The significance of nonvisualization of extrahepatic bile duct in intravenous radionuclide cholescintigraphy with special reference to acute suppurative cholangitis.

Intravenous radionuclide cholescintigraphy using Tc-99m HIDA was performed in 386 consecutive patients with suspected biliary disease. Among 365 patients with prompt hepatic uptake, the common bile duct was not visualized in 19 (5.2%). Biliary calculi with infection, especially suppurative cholangitis, is the most frequent condition responsible for this cholescintigraphic pattern. Conditions involving the common bile duct from extrinsic causes may also present this pattern. This pattern is a specific indicator of pathology in the common bile duct. In addition, it is diagnostic for acute suppurative cholangitis, with a sensitivity of 66.7%, a specificity of 90.5%, an accuracy of 88.3%, a positive predictive value of 42%, and a negative predictive value of 96.3%. Aside from mechanical obstructions, functional obstruction of a normal sized common duct that contained no calculi could also be detected by this pattern.