Hepatobiliary imaging using Tc-pyridoxylideneglutamate in the diagnosis of obstructive jaundice

In 77 of 114 consecutive patients with suspected hepatobiliary disease undergoing cholescintigraphy a firm clinical or operative diagnosis was possible. These patients were classified as normal, or as having extra-hepatic biliary obstruction (partial or complete) or hepatocellular disease. On a double-blind basis cholescintigraphy correctly interpreted 18 of 20 (90%) normal controls, 12 of 14 (86%) of those with partial obstruction, 16 of 16 (100%) of those with complete obstruction and 23 of 27 (85%) of those with hepatocellular disease giving an overall diagnostic accuracy of 69 of 77 (90%). There were no complications or toxic reactions. Ninety-three percent of patients with biliary obstruction (sensitivity) and 87% of those without biliary obstruction (specificity) were correctly diagnosed. Cholescintigraphy is a non-invasive, cheap and reliable investigation which can be used in the presence of icterus to discriminate between patients with and without extra-hepatic biliary obstruction. In contrast to grey scale ultrasonography the production and interpretation of scans are simple. Moreover cholescintigraphy adds a functional element to the investigation of liver disease.