ABSTRACT

Hepatobiliary scintigraphy is a nuclear medicine imaging method to evaluate liver and biliary system. For imaging, radiopharmaceuticals that are taken up by hepatocytes and secreted to the biliary system are used. Mebrofenin can be preferred over disofenin in patients with hepatic disfunction due to its higher hepatic excretion rate. There are several clinical conditions that can be false negative or positive findings in hepatobiliary scintigraphy. For this reason, some physiological and pharmacological applications can be performed to increased diagnostic sensitivity. In a normal hepatobiliary scintigraphy, radiopharmaceutical should be cleared form blood pool and taken up by liver parenchyma. Then radiopharmaceutical should be pass through to intrahepatic and extrahepatic biliary tract, gallbladder and proximal small bowel. All this passage should be completed with 1 hour. In newborn with jaundice, hepatobiliary scintigraphy can distinguish two most common ethiologies; neonatal hepatitis and biliary atresia. While liver uptake is decreased in neonatal hepatitis, it is normal in biliary atresia. Although acute cholecystitis is the most common indication for hepatobiliary scintigraphy in the past, today because of the common usage of ultrasonography clinical application of hepatobiliary scintigraphy for this indication is decreased. Absence of the radioactivity in gallbladder in hepatobiliary scintigraphy is the finding of acute cholecystitis but it is not specific. For further evaluation, late imaging or morphine medication is needed. Chronic gallbladder disease shows itself with late gallbladder filling. Another finding of chronic cholecystitis is decrease of gallbladder ejection fraction. Biliary leakage can easily be diagnosed with appearance of radioactivity in the locations apart form liver, gallbladder, biliary system, small bowel or urinary tract. In patients with epigastric discomfort, diagnosis of enterogastric reflux can be done in the case of passage of radiopharmaceutical form duodenum to stomach. Application of hepatobiliary scintigraphy for evaluation of future liver remnant function in patients who will undergo hepatectomy is a recent method. In patients who underwent embolic or surgical procedures due to insufficient future liver remnant, postprocedural functional change in hypertrophic liver can be calculated with hepatobiliary scintigraphy. To conclude, hepatobiliary scintigraphy, is an easily performed and non-invasive imaging method with high sensitivity for the evaluation of liver function and biliary system and gallbladder. Despite, decrease of its application for diagnosis of acute cholecystitis, today it found new application areas such as evaluation of future liver remnant function before liver surgery.