Hepatobiliary excretion of 99mTc-EC: A potential source of mistake in the interpretation of renal scintigraphy

Document Type: Case Report

Authors

Nuclear Medicine and Molecular Imaging Research Center, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

A 10-year-old boy with a history of bloody discoloration of urine following recent appendectomy was referred to our department for urinary leakage/fistula evaluation. A renal Technetium-99m-L,L-ethylenedicysteine (99mTc-EC) scintigraphy was performed. After injection of radiotracer, a focus of activity appeared in the supralateral part of the right kidney which was confirmed as accumulation of radiotracer in the gall bladder by SPECT and delayed images. Although it is stated that the biliary excretion of 99mTc-EC is negligible, in some cases it could be prominent and potential source of misinterpretation.

Keywords

Main Subjects


  1. Dogan AS, Kirchner PT. Hepatobiliary excretion of MAG3. Simulation of a urinary leak. Clin Nucl Med. 1993 Sep;18(9):746-50.
  2. Niederkohr RD, McDougall IR. Incidental gallbladder visualization on nonhepatobiliary nuclear medicine studies: case series and review of the literature. Clin Nucl Med. 2007 Dec;32(12):915-9.
  3. Beiki D, Eftekhari M, Fallahi B, Gheisari F, Hozhabrosadati M, Fard-Esfahani A, Takavar A, Gholamrezanezhad A, Saghari M, Ansari Gilani K. Comparative scintigraphic study of renal function with 99mTc-Mercaptoacetyl-triglycine and 99mTc-Ethylenedicysteine. DARU J. Pharm. Sci. 2008;16(1):41-6.
  4. Durand E, Chaumet-Riffaud P, Grenier N. Functional renal imaging: new trends in radiology and nuclear medicine. Semin Nucl Med. 2011 Jan;41(1):61-72.
  5. Kibar M, Noyan A, Anarat A. 99Tcm-N,N-ethylenedicysteine scintigraphy in children with various renal disorders: a comparative study with 99Tcm-MAG3. Nucl Med Commun. 1997 Jan;18(1):44-52.
  6. Prvulovich EM, Bomanji JB, Waddington WA, Rudrasingham P, Verbruggen AM, Ell PJ. Clinical evaluation of technetium-99m-L,L-ethylenedicysteine in patients with chronic renal failure. J Nucl Med. 1997 May;38(5):809-14.
  7. Nielsen SS, Poulsen EU, Marqversen J, Nielsen LE, Bacher T, Rehling M. Clearance and renal extraction of technetium-99m-L,L-ethylenedicysteine, I-131-ortho-iodohippurate and I-125-iothalamate in pigs. Clin Physiol. 1999 Jul;19(4):338-43.
  8. Kabasakal L. Technetium-99m ethylene dicysteine: a new renal tubular function agent. Eur J Nucl Med. 2000 Mar;27(3):351-7.
  9. Zakko S, Mrhac L, Al-Bahri J, Al-Shamsi H, Lootah S, Benjamin RJ. Biliary excretion of Tc-99m EC in renal studies. Clin Nucl Med. 1998 Jul;23(7):417-9.
  10. Jain TK, Phulsunga RK, Gupta N, Sood A, Bhattacharya A, Mittal BR. Vicarious liver visualization in solitary functioning kidney with technetium-99m ethylenedicysteine renal scintigraphy. Indian J Nucl Med. 2015 Jul-Sep;30(3):272-4.
  11. Arora G, Damle NA, Tripathi M, Bal C, Kumar P. Vicarious visualization of gall bladder on Tc-99m ethylene dicysteine renal dynamic study. Indian J Nucl Med. 2012 Oct;27(4):257-8.
  12. Verbruggen AM, Nosco DL, Van Nerom CG, Bormans GM, Adriaens PJ, De Roo MJ. Technetium-99m-L,L-ethylenedicysteine: a renal imaging agent. I. Labeling and evaluation in animals. J Nucl Med. 1992 Apr;33(4):551-7.
  13. Ngai S, Stuckey SL. Peri-aortofemoral prosthesis urinoma: diagnosis by Tc-99m MAG3 SPECT/CT and differentiation from simultaneous hepatobiliary excretion. Clin Nucl Med. 2008 May;33(5):337-9.