Quantitative cholescintigraphy in the assessment of choledochoduodenal bile flow.
Quantitative cholescintigraphy has been proposed as a noninvasive method to assess function of the sphincter of Oddi in cholecystectomized subjects. The present study evaluated several quantitative cholescintigraphic variables to assess their time-related variability as well as their capability to detect delay of choledochoduodenal bile flow. Cholescintigraphy with 2,6-diethylphenylcarbahoylmethyl diacetic acid 99mTc was performed in 24 cholecystectomized patients with recurrent biliary-like pain, laboratory evidence of bile stasis, normal hepatocellular function tests, and no evidence of choledocholithiasis. The study was also performed in 26 asymptomatic cholecystectomized subjects and repeated at 2-week intervals during identical experimental conditions in 10 of them. Of the following quantitative cholescintigraphic variables investigated, (a) hepatic T peak, (b) 50% hepatic retention (T peak, 1/2), (c) percent hepatic retention at 30 minutes, (d) percent hepatic retention at 40 minutes, (e) vein-hepatic hilum transit time, (f) vein-duodenum transit time, and (g) hepatic hilum-duodenum transit time, only the hepatic hilum-duodenum transit time showed a statistically significant correlation between the duplicate studies. Only vein-duodenum transit time and hepatic hilum-duodenum transit time discriminated the symptomatic from the asymptomatic patients; of the two variables, however, hepatic hilum-duodenum transit time showed less intrasubject variability and no overlap between the two groups of patients. Hepatic hilum-duodenum transit time showed a positive linear correlation with the maximum diameter of the choledochus. It is concluded that in cholecystectomized patients, the hepatic hilum-duodenum transit time appears to detect a delay of bile flow into the intestine better than any other cholescintigraphic variable. However, in patients with a dilated common bile duct, this variable cannot discriminate bile flow delay due to increased choledochal capacity and/or obstruction of the sphincter of Oddi.
Cicala
M
M
Cattedra di Gastroenterologia I, Universitá La Sapienza, Rome, Italy.
Scopinaro
F
F
Corazziari
E
E
Vignoni
A
A
Viscardi
A
A
Habib
F I
FI
Torsoli
A
A
D000328:Adult; D000368:Aged; D001646:Bile / Q000502:physiology*; D002763:Cholecystectomy; D003135:Common Bile Duct / Q000000981:diagnostic imaging* / Q000502:physiology; D004386:Duodenum / Q000000981:diagnostic imaging* / Q000502:physiology; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging / Q000379:methods; D009803:Sphincter of Oddi / Q000502:physiology*