A study of bile duct dynamics using computer-assisted 99mTc-HIDA scintigraphy

Using computer-assisted scintillation camera imaging bile duct dynamics was studied in 28 patients with a nonvisualizing gallbladder due to acute cholecystitis. Postoperative repeat studies were carried out in 8 of the 28 patients. In half of the studies three accumulations of activity were evident on the 60 added 1-min views. These three accumulations were interpreted as corresponding to the biliary tree. An explanation for the separation of the activity into three depots, is proposed. Analysis of the time-activity curves of the accumulations showed an irregular exchange of activity, suggesting intracholedochal movements of bile. Passage of bile from the common duct into the duodenum was observed 1-7 times during the 1-h studies. In most studies the bulk of the activity was caught by an antegrade peristaltic wave as soon as it left the duct. The activity was then transported rapidly in a medial direction. This finding suggests that relaxation of the sphincter occurs in phase with duodenal peristalsis.