RADIONUCLIDE HEPATOBILIARY SCANNING IN PATIENTS WITH AIDS-RELATED SCLEROSING CHOLANGITIS

Biliary disease, primarily manifesting as papillary stenosis or sclero sing cholangitis, is being increasingly recognized as a problem in the acquired immunodeficiency syndrome (AIDS) and may be amenable to spec ific treatment. Ultrasound, followed by endoscopic retrograde cholangi opancreatography (ERCP) for definitive diagnosis, is currently the pri me mode of investigation of suspected hepatobiliary diseases in AIDS. There are few published reports of the use of radionuclide cholescinti graphy in the assessment of these patients. This report presents Tc-99 m DISIDA cholescintigraphy data from three patients with AIDS-related hepatobiliary disease confirmed by ERCP. Radionuclide cholescintigraph y was abnormal in all three patients. In two of the subjects, there wa s focal duct dilation with strictures in the biliary tree. The third p atient demonstrated diffuse hepatic parenchymal retention with marked delay in tracer washout. Two of the subjects, treated with specific an ticryptosporidial therapy, subsequently underwent progress cholescinti graphy. In one of these patients with initial diffuse parenchymal rete ntion, there was marked improvement in scan appearances. The second pa tient with initial duct dilation had no significant change in scan app earances, but quantitative analysis did demonstrate improvement in hep atobiliary tracer clearance rate. In conclusion, although ERCP remains the gold standard in the diagnosis of AIDS-related biliary disease, r adionuclide cholescintigraphy may be a useful modality in these patien ts as a screening test before proceeding to more expensive and invasiv e techniques. In addition, quantitative analysis of cholescintigraphy may allow assessment of patient response to specific antimicrobial or surgical intervention.