu\textrm{g}$) in 2% human serum albumin in saline. Scintigraphy was performed with a ${\gamma}$-camera equipped with a 1-mm diameter pin-hole collimator for 30 min and images were acquired every 15 s. We compared the values of physical parameters, such as peak liver/heart ratio ($${\gamma}$_{max}$) and peak ratio time ($t_{max}$) far $^{99m}$Tc-MAG3-biocytin scintigraphy. Results: Scintigraphic parameters of the $CCl_4$-pretreated (0.5 $m\ell$/kg) group showed a 81.9% decrease of r$_{max}$, and 42.2% decrease of $t_{max}$, whereas the ANIT-pretreated ( $150m\ell$/kg) group showed a 53% decrease of $r_{max}$, and 2.36-fold increase of $t_{max}$, (P<0.05). These results demonstrate that the decrease of $r_{max}$ and the shortening of $t_{max}$ are characteristic features for hepatotoxicity, in contrast to the increase of $t_{max}$ and decrease of $r_{max}$ for biliary hyperplasia. Conclusion: $^{99m}$Tc-MAG3-biocytin hepatobiliary scintigraphy can distinguish hepatitis from cholestasis in mice model and may be similarly useful in humans which differentiating the cause of neonatal jaundice in clinical study.cal study.cal study.cal study.

• The Korean Journal of Nuclear Medicine
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• v.29 no.3
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• pp.313-318
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• 1995

Reflux of bile and digestive enzymes from the small bowel and duodenum into stomach has been observed in patients with various gastroduodenal diseases. Tc-99m iminodiacetic acid delivatives hepatobiliary scan has been used as a noninvasive method to detect duodenogastric reflux. Sometimes, gastric reflux can be observed incidentally on routine Tc-99m DISIDA hepatobiliary scintigraphy. To evaluate the clinical meaning of gastric reflux on routine Tc-99m DISIDA hepatobiliary scan, we analyzed 36 patients showed gastric reflux incidentally on the routine Tc-99m DISIDA hepatobiliary scintigraphy from December 1991 to June 1995 in Chungnam National University Hospital. The results were as follows : 1) The gastric reflux was observed in 2.3% of 1,553 cases of routine Tc-99m DISIDA Hepatobiliary scintigraphy for 43 months. 2) Nineteen percent of patients with gastric reflux had the past medical history of operations on stomach or biliary system. And that history was more prevalent in patients with reflux than those without reflux, significantly (p<0.01). 3) On fiberoptic gastroduodenoscopic examination, 87% of the patients with gastric reflux had the gastroduodenal diseases such as gastritis, gastric ulcer, duodenal ulcer, gastric cancer, duodenal cancer and ampullary diverticulosis. We thought that the gastric reflux can be observed considerably in patients without any operation history on stomach or duodenum, although the operation history is more prevalent in patients with gastric reflux than those without reflux, significantly and most of patients with gastric reflux on routine Tc-99m DISIDA scan has various gastroduodenal diseases.

• The Korean Journal of Nuclear Medicine Technology
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• v.12 no.3
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• pp.229-234
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• 2008

Hepatobiliary scintigraphy is very sensitivity of hepatic cell and gallbladder, biliary track atresia and biliary leakage. however, Hepatobiliary scan of biliary leakage diagnosis was separated determine biliary leakage and bowl drainage bile-juice. The object of this study will determine biliary leakage and bowl drainage bile-juice to hepatobiliary scintigraphy both decubitus position in bile leakage patients. Material & Methode: 31 patients (meal 14, Femeal 17), $51.1{\pm}14.4$ years. dynamic scan acquisition 60 farme for 60 minute on supine position. and delay scan was 2 hrs, 4 hrs, 24 hrs for 5 minute on supine, both decubitus position. Both decubitus position scan was kept for 5 minutes. Efficient of Hepatobiliary Scintigraphy both decubitus position in bile leakage patients was compared leakage size, density, image of supine position and both decubitus position. Results: 23 patients for 31 bile leakage patients was checked up function image or delay image, and 8 patients was checked up bile leakage on both decubitus. anatomical leakage location was supine position very well, but both decubitus position was separated bile leakage and moving bile-juice in bowl. also, uptake (counts/pixel) average of roi and bkg was supine 5.02, left decubitus 2.08, right decubitus 2.68. No. pixels of supine ROI counted 1.91 times than left decubitus, 1.05 times than right decubitus. Conclusion: 31 patient both decubitus position, but decubitus position was separated bile juice movement in bowl leakage location. also, It was compared ROI/BKG ratio and ROI No. pixels of supine, both decubitus in 38.5% patients. And No. pixels of supine position was large 19%, 5% than left decubitus, right decubitus, And density was in low 60%, 50% than left decubitus, right decubitus. It was mean bile leakage of ROI. so, If Hepatobiliary Scintigraphy was additional both decubitus position scan in bile leakage patients, this study will be more valuable in diagnosis of bile leakage.

• Journal of Veterinary Clinics
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• v.24 no.4
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• pp.593-596
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• 2007

The purpose of this study is to investigate normal hepatobiliary functions in healthy miniature pigs. $^{99m}Tc-DISIDA$ hepatobiliary scintigraphy(HBS) was used for it. Five mCi dose of $^{99m}Tc-DISIDA$ was injected intravenously into 3 healthy adult miniature pigs, and dynamic images were obtained during 1 hour. $^{99m}Tc-DISIDA$ HBS in a miniature pig was evaluated for 6 variables. A cardiac washout occurred within 1 min in all miniature pigs and radioactivities in the gallbladder were not detected in two miniature pigs. Thus, the initial radioactivity and Tmax of the gallbladder were non-available to identify. Mean Tmax of liver was $8.67{\pm}2.08$ min and initial small intestinal radioactivity was seen at $9.67{\pm}2.52$ min after $^{99m}Tc-DISIDA$ injection. Mean hepatic washout time was not detected in 60 min dynamic images. Therefore, $^{99m}Tc-DISIDA$ HBS is the effective diagnostic method to evaluate the function of hepatocyte and bile flow rate. However, it was not a proper method to evaluate the function of gallbladder, which indicates that an additional study is needed to further specify the reasons for the absence of radioactivities in gallbladder of two miniature pigs.