Quantitative hepatobiliary scintigraphy as a measure of bile flow in dogs with cholestatic disease

In 25 dogs with spontaneous cholestatic disease, the hepatobiliary dynamics were evaluated by use of scintigraphy and a 99mTc-labeled iminodiacetate (IDA) derivative. Hyperbilirubinemia existed in all dogs, with serum total bilirubin concentration ranging from 6 to 262 mumol/L. An appropriate compartmental model was used to characterize the liver time-activity curves. Model-dependent variables for hepatic uptake and biliary excretion of radiolabeled IDA were found to reliably represent the underlying physiologic processes. Measurements directly derived from the liver time-activity curves of IDA, representing the moments of accumulation of 50 and 95% of the maximal hepatic activity did not accurately represent the hepatic uptake by being significantly influenced by biliary excretion and by competition of renal excretion. The time-interval between 95% and 50% of the maximal activity in the excretory phase proved to be a quantitative characteristic of bile flow in all instances. Compartmental analysis of 99mTc-IDA excretory scintigraphy characterized bile flow quantitatively in clinically normal dogs and in dogs with cholestasis. The method permitted the clinical evaluation of cholestasis based on quantitative, instead of the usual qualitative, and on functional, instead of phenomenologic, criteria.