肝胆显像（ Hepatobiliary scintigraphy ）

1. Bingxiu Ren Department of Nuclear Medicine,the first affiliated hospital of Kunming Medical University Mar.31,2014 肝胆显像（Hepatobiliary scintigraphy）

2. Bingxiu Ren, PhD, attending doctor. Mayjor in nuclear imaging & therapy. Email:yn76ren@126.com Phone: +86 13529168551

3. 显像原理 • 放射性示踪剂（radiotracers） 肝细胞摄取 分泌至胆汁 排泄至肠道. • Ideal agents exihibit high extraction efficiency by liver,rapid transit, and high concentration in bile.

4. 肝胆系统图 ：radiotracer 胆红素肠肝循环及肝胆动态显像原理示意图 ：胆汁

5. Radiopharmaceuticals （放射性药物） 99mTc-imniodiactic acid(IDA): 可与胆汁均匀混合，早期常用，但图像质量易受血液中总胆红素浓度的影响. 99mTc-MIBI can be up taken and secreted by hepatocytes, often used without concerning the TBIL level.

6. Normal images 3-5 min liver can be visualized clearly 5-10min left and right hepatic ducts can be displayed 15-30min gallbladder ,choledochus and duodenum were seen clearly with the gradual decrease of radioactivity in the liver The time of radio-tracer appears in gallbladder and duodenum ≤ 60min if over 24 h,no bowel excretion is visualized ,high possibility of biliary atresia may exit

8. Clinical application • 鉴别胆道闭锁（ biliary atresia ）和新生儿肝肝炎综合症（neonatal hepatitis syndrome） • 诊断急性胆囊炎（Acute cholecystitis） • 判断胆道梗阻情况 • 判断损伤或术后胆漏情况

9. Case 1, 患儿因临床黄疸查因，请对根据其hepatobiliary scintigraphy 图像做其出最可能的诊断。 Biliary atresia（胆道闭锁） 图像特点：肝影消退缓慢，动态采集和延迟至24 h, 肠道内始终无放射性聚集。

10. neonatal hepatitis（新生儿肝炎） Case 2, 患儿因临床黄疸查因，请对根据其hepatobiliary scintigraphy 图像做其出最可能的诊断。

11. case 3, A patient complaining of acute right quadrant pain. What is the most possible diagnose of the patient? Acute cholecystitis

12. Questions 1. In hepatobiliary scintigraphy, the radio tracer can be up taken by ( ). A.hepatic cells B. vascular endothelial cells C.Kupffer cells D. stellate cells E.biliary duct endothelial cells. 2. 如何通过肝胆动态显像鉴别婴儿先天胆道闭锁和新生儿肝炎综合症？

13. Thank you !