HEPATOBILIARY STUDY

INDICATIONS:

1. Diagnosis of acute cholecystitis.
2. Evaluation of patency of hepatobiliary system.
3. Biliary leaks: Post-op evaluation.
4. Detection of biliary reflux.
5. Diagnosis of biliary atresia and other congenital anomalies of the biliary tract.
6. Evaluation of transplanted livers.

PATIENT PREPARATION:

Patient should fast 2-4 hrs before scanning. Recent meals, as well as prolonged fasting (>48 hours) may cause false-positives results. For emergency studies, discuss the case with the attending or the Nuclear Medicine physician. For newborns with jaundice (studied to differentiate atresia vs. hepatitis) a baseline study should be done. A follow-up scan may be done, if necessary, using 5 mg/kg of phenobarbital (divided doses) given for 5 consecutive days prior to rescanning.

RADIOPHARMACEUTICALS:

The dose is 5 mCi of Tc-99m-mebrofenin given I.V. Depending on hepatobiliary function, either the liver, gallbladder or colon is the critical organ. Total body exposure = 0.05 rad per exam. The gallbladder receives 0.65 rad/5 mCi.

SCANNING TIME:

Activity is normally seen in the liver within the first 5 minutes of injection. Gallbladder visualization and small bowel activity are normally seen by 40 minutes. If Tc-99m-mebrofenin is visualized in the small bowel and not the gallbladder, I.V. morphine (2.0-4.0 mg) is given to contract the sphincter of Oddi and promote gallbladder filing. Delayed imaging is carried out for an additional 20 minutes. In special cases, further delayed views may be obtained.

OTHER CONSIDERATIONS:

1. Recent meals cause gallbladder contraction and may produce false positive results. Prolonged fasting and TPN can have the same effect.
2. Hepatocellular dysfunction can also compromise the study; visualization of the hepatobiliary system decreases with significantly elevated serum bilirubin (newer agents like DISIDA and mebrofenin can be used up to 20-25 mg/dl).

NOTE: This scan may be ordered on an emergency basis.