THE APPLICATION OF COLLOIDAL RADIOGOLD AND RADIOIODINATED ROSE BENGAL IN HEPATOBILIARY DISEASE

¹ From the Division of Nuclear Medicine, Montreal General Hospital, Montreal, Quebec, Canada

A radionuclide study is described for the evaluation of hepatobiliary disease. The study consists of Au¹⁹⁸ retention and liver scans, and radioiodinated rose bengal (RBI¹³¹) retention and serial scans of the liver and abdomen. Twenty minute RBI¹³¹ and 4.5 minute Au¹⁹⁸ retentions are given for normals, acute hepatitis, obstructive jaundice, fibrotic liver disease with and without jaundice, acute congestive heart failure, and liver containing tumor.

RBI¹³¹ retentions greater than 86 per cent indicated polygonal cell disease, whether or not excretion into the intestine was detected (Table II). Complete extrahepatic obstruction was present when the RBI¹³¹ retention was 86 per cent or less, and excretion into the intestine was not observed in the scans of the abdomen. Serial RBI¹³¹ liver and abdomen scans may exhibit the presence of a dilated biliary tree or nonuniform drainage in the liver, and thus distinguish partial obstruction from hepatocellular disease. An indeterminate group remains which consists of a RBI¹³¹ retention less than 80 per cent, excretion into the intestine, and a uniform distribution of activity in the liver with Au¹⁹⁸ and RBI¹³¹.

Intra-abdominal bile spill can be diagnosed with serial RBI¹³¹ scans. The findings in 2 cases of biliary atresia are described. A 3 month old infant with biliary atresia showed persistence of RBI¹³¹ in the liver and no excretion into the intestine which is the usual picture in obstruction, whereas a 2 year old child showed only a transient appearance of RBI¹³¹ in the area of the liver and a higher concentration in the kidneys at 1 and 4 hours.

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