HEPATOBILIARY SCAN

HEPATOBILIARYSCAN

Gastrointestinal System • Liver • gallbladder • small and large intestines

Gallbladder • Stores bile ( breakdowns fat after a meal)

Indications • Cholecystitis • Biliary dyskinesia • Congenital abnormalities • Eval. after gallbladder surgery

Contraindications • NPO for less than two hours • Patient who have taken morphine or CCK

Radiopharmaceuticals • Mebrofenin (CHOLETEC) • Disofenin (DISIDA) • Iminodiacetic acid (IDA)

Dosage • Dose range for all three radiopharmaceuticals are 5-10 mCi

Mechanism of uptake • Radiopharmaceuticals are removed from the blood by hepatocytes • Hepatocytes are the cells of the liver that form bile • Bile is then stored in the gallbladder until needed

Mechanism of uptake • Bilirubin excretion affects all of the radiopharmaceuticals after a certain point • CHOLOTEC ( >30 to 40 mg/dl) • IDA and DISIDA ( >20 mg/dl) • Gallbladder may not be visualized

Cholescintigraphy • Patient preparation • Imaging • Processing of images • Radiologist findings

Patient Preparation • NPO at least two hours • Discontinue morphine • Verify physicians orders • Verify patient’s name and MRN • Explain procedure to patient • Straight stick or I.V. line set-up

Test • 1: Hepatobiliary scan • 2: Hepatobiliary scan w/ CCK • CCK naturally occurring enzyme that causes the gallbladder contract • 3: Hepatobiliary scan w/ Morphine • Morphine causes Sphincter of Oddi to contract

Hepatobiliary Scan Imaging • Supine • Liver positioned in left quadrant of field of view • Anterior images are obtained immediately then every fifteen minutes for up to two hours

Hepatobiliary scan w/CCKImaging • Images are obtained after 30 min - 1hr delay • Supine • Liver (left quadrant FOV) • Gallbladder is located (if not seen pt will have to wait another hour before imaging) • 60 sec baseline image is obtained • CCK is injected slowly over five minutes

Normal Findings • Hepatocytes take up the radiopharmaceutical in minutes after injection • Hepatic ducts seen in fifteen minutes • Gallbladder seen within 45 to 60 miutes • GBEF >40 • Small intestine seen by 30 minutes

Abnormal findings • Delay in visualizing the gallbladder • GBEF <40 • Small intestine is not seen

Case Study • Sixty-five year old man w/ abdominal pain • Order PIPIDA Scan r/o obstruction of the ducts • verified orders on patient’s chart • verified pt.’s name and MRN • verified patient was NPO for 4 hours • Injected with 10 mCi of Tc-99m mebrofenin

Case study • Patient placed in supine position • Liver positioned in the left upper quadrant of FOV • Anterior images obtained every five minutes for one hour • Problem occured

Radiologist findings • Multiple photopenic filling defects throughout the liver compatible with polycystic liver disease. • The tracer was localized in the gallbladder within twenty minutes post injection, no indication of obstruction

Polycystic Liver disease • Cause of the convolusions seen by the technologist • Two types: • 1# Cyst form only on the liver • 2# Cyst form on both the liver and the kidneys

HEPATOBILIARY SCAN