Christopher C. Kuni

Communication of intrahepatic cavities with bile ducts: demonstration with Tc-99m-diethyl-IDA imaging.

Tc-99m-diethyl-IDA imaging demonstrated intrahepatic bile leaks in two patients. The first patient had an intrahepatic abscess associated with a common bile duct stone; he was successfully treated with common duct lithotomy and antibiotics, but without surgical drainage of the intrahepatic abscess. The second patient had bile leakage into an intrahepatic cavitary hematoma after abdominal trauma.

Evaluation of intrahepatic cholestasis with radionuclide hepatobiliary imaging

Since hepatobiliary imaging with99mTc=labeled iminodiacetic acid derivatives (HIDA) allows relatively separate, sequential measurement of hepatocyte clearance, parenchymal transit, and biliary excretion, these agents should be useful in differentiating intrahepatic cholestasis (IC) from other hepatobiliary disorders. We studied 18 patients with clinical evidence of IC in whom the parenchymal transit time was increased disproportionately to any decrease in hepatocyte clearance. In a second group of 14 patients with hepatocyte disease but without clinical evidence of IC, the average parenchymal transit time was increased less in relation to the average decrease in hepatocyte clearance than in the IC group. In 15 patients with extrahepatic biliary obstruction, the average hepatocyte clearance was disproportionately increased, as in IC, but large-duct obstruction was identified by scintigrams, ultrasound, or computed tomography. These preliminary results suggest that IC can be diagnosed with hepatobiliary imaging.

Detection of impending pericardial tamponade during skeletal imaging

Bone imaging using Tc–99m MDP was performed on a 68–year–old man with a newly diagnosed adenocarcinoma of the lung. The image unexpectedly showed increased activity in the heart area. Emergent echocardiography demonstrated impending pericardial tamponade. A malignant pericardial effusion was verified by pericardiocentesis.

Ectopic splenomegaly in Felty's syndrome.

A 50-year-old woman with Feltys syndrome, who presented with “menopausal” symptoms, was found to have a large pelvic mass on physical exam. Computed tomography of the pelvis led to an incorrect diagnosis of malignancy, while radionuclide imaging using Tc-99m sulfur colloid confirmed the diagnosis of ectopic splenomegaly.

Comparison of [99mTc]parabutyl-IDA and [99mTc]diethyl-IDA for imaging the hepatobiliary system in patients with hyperbilirubinemia

Abstract Animal and preliminary patient data suggest that [ 99 m Tc]parabutyl-IDA might be superior to [ 99 m Tc]diethyl-IDA in imaging the hepatobiliary system in patients with high blood bilirubin levels. A direct clinical comparison between these two agents was made in 14 patients. The total serum bilirubin range was 1.2−50.6 mg/dl (mean = 13.3 mg/dl) and the average time between studies was 2.0 days. Visual evaluation of all 14 paired studies showed [ 99 m Tc]parabutyl-IDA to be superior ( p 99 m Tc]diethyl-IDA was superior ( p p > 0.05) for [ 99 m Tc]diethyl-IDA to demonstrate the intrahepatic ducts better and to show an earlier intestinal arrival time. In the 7 patients who showed evidence of biliary excretion, both agents demonstrated excretion in 6 and only [ 99 m Tc]parabutyl-IDA in I (bilirubin: 50 mg/dl). We conclude that, in general, [ 99 m Tc]para-butyl has no clear advantage over [ 99 m Tc]diethyl-IDA even in patients with elevated bilirubins.