Radionuclide hepatobiliary procedures

For more than two decades radionuclide hepatobiliary procedures have been performed, mainly with I-131 rose bengal or I-131 bromsulphathelin. Technetium-99m-labeled agents should, if otherwise equivalent, produce better images; and Tc-99m HIDA, and its chemical relatives, are vigorous candidates for clinical acceptance. This paper considers major hepatobiliary diagnostic problems and some radionuclide procedures developed to assess these problems, and predicts the likely roles of Tc-99m-labeled agents in performing these procedures. The problems addressed are obstructive jaundice, cystic duct patency, and unusual bile communications. It is suggested that the researcher or clinician is most likely to succeed when he uses any of the radionuclides hepatobiliary agents to exploit the functional information they provide, relies on Tc-99m-labeled agents for superior anatomic resolution in early images, and continues to use I-131-labeled agents when late images are required. (RWR)