Technetium-99m Pyridoxylideneglutamate (P.G.) Cholescintigraphy

Abstract

Technetium-99m P.G. cholescintigraphy was performed in 27 human volunteers and 81 patients referred for hepatobiliary tract disease. The gallbladder, biliary system, and gastrointestinal tract were well visualized in the normal patients and volunteers. The gallbladder was not visualized in 22 patients with histologically proved cholecystitis with cystic duct obstruction. Nine patients with complet extrahepatic obstruction of the common bile duct were correctly diagnosed. Hepatocellular disease and incomplete obstruction, with and without jaundice, were diagnosed with this technique. Oral cholecystography is superior to this method for the detection of cholelithiasis in nonjaundiced patients.

A comparative study of intravenous cholangiography and99mTc-pyridoxylideneglutamate in patients with hepatobiliary disease

“…The advantages of 99mTc-P.G. include its simplicity, short examination time, lack of m o r b i d i t y and mortality, and most importantly, its value in cases with elevated bilirubin [16][17][18][19]. If the bilirubin level is above 3.0 m g % there is little possibility of visualizing the ductal system by I.V.C.…”

“…e x a m i n a t i o n may be successful with bilirubin levels as high as 23 m g % Three nonvisualized studies had bilirubin levels of 2.2, 2.1, and 0.7 mg% b One case interpreted as normal; two showed findings of incomplete obstruction or hepatocellular disease [19]. With this procedure it is possible to diagnose cystic duct obstruction and partial or complete obstruction of the common duct [16][17][18][19]. The chief disadvantage of 99mTc-P.G.…”

“…99mTc-P.G. probably is most useful in patients with symptoms suggesting acute cholecystitis [16,19]. In this group of patients the examination rapidly (within one hour) provides information about possible obstruction of the cystic duct which may be caused by an impacted stone or inflammation of the duct.…”

“…In patients with hepatocellular disease, definite radioactivity is identified in the gastrointestinal tract, an important differentiating factor in deciding whether the patient has liver disease or complete obstruction. Patients with incomplete obstruction and elevated bilirubin may be correctly diagnosed if a negative image of the gallbladder is associated with delayed excretion of radiopharmaceutical into the gastrointestinal tract [16,19]. The negative image is produced by the dilated, obstructed gallbladder.…”

Evaluation of hepatocyte‐specific paramagnetic contrast media for MR imaging of hepatitis

“…Nuclear medicine studies have been attempted with radiopharmaceuticals targeted to bilirubin (6.7) and asialoglycoprotein (8,9) receptors on hepatocytes. Unfortunately, in clinical practice, hepatic scintigraphy has failed to quantitate liver function and cannot reliably allow distinction between patients with normal livers and those with hepatitis (7,9). This failure has been attributed to multiple factors, including competition for hepatocyte receptors, nonspecific biodistribution of the scintigraphic agent, and imprecision of the imaging method (9.10).…”