Tc-99m pyridoxylidene glutamate in jaundiced patients

Ninety patients, 85 of them jaundiced, were examined after the injection of Tc-99m pyridoxylidene glutamate, a substance rapidly concentrated by normal hepatocytes and excreted into the biliary tract. It appears in the gallbladder after 10-15 min, and in the gastrointestinal tract at 30 min. On the basis of the time of appearance in the intestine, four groups of patients were recognized: 1. Seventeen patients with a normal pattern, with visualization of the gut at 30 min. 2. Nineteen patients with a slight delay in passage, with appearance in the gut between 30-180 min. 3. Twenty-nine patients showing very slow excretion visualized only at 24 hr; 21 of these had parenchymatous disease of the liver, three choledocholithiasis and five had malignant disease causing partial obstruction. 4. Twenty-five patients with no visualization of the intestine; eight of them proved to be cases of medical jaundice, and 17 were surgical cases. Groups 3 and 4 comprise 54 patients where the question of medical or surgical jaundice was critical. If lack of intestinal activity is considered an indicating surgical jaundice, the accuracy of this study was only 72.4%.