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Detection, Localization, and Quantitation of Degree of Common Bile Duct Obstruction by Scintigraphy

Nuclear Medicine Service and Gastroenterology Section, VA Medical Center
Departments of Clinical Pathology and Medicine, Oregon Health Sciences University, Portland, Oregon

Correspondence: For reprints contact: G. T. Krishnamurthy, MD, VA Medical Center (115P), PO Box 1034, Portland, OR 97207.

ABSTRACT

The detection, localization, and quantitation of the degree of obstruction was successfully accomplished by [^99mTc]IDA scintigraphy in 13 of 14 patients with cholangiographically documented common bile duct (CBD) obstruction. Ductal dilatation was present on ultrasound examination in only seven patients. The accuracy of biliary scintigraphy was enhanced by several innovations including: (a) selection of a radiopharmaceutical with rapid hepatic uptake and excretion; (b) shorter imaging interval over longer period of time; (c) substitution of image parameter for appearance time; and (d) quantitative measurement of bile emptying parameters following cholecystokinin infusion. Scintigraphically, the partial obstruction was characterized by CBD segmental narrowing or intraluminal filling defects and bile stasis within the area and segmental ducts. The gallbladder mean (± s.d.) ejection fraction of 20.0 ± 17.5%, ejection period of 6.8 ± 1.6 min, and ejection rate of 3.1 ± 2.6% per min following 3-min infusion of 10 ng/kg of cholecystokinin octapeptide were reduced significantly when compared to control subjects. The level of CBD obstruction correlated well with the results of cholangiography. It is concluded that quantitative biliary dynamic scintigraphy employing modern techniques can accurately detect and localize CBD obstruction.