Dr DeR Kolisch should not be astonished that we did not include radionuclide scintigraphy in our algorithm at this time. There are several reasons. It should first be noted that it is still not approved by the Food and Drug Administration for unrestricted use and still not available in many hospitals.Our algorithm not only attempts to differentiate intrahepatic from extrahepatic cholestasis but tries to advocate modalities that give definitive visual evidence of the specific surgical causes for extrahepatic obstruction. Although radionuclide scintigraphy can differentiate complete biliary obstruction from hepatocellular disease, it is much less effective when the obstruction is partial and when it is superimposed on hepatocellular disease as stressed by Cheng et al, whom Dr DeR Kolisch cites. Pelot et al1 point out that in their experience, the diagnostic accuracy of technetium Tc 99m iprofenin (Pipida) scintigraphy in patients with jaundice owing to extrahepatic obstruction
Fischer MG, Gelb AM, Weingarten LA. Diagnosis of Cholestatic Jaundice-Reply. JAMA. 1981;246(24):2805. doi:10.1001/jama.1981.03320240015005
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