Studies of hepatobiliary scintigraphy and functional examination with sup(99m)Tc-HIDA

We studied both morphologically and functionally the clinical application of sup(99m)Tc-N-[N'-(2,6-dimethyl phenyl) carbamoylmethyl] iminodiacetic acid (HIDA) in 130 patients with various hepatobiliary diseases. Highly resolved images were obtained from morphological diagnosis. However, in the patients with high bilirubin levels of over 4-6 mg/dl, liver uptakes of sup(99m)Tc-HIDA were disturbed. From the bileduct images, we could prove calculi or extension of the bileduct. We could also prove the abnormal localization or extension of the gallbladder, but failed to visualize gallstones as defective images. The diagnostic method of contractile function of the gallbladder was examined by comparison of the activities of the gallbladder before and after oral administration of yellow egg. In normal cases, the activity of the gallbladder was decreased to 5-30%. The liver uptake rate (K sub(u)) and excretion rate (K sub(e)) in the normal cases were 12.7% min and 1.89% min, respectively; hence, it was suggested that the metabolism of sup(99m)Tc-HIDA was turning over faster than that of 131I-BSP. K sub(u) and K sub(e) were low in the patients with hepatobiliary diseases. The correlation between K sub(u), total bilirubin level and ICG, and also that between K sub(e), total bilirubin level, γ GTP and Al. Pase were recognized. In the normal cases, the blood concentration ratio 30 and 60 min to 5 min after injection were 27.7% and 16.1%, respectively, and higher value were obtained in the patients with liver functional diseases. (author)