Measurement of hepatocellular function with deconvolutional analysis: application in the differential diagnosis of acute jaundice.
A direct, noninvasive technique was developed to quantitate hepatocyte function with computer assessment of scintiscans obtained after administration of technetium-99m disofenin in 53 patients with acute jaundice: 32 patients with normal livers, 10 patients with acute biliary obstruction, and 11 patients with acute hepatocellular dysfunction. In all patients a final clinical diagnosis was obtained with follow-up for a minimum of 4 months and, in most patients with obstruction or dysfunction, with surgery, intraoperative cholangiography, ultrasound, and/or computed tomography. Heart (blood pool) and liver time-activity curves were generated for 32 minutes after intravenous injection of 5-15 mCi (185-555 MBq) of Tc-99m disofenin and were subjected to deconvolutional analysis to determine the first-pass hepatocyte extraction fraction (HEF) of the tracer. The difference in HEF between patients with obstruction and those with dysfunction was highly significant (P = 3.3 X 10(-19)). Deconvolutional analysis eliminates the effects of tracer recirculation, thus permitting direct measurement of hepatic disofenin extraction, and appears to provide functional information useful in evaluation of the patient with acute jaundice.
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor.
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D000208:Acute Disease; D000328:Adult; D001663:Bilirubin / Q000097:blood; D002779:Cholestasis / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D006801:Humans; D007565:Jaundice / Q000000981:diagnostic imaging* / Q000209:etiology; D008099:Liver / Q000000981:diagnostic imaging*; D008107:Liver Diseases / Q000150:complications; D008297:Male; D011446:Prospective Studies; D011877:Radionuclide Imaging
D001663:Bilirubin