Preoperative evaluation of liver function using 99mTc-diethyl iminodiacetic acid based on single photon emission computed tomography / 中国医学科学院学报

<p><b>OBJECTIVE</b>To establish a three-dimentional liver function evaluation system using 99mTc-diethyl iminodiacetic acid (99mTc-EHIDA) scintigraphy based on single photon emission computed tomography (SPECT).</p><p><b>METHODS</b>Totally 16 patients with liver lesions were divided into cirrhosis group and non-cirrhosis group. SPECT was performed 2 days before operation and 5 days after operation. Serum liver functions were examined on the same day of scintigraphy. SPECT images of areas of interest of heart and liver were aquired. Time of the peak of EHIDA density in liver (Tpeak), five-minutes heart liver index (HLI5), blood clearance index (HH15), receptor index (LHL15), and the predictive values were calculated.</p><p><b>RESULTS</b>Tpeak was not significantly different between two groups, while HLI5, HH15, and LHL15 were significantly different (P = 0.033, P = 0.001, and P = 0.005). HLI, and LHL15 were significantly correlated with preoperative total protein and prealbumin levels (P = 0.003, P = 0.015, P = 0.022, P = 0.038) and post-operative prealbumin (P = 0.037, P = 0.042). The predictive values of HLI5 and LHL15 correlated well with postoperative HLI5 and LHL15 (r = 0.675, P = 0.016; r = 0.629, P = 0.028).</p><p><b>CONCLUSION</b>The three-dimentional liver function evaluation system using 99mTc-EHIDA based on liver SPECT may facilitate the further studies of risks of liver surgery.</p>

A Case of Cholethorax following Percutaneous Transhepatic Cholangioscopy / 결핵및호흡기질환

Cholethorax (bilious pleural effusion) is an extravasation of bile into the thoracic cavity via a pleurobiliary fistula (and also a bronchobiliary fistula). It is an extremely rare complication of thoraco-abdominal injuries. It can be caused by congenital anomaly and also by hepatobiliary trauma, severe infection or iatrogenic procedures. The definitive diagnosis is made with aspiration of bilious fluid from the pleural space during thoracentesis, by finding a fistulous tract during endoscopic retrograde cholangiopancreatography (ERCP) or cholagioscopy, or with finding an abnormal pleural accumulation of radioisotope during hepatobiliary nuclear imaging. Its symptoms include coughing, fever, dyspnea and pleuritc chest pain. Herein we report on a case of cholethorax following performance of percutaneous transhepatic cholangioscopy (PTCS) to remove incidentally discovered common bile duct (CBD) stones.

role of CCK-HIDA scan and cholecystectomy in patients with biliary symptoms and normal ultrasound

Laparoscopic cholecystectomy is a safe and effective treatment for symptomatic gallstones. "Biliary dyskinesia" refers to postprandial right upper abdominal pain, fatty food intolerance, nausea or bloating without cholelithiasis. There is a striking increase in number of cholecystectomies performed for dyskinesia. Cholecystokinin stimulated hepatobiliary 99m- Tc iminodiacetic acid scintigraphy [CCK-HIDA] has been suggested as an objective diagnostic tool and predictor of outcome. Over a period of 3 years [July 200/ to June 2004] patients between 18 and 90 years with symptoms of gallbladder disease and no stones on ultrasound were evaluated with CCK-HIDA scan. Other appropriate tests were done to exclude potential causes of each patient symptom. Cholecystectomy was performed when no cause was found to explain the complaint. Patients were divided into 2 groups, group A with EF 35% or less and group B with EF> 35%. Success was considered if symptoms improved, patients were satisfied and would agree to go for surgery again f time goes back. Improvement was correlated with degree of dyskinesia, type of symptom, reproduction of pain during CCK-HIDA, age, sex and pathology findings. 57 patients were included. Mean age was 42.6 years with 46 female and 5 males. 49 patients had recurrent symptoms. 43 patients had classic gallbladder pain. 69 US, 32 CT scan, 33 EGD, 9 colonoscopies, 6 ERCP 's, 9 barium meal fallow through. 6 HIDA scans, 3 gastric emptying studies, I MRCP, I barium enema and I endoscopic US have been performed without being able to explain the patients symptom. All patients had CCK-HIDA scan, EF was 35% or less in 31 patients [group A] and >35% in 20 patients [group B]. Groups were similar in other aspects. All patients had cholecystectomy. Mean follow up was 17.4 months [range 3-36]. Most common,morbidity was diarrhea [23/51]. Most common pathology was chronic cholecystitis [39/51]. The overall success was 67%, similar results were found in groups A and B [68% and 65% respectively,] with no correlation found between the result of surgery and EF. In addition reproduction of pain during CCK administration and patient age did not predict the outcome. Patients with typical symptoms had better results [70% success] when compared to patients with atypical symptoms [50% success,] [p=0.42,]. Females showed more favorable outcome [70% success] when compared to males [40% success] [p=0.32] Only 67% of patients with pathologic evidence of chronic cholecystitis improved after surgery. The 3 patients with stones did not improve. Biliary Dyskinesia remains a challenge. Cholecystectomy is safe and provides improvement in 70% of patients with typical symptoms after exclusion of other possible causes of pain by appropriate investigations. Patients with atypical symptoms and males tend to have less favorable outcome [50% success]. Clinical evaluation is the best predictor of outcome and careful patient selection is important to assure good results

