Pseudohydronephrosis on bone scan due to crossed renal ectopia.

We present a patient with crossed renal ectopia whose bone scan gave the appearance of unilateral hydronephrosis with contralateral absent or nonfunctioning kidney. An excretory urogram revealed crossed renal ectopia without obstruction. The axiom that unilateral absence of a kidney without previous nephrectomy should stimulate a search for ectopic kidney applies equally well to the bone scan as to the excretory urogram.

A clinical comparison of 99mTc-diethyl-iminodiacetic acid, 99mTc-pyridoxylideneglutamate, and 131I-rose bengal in liver transplant patients.

The relative merits of three radiopharmaceuticals for evaluating liver transplant patients were determined in paired studies. In 86% of studies both 131I-RB and 99mTc-PG gave similar information for differentiation of hepatocellular disease and billary tract obstruction. 99mTc-PG probably demonstrates the biliary tract and small intestine better early after injection (8%); 131I-RB is probably better in showing the colon at 24 hours when intestinal activity is not seen by 1 hour (6%). 99mTc-diethyl-IDA is superior in all respects when compared to 99mTc-PG. The blood retention method (20 min./5 min.) showed that none of the radiopharmaceuticals was a reliable indicator of hepatocyte function when compared to total serum bilirubin.

The radiology of ex vivo renal perfusion and autotransplantation.

The radiologic findings in 16 patients subjected to ex vivo renal perfusion and autotransplantation are reviewed. Preoperative excretion urography and renal arteriography are essential to define ureteral and arterial anatomy; renal scintiangiography and renography are useful for baseline studies. Plain radiographs should be obtained during nephrolithotomy. Intraoperative renal arteriography should be reserved for patients who require more precise definition of vascular anatomy or verification of adequate repair after a difficult dissection. Postoperative scintiangiography is required on the first day to exclude arterial occlusion. Renography and urography to evaluate autotransplant anatomy and function should be deferred for about 3 weeks, unless there is clinical evidence of a complication.

Technetium 99m-pyridoxylideneglutamate: a new hepatobiliary radiopharmaceutical. I. Experimental aspects.

The labeling of pyridoxal and the pyridoxylidene derivative of glutamic acid with 99mTc has been achieved by a simple autoclaving procedure. Technetium-99-m-pyridoxylideneglutamate (99mTc-PG) shows marked biliary excretion with accumulation of radioactivity in the gallbladder and intestines of experimental animals. This compound has been extensively investigated with a view to its application in the diagnosis of biliary disorders in man by scintigraphy. Both scintigraphic and quantitative distribution studies showed that 99mTc-PG passed rapidly through the mouse liver with progressive accumulation in the gallbladder, allowing visualization of this organ within 10 min of injection. In 30 min over 40% of the injected dose was excreted into the intestine with an equivalent amount appearing in the urine; however, renal activity remained low. Scintigraphic studies in dogs showed results similar to those obtained in mice. Studies of the toxicity in three animal species indicated a wide margin of safety for 99mTc-PG in the dose proposed for diagnostic purposes in humans.

Technetium-99m-pyridoxylideneglutamate: a new hepatobiliary radiopharmaceutical. II. Clinical aspects.

Technetium-99m-pyridoxylideneglutamate (99mTc-PG) is a nontoxic radiopharmaceutical that was found to undergo rapid biliary excretion in normal humans. The biliary tree and gallbladder were seen within 10-15 min of injection and by 20 min marked accumulation of radioactivity was noted in the gallbladder and gastrointestinal tract. Of ten "control" volunteers, seven had normal 99mTc-PG-cholescintigrams. In the remaining three, the gallbladder was not visualized. Gallbladder disease was not excluded in these three subjects. Of 24 patients referred for investigation of right upper quadrant abdominal pain, 13 proved to have gallbladder disease. All seven patients with acute cholecystitis and one of four patients with chronic cholecystitis had nonvisualization of the gallbladder on the cholescintigram whereas five patients with chronic cholecystitis or cholesterolosis had normal cholescintigrams. Six of the eight patients with nonvisualization of the gallbladder on cholescintigram had contrast radiologic studies (oral cholecystogram or intravenous cholangiogram or both), and in all six, nonvisualization of the gallbladder was also reported on the contrast study. cholescintigraphy was found to be greatly inferior to contrast radiologic studies in the detection of gallbladder stones. Eleven patients had complete extrahepatic biliary obstruction and this diagnosis was correctly made in all 11 by the cholescintigram. Fourteen patients had incomplete extrahepatic biliary obstruction. The correct diagnosis was made on the cholescintigram in seven but in the remaining seven it was not possible to distinguish between incomplete extrahepatic biliary obstruction and hepatocellular disease. Malignant lesions (carcinomas of head of pancreas, gallbladder, common bile duct or ampulla of Vater) were the cause of obstruction in 10 of the 25 patients with complete or incomplete obstruction and the diagnosis of obstruction due to malignancy was correctly made in 8 of these 10 by means of a scintigraphic equivalent to Courvoisier's sing. Finally, 11 patients had hepatocellular disease and a nonspecific pattern consistent with either imcomplete biliary obstruction or hepatocellular disease was observed on the cholescintigram in all 11. The 99mTc-PG cholescintigram is suggested for a role complementary to that of contrast radiologic studies in the preoperative investigation of patients with possible surgical disease of the biliary tract. Contrast radiologic techniques are advocated as being more appropriate in the nonjaundiced patient with suspected gallbladder disease whereas the 99mTc-PG cholescintigram is advocated as being more appropriate in the patient with jaundice. The value of the 99mTc-PG cholescintigram lies in the confidence with which complete extrahepatic biliary obstruction can be diagnosed. The "scintigraphic Courvoisier's sign" seems a useful indicator of malignant obstruction.