The Early Diagnosis of Common Bile Duct Obstruction Using Cholescintigraphy

Abstract

The technetium Tc 99m-labeled iminodiacetic acid cholescintigram is an extremely accurate examination for detecting early obstruction of the common bile duct in acutely ill patients suspected of having acute cholecystitis or possible obstruction days to years after cholecystectomy. The examination accurately detected common bile duct obstruction in 63 of 65 patients in these two diagnostic categories (positive predictive value, 96.9%). Sonographic evaluations in 43 of these patients failed to reveal ductal dilatation or other abnormality in 26 cases (false-negative rate, 63.4%), and was nondiagnostic because of overlying bowel gas in two cases. The success of the radionuclide examination is attributed to its ability to detect functional impedance to bile flow hours to days before anatomic ductal dilatation occurs, and occasionally even before the alkaline phosphatase level and other liver chemistry values suggest the presence of an obstruction.

Evaluation of the Predictors of Choledocholithiasis: Comparative Analysis of Clinical, Biochemical, Radiological, Radionuclear, and Intraoperative Parameters

“…It is also useful for diagnosing complete CBD obstruction. In a series by Kaplun et al 22 HIDA scanning accurately detected CBD obstruction in 63 of 65 patients, achieving a PPV of 97%. Lecklitner et al 23 reported that scintigraphy had 100% sensitivity and 99% specificity for diagnosing total CBD obstruction.…”

Travel Jaundice Caused by Pathological Common Bile Duct Angulation: A Case Report

“…Given the patient's anamnesis, we decided to examine her biliary tree while she remained in a sitting position (the primary factor causing her symptoms). This examination was performed after introducing a nasobiliary tube (NBT); in particular, an X-ray image was obtained small bile ducts but fails in cases involving extended CBD and may produce false-negative results for up to 63.4% of patients in evaluations of biliary obstruction [11,12]. Nonetheless, the fact that these two types of ultrasound can be performed in different body positions creates certain opportunities for diagnosing pathological biliary angulation.…”