• The Korean Journal of Nuclear Medicine
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• v.28 no.1
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• pp.141-144
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• 1994

As the laparoscopic cholecystectorny is performed more widely, complication associated with the procedure, although rare, are encountered occasionally. Injury to the bile duct occurs somewhat more frequently after the laparoscopic cholecystectorny than the open method. The bile leakage following a bile duct injury can be detected non-invasively either by ultrasonography or radionuclide hepatobiliary scan, but the former is not very specific. Hepatobiliary scan can show the bile leakge and the localization of the bile accumulation. We report two cases of the common bile duct injury following laparoscopic cholecystectorny, accurately detected by hepatobiliary scan using $^{99m}Tc$-diisoprophylimi-nodiacetic acid (DISIDA).

• The Korean Journal of Nuclear Medicine
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• v.29 no.4
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• pp.484-491
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• 1995

It is well known that hepatobiliary agent are taken up by metastatic hepatocellular carcinoma(HCC) as well as primary HCC. But the reported cases of the extrahepatic metastasis of HCC diagnosed by hepatobiliary scintigraphy are for the most part hematogenous ones. The relation of the uptake pattern of hepatobiliary agent in the primary and metastatic HCC is also still remains unknown. So we undertook this study to evaluate the relation of the hepatobiliary scintigraphic patterns of primary and metastatic HCC with different metastatic routes. Nine patients with primary HCC and twelve cases of metastatic HCC including four lung metastases, one bone metastasis, one right atrial metastasis, one peritoneal wall metastasis, and five lymph node metastases were studied with $^{99m}Tc-DISIDA$ scintigraphy. The images were taken on 10, 30 minutes, 1, 2, 4-6 hours. The overall detection rates of hematogenous metastases(lung and bone) is 60%(3 of 5), direct metastasis(right atrium and peritoneal wall), 100%(2 of 2) and lymphatic metastases, 0%(0 of 5). In four of five metastatic cases demonstrated with hepatobiliary scintigraphy, biliary agent is also taken up by primary HCC lesions. And the appearing time of the radioactivity in the direct metastatic HCC lesioin is same as that of primary HCC and in the cases of hematogenous metastasis, earlier than that of primary HCC. Hepatobiliary scintigraphy is more useful in the diagnosis of the metastatic HCC than primary HCC, in the cases of hematogenous and direct metastasis.

• The Korean Journal of Nuclear Medicine
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• v.25 no.1
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• pp.53-60
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• 1991

Extracorporeal shock wave lithotripsy (ESWL) with adjunctive oral litholytic therapy has proven to be a useful treatment in selected patients with gallbladder stones. To study the effect of ESWL on gallbladder dynamics, $^{99m}Tc-DISIDA$ hepatobiliary scintigraphy was done for 25 patients with symptomatic gallstones and 10 normal controls. Of these 25 patients, 15 were treated with ESWL and adjunctive oral litholytic agents (ESWL group) and 10 were treated only with oral litholytic agents (UDCA group). After overnight fast and gallbladder visualization on a routine hepatobiliary scintigraphy with 7mCi of $^{99m}Tc-DISIDA$, subjects were given fatty meal and imaged with a gamma camera interfaced to a computer (1 frame/minute for 70 minutes). A gallbladder time-activity curve was generated and latent period (LP), ejection period (EP), ejection fraction (EF) and ejection rate (ER) were calculated. ESWL group were studied before, 1day after and 2weeks after ESWL, and WDCA group were studied before and 2weeks after starting oral medication. Mean basal EF was significantly reduced in patients but other parameters were not reduced. In ESWL group, mean EF and mean ER at lday after ESWL were reduced. In 3 of them, gallbladder was not visualized at all. Two weeks after ESWL, however, all parameters were recoverd to basal level. In UDCA group, all parameters were not changed significantly during medication. We can conclude that ESWL has such immediate adverse effect on gallbladder dynamics as reducing contractility and nonvisualization of gallbladder but it has no long-term effect.

