Utility of Dynamic ⁶⁸Ga-DAZA-PET/CT for Bile Leak Localization After Liver Transplantation: First Clinical...

Area of Science:

• Nuclear Medicine
• Radiopharmaceuticals
• Medical Imaging

Background:

• Biliary complications, particularly bile leaks, are frequent causes of morbidity after liver transplantation (LT).
• Conventional imaging methods (ultrasound, CT, MRCP, endoscopy) often struggle to pinpoint complex or peripheral bile leaks.
• Accurate localization is crucial for effective treatment and improved patient outcomes.

Purpose of the Study:

• To assess the feasibility and efficacy of [⁶⁸Ga]Ga-TEoS-DAZA-PET/CT for non-invasive localization of bile leaks post-liver transplantation.
• To evaluate [⁶⁸Ga]Ga-TEoS-DAZA-PET/CT as a complementary diagnostic tool in cases with inconclusive conventional imaging.

Main Methods:

• Five male patients with suspected bile leaks and inconclusive prior imaging underwent dynamic [⁶⁸Ga]Ga-TEoS-DAZA-PET/CT scans.
• The tracer was synthesized under Good Manufacturing Practice (GMP) conditions and administered.
• Imaging was performed for 60 minutes, with findings classified using the Nagano classification.

Main Results:

• [⁶⁸Ga]Ga-TEoS-DAZA-PET/CT accurately detected and anatomically localized bile leaks in all five patients.
• Identified leak sites included the liver resection surface, central bile ducts, bilioenteric anastomosis, and biliary drainage exit.
• Findings guided subsequent interventions (surgery or endoscopy) in four patients, with one improving conservatively. No adverse events were reported.

Conclusions:

• [⁶⁸Ga]Ga-TEoS-DAZA-PET/CT is a feasible and safe imaging modality for localizing bile leaks after LT.
• Its ability to visualize antegrade biliary flow, coupled with high resolution and no contraindications, makes it valuable when conventional imaging is insufficient.
• Further research is needed to confirm its diagnostic utility for postoperative and post-traumatic biliary injuries.