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Tc-99m-Diethyl-IDA Imaging: Clinical Evaluation in Jaundiced Patients

University of Louvain Medical School, Brussels
Université Libre de Bruxelles, Brussels, Belgium

Correspondence: For reprints contact: S. Pauwels, MD, Centre de Médecine Nucléaire, UCL 54.30, Avenue Hippocrate, 54, B-1200 Bruxelles, Belgium.

ABSTRACT

Hepatobiliary imaging with Tc-99m-N,-(2,6-diethylacetanilide)-iminodiacetic acid (Tc-diethyl-IDA) was performed in 91 jaundiced patients with documented hepatobiliary damage and serum total bilirubin up to 35 mg/dl. There were 56 patients with obstructive jaundice and 35 with hepatocellular disease. Correct discrimination between hepatocellular and obstructive jaundice was possible with an overall accuracy of 90%. Agreement with the final clinical diagnosis was obtained in 97% of patients with hepatocellular disease, and in 86% of patients with obstructive jaundice. The reliability of the test was inversely related to the serum bilirubin concentration. The incidence of true-positive scans dropped from 93% for bilirubin levels below 10 mg/dl to 83% for bilirubin between 10 and 20 mg/dl. Above 20 mg/dl, the demonstration of a mechanical obstruction was possible in only one out of the four patients with obstructive jaundice. The high predictive values of the test illustrate that Tc-diethyl-IDA imaging constitutes a reliable method to demonstrate an obstructive cause for the jaundice as long as the bilirubin level remains below 20 mg/dl.