Imaging and retention measurements of selenium 75 homocholic acid conjugated with taurine, and the carbon 14 glycochol breath test to document ileal dysfunction due to late radiation damage

In order to assess ileal dysfunction in patients with complaints after pelvic radiation therapy, retention measurements and scintigraphic imaging with selenium 75 homocholic acid conjugated with taurine (75Se-HCAT), combined with the carbon 14 glycochol breath test, were evaluated in 39 patients. In 22 patients without ileal resection the results of the 75Se-HCAT test and the breath test differentiated between a normal functioning ileum (both tests negative) and ileal dysfunction as a cause of complaints (one or both tests positive). Among the patients with ileal dysfunction, the combination of both tests permitted those with bacterial overgrowth (breath test positive, 75Se-HCAT negative) to be separated from patients with evidence of bile acid malabsorption (75Se-HCAT positive, breath test positive or negative). In 17 patients with small-bowel resection, the 75Se-HCAT test helped to estimate the severity of bile acid malabsorption with implications for therapy. In this group the breath test was false-negative in 7 cases with abnormal 75Se-HCAT. Additional systematically performed scintigraphic imaging improved the accuracy of the 75Se-HCAT test, revealing cases with prolonged colonic accumulation of the radiopharmaceutical, causing spurious retention values. In conclusion, assessment of ileal dysfunction by nuclear medicine techniques in post-irradiation conditions provides information about the aetiology and therefore the possibility of adjustment in the clinical management.