• 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.5 no.2
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• pp.186-191
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• 2002

Choledochal cyst is a congenital anomaly with classic triad of abdominal pain, jaundice and right upper abdominal mass. Bile peritonitis caused by cyst rupture is relatively not rare in infancy. The mechanism of rupture must be epithelial irritation of the biliary tract by refluxed pancreatic juice caused by pancreatico-biliary malunion associated with mural immaturity in infancy, rather than an abnormal rise in ductal pressure or congenital mural weakness at a certain point. We experienced a case of bile peritonitis caused by spontanenous rupture of choledochal cyst in a 10-month-old girl presented with abdominal distension, persistent fever, diarrhea, irritability and intractable ascites. She was presumed as having bile peritonitis by bile colored ascitic fluid with elevated bilirubin level and diagnosis was made by $^{99m}Tc$ DISIDA hepatobiliary scan showing extrahepatic biliary leak. The perforated cyst was surgically removed and the biliary tree was reconstructed with a Roux-en-Y hepaticojejunostomy.

• The Korean Journal of Nuclear Medicine
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• v.30 no.1
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• pp.126-129
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• 1996

Spontaneous perforation of CBD in infant is a rare but fatal disease. We report a case of bile leakage from common bile duct in 11 months old girl with progressive abdominal distension and vomiting, preoperatively diagnosed by hepatobiliary scan with 99mTc-DISIDA, which was confirmed by surgery, Operative cholangiogram showed a small perforation at the confluence of cystic duct and common bile duct with mild fusiform dilatation, and no definite abnormality in confluence of the common bile duct and pancreatic duct. Simple drainage of the free peritoneal bilous fluid and T-tube drainage were performed without any evidence of the complication. Patient was inevitable for 6 months OPD follow-up examination.

• Journal of Biomedical Engineering Research
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• v.18 no.3
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• pp.301-306
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• 1997

Surgical removal of hepatic cancerous tissues have been widely performed due to its early detection. However, a patient can not survive if excessive hepatic tissues were removed. Therefore, quantitative evaluation of remaining hepatic function after surgery is a really important factor for surgeon. the currently used ICG Rmax and Lidocaine clearance tests have disadvantages such as tedium, complexity, and inability to estimate remaining hepatic function after surgery. While HEF has advantages such as simplicity, quickness, nonivasiveness, and quantification, its reliability has been doubtful. Thus, the program for calculation of HEF has been developed from serial gamma camera image data. And we compared the reliability of HEF with ICG Rmax and Lidocaine clearance test using 6normal and 18 abnormal rabbits with damaged livers. The correlation coefficient of HEF to ICG Rmax and MEGX was 0.91, 0.94, respectively. I was also found that the HEFs of normal and abnormal hepatic tissues was higher than 100% and lower than 80%, respectively. Thus we confirmed that HEF can be a good indicator distinguishing between abnormal tissues and normal ones. Finally, we could conclude that patients would survive if both the pre-and the post-operative HEF were greater than 60%.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.5 no.1
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• pp.101-107
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• 2002

We experienced two cases of Rotor syndrome in brothers who were a 13 year-old boy and an 11 year-old boy, respectively. They presented with icteric scleras for a few months. Their common laboratory characteristics were as follows: Direct bilirubin was more increased than indirect bilirubin, but aminotransferases were normal. Plasma indocyanine green (ICG) test revealed hepatic excretory defect: plasma ICG concentrations 15 minutes after intravenous injection were 80.45% and 78.28%, respectively. 99mTc-DISIDA Hepatobiliary scan showed that severely decreased hepatic extraction with mild cardiac blood pool, markedly delayed biliary excretion in both intra- & extra- hepatic bile ducts, delayed visualization of gall bladder, and markedly delayed intestinal biliary passage. Needle liver biopsy showed normal hepatic histology without pigmentation.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.2
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• pp.219-222
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• 2008

Crigler-Najjar syndrome is a rare inherited disease associated with unconjugated hyperbilirubinemia. It is inherited via an autosomal recessive pattern and is caused by mutation in one of the five exons of the bilirubin uridine-diphosphoglucuronate glucuronosyltransferase (UGT1A1) gene. The synthesis of inactive isoforms of bilirubin uridine-diphosphoglucuronate glucuronosyltransferase (B-UGT) results in unconjugated hyperbilirubinemia. A 13-year-old boy with jaundice for 4 months was admitted to our hospital. He had unconjugated hyperbilirubinemia with no evidence of infection, hemolysis, or structural abnormalities on abdominal ultrasonography or 99mTc-DISIDA scan. The authors identified a missense mutation of Tyr486Asp in the fifth exon of the UGT1A1 gene and diagnosed the patient with Crigler-Najjar syndrome type II. This is the first reported case of Crigler-Najjar syndrome in a Korean child, and it is also the first reported case of a genetic mutation leading to Crigler-Najjar syndrome in Korea.

