Pryanka Relan, Abstract Co-Author: Nothing to Disclose

Robert Matthews MD, Presenter: Nothing to Disclose

Mera Goodman BS, Abstract Co-Author: Nothing to Disclose

Elham Safaie MD, Abstract Co-Author: Nothing to Disclose

Dinko Franceschi MD, Abstract Co-Author: Nothing to Disclose

Hepatobiliary (HIDA) imaging periodically reveals a complete obstructive pattern (non-visualization of bile ducts, gallbladder and intestines). In the newborn, delayed imaging differentiates between obstructive causes; however, the value of delayed imaging in the adult population remains to be clarified. We evaluated causes of obstruction in adult patients who underwent delayed HIDA imaging.

A retrospective review was performed of adults demonstrating a complete obstructive pattern on initial HIDA from Jan 1, 2004 to Oct 31, 2013. Studies with severe hepatic dysfunction were excluded. Two trained physicians qualified the presence of intestinal activity (negative, low, moderate, high) and noted visualization of gallbladder on delayed images. Patients were divided into early delayed (<10 hr; ED) and late delayed (≥10 hr; LD) groups. Diagnosis of intrahepatic and extrahepatic obstruction (IHO, EHO) was obtained from chart review. Data were analyzed using descriptive statistics, χ2, and linear regression.

Fifty-one patients had complete obstruction on initial HIDA with delayed imaging at 3-24 hours. Mean age (SD) was 60.8 yrs (17.6) among 23 males and 28 females. 35% (n=18) patients underwent LD imaging. EHO (choledocholithiasis, stricture, etc) represented 69% of cases (n=35), IHO (cirrhosis, hepatitis, etc) represented 27% cases (n=14), and 2 cases indeterminate. Number of IHO were not significantly different in ED or LD groups (28% vs 27%, p=0.925). On linear regression, absence of gallbladder on delayed image was positively associated with EH cause of obstruction (p=0.038). There was no association between degree of radiotracer and cause of obstruction in the ED or LD groups (p=0.775, 0.736 respectively).

Absence of gallbladder on delayed imaging suggests an EH cause of obstruction. Degree of intestinal activity and image delay time of 10 hours or less does not differentiate between IH and EH diagnoses. These data suggest that delayed hepatobiliary imaging may have a role in determining the cause of obstructive pathology in adults.

Knowing the different findings associated with an obstructive pattern on delayed hepatobiliary imaging within the adult population will potentially help clinicians treat the underlying causes.

Relan, P, Matthews, R, Goodman, M, Safaie, E, Franceschi, D, Do Delayed Images on Mebrofenin Hepatobiliary Scan Determine Cause of Obstructive Hepatobiliary Disease?: A 9 Year Single-Center Review.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045717.html