Confirmation of a Biliothoracic Fistula With Dynamic [68Ga]Ga-TEoS-DAZA-PET/CT.

Area of Science:

• Nuclear medicine
• Radiology
• Gastroenterology

Background:

• Accurate localization of biliary leaks is challenging with conventional imaging techniques.
• Biliothoracic fistula is a rare but serious complication, often following abdominal surgery or trauma.

Purpose of the Study:

• To report the successful use of dynamic hepatobiliary PET/CT in a critically ill patient with a suspected biliothoracic fistula.
• To highlight the advantages of hepatobiliary PET/CT over conventional imaging for complex biliary leak detection.

Main Methods:

• A critically ill patient with a suspected biliothoracic fistula underwent dynamic hepatobiliary PET/CT using the tracer [68Ga]Ga-TEoS-DAZA.
• Bile flow was visualized in high temporal resolution to track leakage.
• Imaging findings were compared with scintigraphy and MRI.

Main Results:

• Dynamic hepatobiliary PET/CT clearly demonstrated antegrade bile flow and precisely localized the leak.
• The imaging revealed bile leakage into a drained abscess cavity with cranial extension into the thorax.
• Hepatobiliary PET/CT offered superior dynamic tomographic imaging and robustness against motion artifacts compared to other modalities.

Conclusions:

• Dynamic hepatobiliary PET/CT is a valuable tool for precise localization of complex biliary leaks, including biliothoracic fistulas.
• This technique offers advantages over conventional imaging in terms of image quality, temporal resolution, and artifact reduction.
• Hepatobiliary PET/CT shows significant potential for managing challenging biliary complications.