• The Korean Journal of Nuclear Medicine
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• v.28 no.1
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• pp.85-88
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• 1994

근래 골조직에 있어서 자율신경의 기능에 대하여 많은 연구가 이루어지고 있으며, 골내의 자율신경의 해부학적 분포는 많이 알려져 있다. 그러나 임상적으로 반사적 교감신경 이상이나 레이노드 현상등과 같은 교감신경의 기능이상증에서나, 버거씨병 등의 치료 목적으로 시행되고 있는 교감신경 절제술 후, 자율신경기능의 변화가 사지골의 혈류나 골대사에 미치는 영향에 대하여는 아직도 논란의 여지가 있다. 저자들은 교감신경절제술 후 시간 경과에 따른 골에 미치는 영향을 알아보기 위하여 흰쥐에서 골대사와 혈류상태를 비교적 충실히 반영하는 정량적 골스캔을 시행하였다. 체중 $300{\sim}400g$의 수컷 흰쥐 10마리에서 복강을 통한 편측 요추부 교감신경절제술을 시행하였고, 수술 전과 후 1일, 3일, 1주, 2주, 3주, 4주에 양측 하지에서 각각 골스캔을 시행하고 교감신경 절제측 하지와 정상 하지에 대칭적으로 관심구역을 정하여 양측의 골스캔상 섭취계수를 비교하였다. 측정부위는 각 하지의 대퇴골간, 경골간 및 중족골로 하였다. 교감신경 절제술을 시행한 하지에서는 골스캔 소견상 수술 후 1일 또는 3일부터 동위원소 집적이 유의하게 증가되었으며 원위부로 갈수록 더욱 증가되었다. 그러나 3주 이후에는 정상측 수준으로 환원되었다. 교감신경절제술 후 골스캔상 동위원소집적이 증가되는 것은 골자체의 혈류가 증가되기 때문이며 이차적으로 골의 흡수를 유발하여 골밀도가 감소하는 것으로 생각되는데 이러한 변화는 시술 후 1일 째부터 관찰되어 사지골이 교감신경 절제에 매우 민감하게 반응하는 것을 알 수 있었다.9m}Tc$-MAA를 이용한 간 동맥 혈류 검사는 간암에서 색전술의 효과를 정확히 평가할 수 있는 유용한 검사법으로 이용될 수 있으리라 생각한다. 활성화 과정을 알아볼 수 있었으며 위상영상히스토그램을 통하여 이를 정량화하여 심실내 전기적 활성의 비동시성 여부를 추적관찰 할 수 있는 비관혈적검사임을 확인하였다.며, 3. $^{99m}Tc$으로 표지된 avidin과 streptavidin은 먼저 간으로 흡수된 후 대사된 다음 신장으로 배설된다는 사실을 알았다.damole에 의한 부작용은 흉통, 두통, 복통 등의 순이었고 전예에서 호전되었으며 생명에 위험을 초래할 수 있는 정도의 심장마비나 심부정맥은 한 예에서도 없었다. 결론적으로 dipyridamole은 약물부하 심근 SPECT 검사에 안전하게 사용할 수 있는 약물로 사료된다. 미소핵 빈도수가 증가하는 경향을 보였으나, 각 군간에 통계학적으로 유의한 차이는 없었다(p>0.05). 결론 : 임상적으로 치료를 중단하게 되는 1000mCi/60 Kg(16.67 mCi/Kg)를 투여한 군에서도 생쥐 골수내 미소핵이 발현되지 않는 것으로 보아, 방사성옥소는 비교적 안심하고 치료에 사용할 수 있는 제제로 사료되었다.반드시 비례하지만은 않아서 시간경과에 따른 추후 검사가 필요하리라 생각된다. 또한 방광요관역류가 있는 환아에서 DMSA 섭취율로 신기능을 평가할 때, 특히 영유아에서 연령에 따른 고려가 있어야 할 것으로 보인다.었다. 4) $^{99m}Tc-DISIDA$ hepatobiliary scintigram 음성율을