Sclerosing cholangitis: cholescintigraphy with Tc-99m-labeled DISIDA

Area of Science:

• Hepatobiliary imaging
• Diagnostic radiology
• Gastroenterology

Background:

• Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease characterized by intrahepatic and extrahepatic bile duct inflammation and fibrosis.
• Accurate diagnosis and staging of PSC are crucial for patient management and prognosis.
• Current diagnostic methods include invasive cholangiography, which carries risks.

Purpose of the Study:

• To evaluate the utility of Tc-99m-labeled DISIDA (diisopropylphenylcarbamoyl iminodiacetic acid) cholescintigraphy in diagnosing primary sclerosing cholangitis (PSC).
• To compare the findings of cholescintigraphy with invasive cholangiography in patients with suspected PSC.
• To assess the ability of cholescintigraphy to detect bile duct abnormalities and estimate obstruction.

Main Methods:

• Four patients with suspected primary sclerosing cholangitis (PSC) underwent Tc-99m-labeled DISIDA cholescintigraphy.
• Hepatobiliary imaging results were correlated with findings from invasive cholangiography.
• Analysis focused on the detection of focal "hot spots" (stasis) and assessment of hepatic parenchymal clearance.

Main Results:

• Three out of four patients showed characteristic findings of PSC on cholescintigraphy, including multiple focal "hot spots" indicative of stasis in ductal dilatations (beading).
• Cholescintigraphy demonstrated superiority over cholangiography in visualizing nonfilling of biliary radicals due to high-grade stenosis.
• Delayed hepatic parenchymal clearance on cholescintigraphy allowed for estimation of bile duct obstruction severity.

Conclusions:

• Tc-99m-labeled DISIDA cholescintigraphy is a valuable noninvasive tool for investigating suspected primary sclerosing cholangitis (PSC).
• The technique can facilitate earlier diagnosis of PSC by identifying characteristic beading patterns and assessing bile duct obstruction.
• While cholescintigraphy offers significant advantages, confirmation with invasive cholangiography is recommended for definitive diagnosis.