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

Four patients with primary sclerosing cholangitis (PSC) were examined with the hepatobiliary agent Tc-99m-labeled DISIDA (diisopropylphenylcarbamoyl iminodiacetic acid), and the results correlated with those of invasive cholangiography. Three of the four patients exhibited a typical pattern of multiple, persistent focal "hot spots" in the duct system, representing stasis within the segmental ductal dilatations (beading), also seen on cholangiography. Cholescintigraphy is superior to cholangiography in cases of suspected PSC where there is nonfilling of biliary radicals due to high-grade stenosis. The finding of delayed hepatic parenchymal clearance can allow estimation of the degree of obstruction of the various branches of the major bile ducts. Cholescintigraphy offers a noninvasive method of investigating patients with suspected sclerosing cholangitis, leading to earlier diagnosis. Confirmation with invasive cholangiographic procedures is recommended.