Complementary role of Tc-99m-diethyl-IDA and ultrasound in large and small duct biliary tract obstruction.

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Abstract
Patients [51] underwent both radionuclide and ultrasound studies of the hepatobiliary system. Of these 11 patients had large bile duct obstruction, 6 had intrahepatic diffuse small duct obstruction and 37 had no obstruction. In all patients with large duct obstruction, the radionuclide images were abnormal. Ultrasound was abnormal in 9 studies (with correct identification of level), normal in 1 and technically inadequate in 1, ultrasound scans were also abnormal in 6 patients without obstruction. In small duct obstruction, the radionuclide scan was abnormal in all 6, but in 5 patients it could not differentiate small from large duct obstruction. In all 6 patients, ultrasound showed no large duct obstruction, thus allowing identification of the level of obstruction in patients whose radionuclide scans were equivocal. A cost analysis indicated that in suspected large duct obstruction, the best strategy is ultrasound first, followed by radionuclide imaging in all positive or technically inadequate ultrasound studies. In suspected small duct obstruction, the best strategy is radionuclide scanning first followed by ultrasound in 99mTc-diethyl-IDA [diethyliminodiacetic acid] studies equivocal as to level of obstruction.