Detection and localization of post-operative and post-traumatic bile leak: hybrid SPECT-CT with 99mTc-Mebrofenin
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To evaluate the role of single photon emission tomography-computed tomography (SPECT-CT) with 99mTc-N-(3-bromo-2,4,6-trimethylacetanilide) iminodiacetic acid (Mebrofenin) for detection and localisation of post-operative and post-traumatic bile leak and compare the same with planar hepatobiliary scintigraphy (HBS).
Data of 32 consecutive patients (Age—35.7 ± 15.3 years; Female—53.2%) who underwent 99mTc-Mebrofenin planar HBS and SPECT-CT for suspected bile leak was prospectively collected and retrospectively analyzed. Twenty-six patients were post-operative and six had history of abdominal trauma. Planar HBS and SPECT-CT images were evaluated by two experienced nuclear medicine physicians. Sensitivity, specificity and predictive values, were calculated for planar HBS and SPECT-CT. Final diagnosis was established based on a combination of re-operative findings, follow up imaging and clinical follow up (1–4 week).For evaluation of observer confidence a third observer used a scoring scale of 1–5, with 1 being definite bile leak and 5 being no leak. Receiver operating characteristic (ROC) curves were drawn and the areas under the curves were compared.
The sensitivity, specificity and accuracy of SPECT-CT were 88.8%, 100% and 96.8% while that of planar HBS were 77.7%, 60.8% and 65.6%, respectively. Planar HBS showed very low diagnostic accuracy compared to SPECT-CT (65.6% vs. 96.8%; P = 0.021). It was false positive in nine patients. SPECT-CT also correctly localised the site of bile leak in eight of nine patients. On ROC analysis the observer confidence for SPECT-CT was significantly better than that for planar scintigraphy (P = 0.045).
99mTc-Mebrofenin hybrid SPECT-CT is highly sensitive and specific for detection and localisation of post-operative and post-traumatic bile leak. It is more accurate than planar HBS and should be routinely done in such patients.
KeywordsBile leak 99mTc-Mebrofenin Hepatobiliary scintigraphy SPECT-CT
Conflict of interest
The authors declare that there is no conflict of interest. No funding received from any organization for this study.
- 9.Stampfl U, Hackert T, Radeleff B et al. (2011) Percutaneous management of postoperative bile leaks after upper gastrointestinal surgery. Cardiovasc Intervent Radiol: Feb [epub ahead of print]Google Scholar
- 12.Ndlovu X, George R, Ellmann A, Warwick J (2010) Should SPECT-CT replace SPECT for the evaluation of equivocal bone scan lesions in patients with underlying malignancies? NucMed Commun 31:659–665Google Scholar
- 18.Task Group of Committee 2 of the International Commission on Radiological Protection (1988) Annals of the ICRP. ICRP Publication 53—Radiation dose to patients from radiopharmaceuticals. Pergamon Press, New York, pp 201–205Google Scholar