The clinical utility of Tc-99m HIDA scintigraphy following liver surgery: A pictorial review

Abstract

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Learning Objectives: After reviewing this presentation, attendees will be able to: 1. Describe the role of Tc-99m HIDA scintigraphy in the assessment of the post-surgical liver patient. 2. Analyse a number of illustrative clinical examples that highlight the diagnostic utility of the technique. 3. Understand the interpretative pearls and pitfalls of Tc-99m HIDA scintigraphy in this important and complex group of patients.

Abstract Body: Tc-99m HIDA (hepatic imido-diacetic acid) scintigraphy is well established in the evaluation of a range of hepato-biliary conditions. In recent years, the surgical management of patients with a variety of hepatic pathologies (particularly tumors) has increased dramatically. Surgical procedures include hepatic resection for primary and secondary liver tumors, biliary reconstruction and both orthotopic and auxiliary liver transplantation. Frequently complex biliary tract anastomoses are performed and up to 40% of patients may develop post-surgical complications. Colour Doppler ultrasound and cross-sectional imaging are indicated in the initial assessment of suspected post-operative complications. Tc-99m HIDA scintigraphy has a complementary role in patient evaluation. Knowledge of post-operative surgical anatomy and details of the surgical procedure performed, in addition to careful attention to detail and technical performance of HIDA scintigraphy, are essential pre-requisites for accurate interpretation. The exhibit will explore the diagnostic utility of HIDA scintigraphy in the assessment of patients following liver surgery. The spectrum of appearances in this often complex group of patients will be illustrated with several examples from the past 10 years at a busy tertiary care centre. Pathologies including post-operative bile leaks, biliary-bronchial fistulae and afferent loop obstruction as well as the appearances of both orthotopic and auxiliary liver transplants will be demonstrated. In addition the interpretative pearls and pitfalls of Tc-99m HIDA scintigraphy in this patient group will be highlighted.