Cholangio-PET/CT with [⁶⁸Ga]Ga-TEoS-DAZA for bile leak localisation after hepatobiliary surgery

To evaluate the clinical feasibility and potential utility of dynamic [⁶⁸Ga]Ga-TEoS-DAZA PET/CT for the detection and localisation of bile leaks in patients after hepatobiliary surgery in a small, single-centre feasibility series.

Ten patients with clinically suspected postoperative bile leakage and prior inconclusive imaging underwent [⁶⁸Ga]Ga-TEoS-DAZA PET/CT between September 2024 and February 2026. Imaging was performed following intravenous administration of [⁶⁸Ga]Ga-TEoS-DAZA (mean activity 214 ± 27 MBq). Dynamic PET acquisition was conducted for 60 min. Findings were analysed and classified according to the Nagano system where applicable, and their contribution to subsequent clinical management was assessed.

[⁶⁸Ga]Ga-TEoS-DAZA PET/CT enabled localisation of bile leaks in 9 of 10 patients (90%). Leak sites were diverse including central and peripheral locations, as well as complex locations, such as ducts of Luschka and bilioenteric anastomoses. Mean detection time was 28.7 min post injection. PET/CT findings informed subsequent clinical management in all patients, including endoscopic, percutaneous, surgical interventions, or continued drainage management. No adverse effects were observed.

Dynamic [⁶⁸Ga]Ga-TEoS-DAZA PET/CT was feasible for bile leak localisation in this selected cohort, including complex and peripheral leak sites. Its physiological, antegrade imaging approach provided clinically useful information in patients with inconclusive or unsuccessful conventional imaging. Further prospective comparative studies are warranted to validate these findings and evaluate its diagnostic performance in larger cohorts.