Bile leak detection by radionuclide scintigraphy.

INTRODUCTION: Bile leak after liver injury has been reported to be a complication associated with significant mortality. Tc99m-IDA (Tc: Technetium) nuclear scan allows rapid and noninvasive diagnosis of bile leak. OBJECTIVE: An accidental case was referred for the detection of suspicious bile leak. METHODS: The ultrasound could not detect any abnormality. Dynamic Hepatobiliary Scintigraphy (DHBS) using radiolabeled tracer was performed. RESULTS: DHBS promptly detected the site of leak. CONCLUSION: This technique should be opted because it has been found to be quite sensitive, specific and accurate for detecting the bile leak, whereas, Ultrasound and CT imaging are less sensitive and nonspecific. Though, they are initially helpful in determining the presence of abdominal fluid collections, they are unable to differentiate between a seroma, lymphocele, hematoma or bile leak. Hepatobiliary scintigraphy is more accurate because it can demonstrate continuity of these fluid collections with the biliary tree. Further, hepatobiliary scintigraphy can provide real-time assessment of hepatocytes function and bile progression from the liver to the intestine.

Hepatobiliary clearance of labelled mebrofenin in normal and D-galactosamine HCl-induced hepatitis rats and the protective effect of turmeric extract.

This study was carried out to see the hepatobiliary clearance of 99m Tc-Mebrofenin radiopharmaceutical in D-galactosamine induced hepatic rats. Furthermore, protective effect of turmeric extract has been studied in these hepatitis rats. Hepatitis was induced with intraperitoneal injection of D-galactosamine (400 mg/kg b. wt) in these rats. 1% turmeric extract was given along with their normal diet for 15 days. Turmeric extract treatment significantly increased the hepatic uptake of radioactivity and accelerated the excretion of 99m Tc-Mebrofenin as compared to control rats. (P < 0.001). In D-galactosamine administered rats, a significant delay was observed in 99m Tc-Mebrofenin excretion as compared to controls. However, D-galactosamine administered rats, pretreated with turmeric extract or concurrently treated with turmeric extract showed a near normal pattern of 99m Tc-Mebrofenin excretion. Hence, it can be suggested that turmeric extract may improve the liver function by detoxification.

Role of biliary scintigraphy in management of bile leak.

BACKGROUND: Endoscopic biliary drainage is effective in the management of patients with postoperative bile leak. Evidently, it cannot be used in patients with completely tied-off common bile duct (CBD). AIM: To ascertain whether biliary excretion scintigraphy could reliably detect patients with tied-off CBD so that endoscopic retrograde cholangiography (ERC), an invasive test, could be avoided. METHODS: Twelve patients with active bile leak (11 postcholecystectomy, one posttraumatic), in whom the biliary system was imaged by both 99m technetium mebrofenin biliary scintigraphy and ERC, were evaluated. RESULTS: Bile leak was demonstrated in all the 12 patients by scintigraphy. In six of these, there was no visualization of radionuclide activity in the intestines; in three of these six patients, ERC showed a patent CBD potentially amenable to endoscopic drainage, whereas in the remaining three, there was complete obstruction presumably due to CBD tie-off during surgery. CONCLUSION: Biliary excretion scintigraphy is unreliable for detecting complete biliary obstruction in patients with bile leak.

Cholescintigraphic detection of biliary leaks.

We report four cases in whom post-traumatic or post-surgical biliary leak was detected using dynamic 99mtechnetium-iminodiacetic acid (IDA) cholescintigraphy. This technique is a non-invasive, safe, simple and sensitive method of documenting the presence, location and extent of biliary leaks. Further, it can be repeated and hence, is useful in evaluating the response to treatment. Surgery is indicated when a moderate extravasation of labeled bile suggests that the leak is the chief pathway of bile drainage, with relatively little bile entering the intestine.

Thoracic stomach: comparative evaluation of endoscopy, gastric aspirate analysis and hepatobiliary scintigraphy in the diagnosis of duodeno-gastric reflux.

Twenty patients with thoracic stomach were subjected to hepatobiliary scintigraphy for the diagnosis of duodenogastric reflux. The results of the radionuclide studies were correlated with those of endoscopy and biochemical estimation of total intragastric bile acid. Hepatobiliary scintigraphy was found to be more sensitive (91.6%) and accurate (95%) than endoscopy (25% and 55% respectively) and biochemical estimation of total intragastric bile acid content (66.6% and 80% respectively). Being noninvasive and physiological, radionuclide study appears suitable for routine clinical use in the diagnosis of duodeno-gastric reflux.

Variations in normal hepatobiliary scintigraphy in Indian population.

Hepatobiliary scintigraphy was performed with Tc99m iminodiacetic acid (IDA) analog, in 100 apparently healthy adults, to study the variations in the normal hepatobiliary scintigraphy. Gall bladder (GB) was visualised in 43% at 15 min; 87% at 30 min, 90% at 45 min and 99% at 60 min and the small intestine (SI) was visualised in 24% at 15 min, 69% at 30 min, 76% at 45 min and 92% at 60 min. Left hepatic duct was prominent in 45%. Reciprocal relation between SI and GB was observed in 21%.