Chervu L R, Nunn A D, Loberg M D
Semin Nucl Med. 1982 Jan;12(1):5-17. doi: 10.1016/s0001-2998(82)80025-1.
Tests for liver function have by and large centered around clinical laboratory diagnostic procedures for a number of years. Besides these, radiographic imaging procedures, including oral cholecystography and intravenous cholangiography, serve a very useful purpose, but several of them are invasive and involve a certain degree of risk from the administered contrast media as well as discomfort to the patient. The cholescintigraphic procedures, though noninvasive, have not played a significant role in the evaluation of hepatobiliary disorders prior to the introduction of the currently available. 99mTc-labeled IDAs. These new hepatobiliary agents offer many advantages over the previously utilized radiopharmaceuticals (131I-rose bengal in particular) in terms of the high degree of specificity for localization in the gallbladder with rapid extraction rates by the polygonal cells of the liver and very low excretion via the GU tract. A detailed understanding of the structure distribution relationship of the various groups in the complex enable the design of agents with an improvement in hepatobiliary specificity and other desirable characteristics. In many clinical situations, even in patients with high bilirubin levels, the 99m-Fc-labeled IDAs offer far superior clinical information over the alternative diagnostic imaging modalities. Further, the absorbed radiation dose imparted to the critical organs is far lower than with the older agents. Thus, the introduction of the cholescintigraphic procedures with the 99mTc-labeled IDAs have ushered in a new phase in the diagnostic workup of patients with impaired hepatocellular function and other biliary disorders.
多年来，肝功能测试大体上都围绕着临床实验室诊断程序展开。除此之外，包括口服胆囊造影术和静脉胆管造影术在内的放射成像程序也发挥着非常重要的作用，但其中一些是侵入性的，会因使用造影剂给患者带来一定程度的风险以及不适。尽管胆闪烁造影程序是非侵入性的，但在目前可用的99mTc标记的亚氨基二乙酸（IDA）引入之前，它们在肝胆疾病评估中并未发挥重要作用。这些新型肝胆显像剂与之前使用的放射性药物（特别是131I-玫瑰红）相比，具有许多优势，比如在胆囊定位方面具有高度特异性，肝脏多边形细胞对其摄取率高，经泌尿系统排泄极少。深入了解复合物中各个基团的结构分布关系有助于设计出肝胆特异性更高以及具备其他理想特性的显像剂。在许多临床情况下，即使是胆红素水平较高的患者，99mTc标记的IDA提供的临床信息也远比其他诊断成像方式优越。此外，给予关键器官的吸收辐射剂量远比旧的显像剂低。因此，99mTc标记的IDA胆闪烁造影程序的引入开启了肝细胞功能受损及其他胆道疾病患者诊断检查的新阶段。
