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HEPATOBILIARY IMAGING. Presented by Yang Shiow-wen 11/26/2001. Hepatobiliary Imaging. The function of the biliary tree and gall bladder A "HIDA" scan or a "DISIDA" scan. Hepatobiliary Imaging. Performed with a variety of compounds that share the common imminodiacetate moiety.

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hepatobiliary imaging

HEPATOBILIARY IMAGING

Presented by

Yang Shiow-wen

11/26/2001

hepatobiliary imaging2
Hepatobiliary Imaging
  • The function of the biliary tree and gall bladder
  • A "HIDA" scan or a "DISIDA" scan
hepatobiliary imaging3
Hepatobiliary Imaging
  • Performed with a variety of compounds that share the common imminodiacetate moiety
structures of disida
Structures of DISIDA
  • Blue color: A polar component (the diacetate)
  • Red: A lipophilic component
structures of disida5
Structures of DISIDA
  • HIDA
    • Little used today
  • DISIDA
    • Imaging the gall bladder better when liver function is poor
pathways of disida
Pathways of DISIDA
  • Thelipophilic component : binding to hepatocyte receptors for bilirubin
  • Transported through the same pathways as bilirubin, except for conjugation
ida chelated tc 99m
IDA-chelated Tc-99m
  • A magnification of two imminodiacetate compounds
  • Polar components chelated a Tc-99m molecule
indications
Indications
  • Acute cholecystitis
  • Chronic cholecystitis
  • Bile leakage
  • Biliary atresia
requirements for disida scan
Requirements for DISIDA Scan
  • Patient preparation: fasted for 4 hours
  • Radiotracer: Tc-99m IDA compounds i.v.
  • Imaging: serial anterior/lateral views for 60 minutes
    • Every 5 minutes for 30 minutes
    • Once at 45 minutes
    • Once at 1 hour
    • Delayed views of the gall bladder 2 hours, 4 hours, 6 hours or 24 hours after injection
requirements for disida scan10
Requirements for DISIDA Scan
  • Morphine
    • Injection at one hour to help force the gall bladder to fill
  • Water
  • CCK
    • Injection prior to the test to empty the gall bladder
  • Suspected chronic cholecystitis
    • Injection to measure how well the gall bladder empties.
acute cholecystitis
Acute Cholecystitis
  • The most common indication
  • S\S
    • Nausea, vomiting, fever
    • Right upper quadrant pain post-prandially
    • Mild to moderate leukocytosis
    • Abnormal liver function test
    • Pain radiates to the back (scapula)
    • Usually blockage of the cystic duct by a gallstone
acute cholecystitis13
Acute Cholecystitis
  • If hepatic scintigraphy reveals adequate filling of the gallbladder, acute cholecystitis is effectively excluded.
  • Within 30 minutes, the gallbladder fails to visualize
  • Wait for one whole hour
  • Differential diagnosis for non-visualization of the gallbladder
    • Relaxation of the sphincter of Oddi
    • Inject morphine (3-5 milligrams) and continue the study for another half an hour
non visualization of gallbladder15
Non-Visualization of Gallbladder

Negative study– after injection of morphine

chronic cholecystitis
Chronic Cholecystitis
  • Ultrasound is the primary modality of choice
  • S\S
    • Usually having gall stones
    • The cystic duct is not blocked
    • More chronic pain
  • Delayed visualization of the gall bladder
  • Biliary dyskinesia in response to administration of CCK
bile leaks
Bile leaks
  • Most appropriate non-invasive imaging technique for evaluation of bile leaks
  • Sensitivity: 87%, Specificity: 100% (2-3 ml of labeled bile)
  • Radiopharmaceutical activity
    • In an extrahepatic and extraluminal location
    • More intense with time
  • Differentiating intraluminal activity from a leak
    • Ingestion of water
    • Standing views in addition to anterior oblique views
no excretion from liver
No Excretion from Liver
  • No excretion up to 6 hours
  • This pattern is commonly seen in
    • Ascending cholangitis
    • Pancreatitis
    • Hepatitis
pseudo gallbladder
Pseudo Gallbladder

Radionuclide in C-loop of the Duodenum

pseudo gallbladder25
Pseudo Gallbladder

Disappear after ingestion of water

references
References
  • http://www.vh.org/Providers/Lectures/IROCH/BiliaryNucs/BiliaryNucs.html (Virtual Hospital)
  • Chapter 38, Hepatobiliary Imaging, Darlene Fink-Bennett, P759-770
the end
The End

Thank for Your Attention !