Henry R E, Daly M J
Crit Rev Diagn Imaging. 1981;17(1):1-18.
Cholescintigraphy with technetium-labeled biliary agents has great value in evaluation of the patient with suspected acute cholecystitis. Visualization of the gall bladder virtually excludes acute cholecystitis and obstruction of the cystic duct. Nonvisualization of the gall bladder, however, is not specific for acute cholecystitis and may also occur in some patients with chronic cholecystitis or pancreatitis. Interpretation of gall bladder nonvisualization, therefore, must be correlated with the clinical presentation. Biliary tract imaging is also useful in evaluation of some focal abnormalities within the liver, neonatal jaundice, detection of bile leaks or bile reflux, and biliary-enteric shunts. The role of technetium-labeled biliary agents in the evaluation of patients with jaundice is less clear. Excretion of tracer into the gut excludes complete biliary tract obstruction, but the test may be nonconclusive at higher serum bilirubin levels. If persistent common bile duct activity is observed with delayed excretion into the gut, the diagnosis of partial obstruction may be made, but this procedure will be inconclusive if the common bile duct is not visualized and/or significant hepatocellular disease is present. Ultrasonography and abdominal CT are the preferred tools for the diagnosis of biliary tract obstruction at present, but newer biliary tract agents which achieve better hepatic extraction and greater bile concentration at high serum bilirubin levels may improve the diagnostic efficacy of cholescintigraphy.
用锝标记的胆汁造影剂进行的肝胆闪烁显像在评估疑似急性胆囊炎患者时具有重要价值。胆囊显影实际上可排除急性胆囊炎和胆囊管梗阻。然而，胆囊不显影并非急性胆囊炎所特有，在一些慢性胆囊炎或胰腺炎患者中也可能出现。因此，对胆囊不显影的解读必须与临床表现相结合。胆道成像在评估肝脏内的一些局灶性异常、新生儿黄疸、检测胆漏或胆汁反流以及胆肠分流方面也很有用。锝标记的胆汁造影剂在黄疸患者评估中的作用尚不太明确。示踪剂排入肠道可排除完全性胆道梗阻，但在血清胆红素水平较高时该检查可能无法得出明确结论。如果观察到胆总管持续有活性且示踪剂延迟排入肠道，则可能诊断为部分梗阻，但如果胆总管未显影和/或存在明显的肝细胞疾病，该检查将无法得出明确结论。目前，超声检查和腹部CT是诊断胆道梗阻的首选方法，但新型胆道造影剂在高血清胆红素水平时能实现更好的肝脏摄取和更高的胆汁浓度，可能会提高肝胆闪烁显像的诊断效能。
