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Intravenous Cholescintigraphy Using Tc-99m-Labeled Agents in the Diagnosis of Choledochal Cyst

Chang-Gung Memorial Hospital, Taipei, Taiwan, Republic of China

Correspondence: For reprints contact: Miau-Ju Huang, MD, Dept. of Nuclear Medicine, Chang-Gung Memorial Hospital, 199, Tung Hwa North Rd., Taipei, Taiwan 105, R.O.C.

ABSTRACT

Twelve patients with choledochal cyst have undergone intravenous radionuclide cholescintigraphy (IVRC) with Tc-99m-labeled HIDA or PG before surgery. The most characteristic findings are: (1) A round or ovoid photon-deficient area in the region of the gallbladder in the early images; (2) progressive accumulation of radioactivity in the same region in later images, especially at 2 hr after injection; (3) the long axis of this particular area directed downward and to the patient's left from the right midclavicular line, suggesting the direction of the common bile duct; and (4) persistent pooling of the tracer up to 24 hr, even after a fatty meal. By these criteria, correct diagnoses have been made preoperatively in ten of 12 cases (83.3 %). We conclude that IVRC using Tc-99m HIDA or Tc-99m PG is an excellent first-line diagnostic tool for choledochal cyst.