Role of [201]TI-[99m]TC.HIDA subtraction liver scan in detection and specification of focal hepatic lesions

Focal hepatic lesion is a common problem accidentally discovered on imaging studies as abdominal ultrasonography, computed tomography and magnetic resonance imaging that must be characterized. The aim of this prospective study is to verify, the efficacy of [201]Tl-[99m]Tc.HIDA subtraction scan in detection and specification of such lesions. Seventy five patients, divided into two groups according to their definitive diagnosis, were the subject of the this work. Group 1: included 41 patients with benign focal hepatic lesions. Group 2 : included 34 patients with malignant focal hepatic lesions. All cases were diagnosed by sonography and /or tissue biopsy through true-cut needle biopsy. All of them were subjected to [201]Tl-[99m]Tc.HIDA subtraction liver scan that was interpreted both qualitatively and quantitatively. Correct diagnosis was achieved in about 80.5% and 82.4% of group 1 and 2 cases respectively using abdominal ultrasonography whereas [201]Tl-[99m]Tc.HIDA subtraction scan achieved correct diagnosis in 100% of group 2 patients. All malignant lesions appeared hot, whereas benign lesions showed no abnormality in subtraction images respectively. Moreover, [201]Tl-[99m]Tc.HIDA subtraction quantitative analysis failed to discriminate between primary and secondary hepatic focal lesions or different histopathological types or grades [P > 0.05]. [201]Tl-[99m]Tc-HIDA subtraction scan is recommended in any patient with hepatic focal lesion suspected sonographically being non-invasive, simple, easy and efficient method that can differentiate between benign and malignant focal hepatic lesions

Diagnostic accuracy of TC99M HIDA cholescintigraphy with fatty meal and gall bladder ejection fraction for assessment of the gall bladder motor function in patuents with chronic acalculous cholecystitis

In this study, 46 patients [36 females and 10 males] presenting with variable degrees of long-standing upper right quadrant abdominal pain were included. All patients underwent clinical evaluation, abdominal ultrasonography and Tc99m hepatic iminodiacetic acid [HIDA] scanning with gallbladder ejection fraction [GBEF] calculation. Clinically, 26 patients had a mild degree of biliary pain, while 20 patients had a moderate degree. Ultrasonography was free in 26 patients, while 20 patients showed an evidence of GB abnormalities ranging from mild to severe changes. A confirmatory test was used in these cases by adding the sonographic and clinical findings for each patient to aid in the decision to operate or not. HIDA scanning was carried out in all patients with GBEF calculation. A 35% value was taken as a cutoff measurement, where patients with values <35% were considered abnormal and positive for acalculous GB disease. In patients with a proper GBEF [>35%], no operation was done and they were placed on the follow up and represent [18 patients]; while patients with abnormal GBEF [<35%], even with a negative confirmatory test, were operated by cholecystectomy [28 patients]. The mean GBEF value in the non- operated group was 55.9%, while that of the operated patients was 23.3%. All the operated patients proved positive to histopathology for acalculous cholecystitis. A remarkably highly positive P-value was found between the operated and non-operated groups as regards the GBEF value