technetium-tc-99m-disofenin and Cholecystitis

We sought to determine whether a reduced gallbladder ejection fraction, (GBEF) ascertained by cholecystokinin-cholescintigraphy (CCK-CS), predicts symptomatic improvement after cholecystectomy.. Medical records of patients who had had CCK-CS as well as negative results of gallbladder ultrasonography were reviewed, and patients were contacted by telephone to determine whether they had benefited from cholecystectomy.. There were 35 patients (33 female, 2 male) who had a decreased GBEF. Cholecystectomy was done in 30, of whom 20 (67%) had resolution of pain, 8 (27%) had partial improvement, and 2 (7%) had no change. The 5 who declined cholecystectomy included none (0%) who were pain free, 2 (40%) who had partial improvement, and 3 (60%) who had no change. The clinical outcome of the two groups was significantly different. There were 14 patients (10 female, 4 male) with a normal GBEF. The 2 patients who had cholecystectomy were asymptomatic. Of the 12 patients who did not have cholecystectomy, 9 (75%) were asymptomatic, 1 (8%) had some improvement, and 2 (17%) had no change.. Cholecystectomy is indicated for patients with acalculous biliary pain and reduced GBEF, since symptoms will likely resolve with surgery and will persist without it. Cholecystectomy for patients with a normal GBEF should be considered only after failure of a nonoperative trial, since improvement usually occurs over time.

Topics: Adolescent; Adult; Aged; Child; Cholecystectomy; Cholecystitis; Cholecystokinin; Chronic Disease; Colic; Female; Follow-Up Studies; Forecasting; Gallbladder; Gallbladder Diseases; Gallbladder Emptying; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Remission Induction; Retrospective Studies; Technetium Tc 99m Disofenin; Telephone; Treatment Outcome; Ultrasonography

Topics: Acute Disease; Aniline Compounds; Cholecystitis; Glycine; Humans; Imino Acids; Morphine; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

An immunosuppressed, neutropenic patient developed symptoms and signs of acute cholecystitis. Gallbladder ultrasound was consistent with acute cholecystitis. Technetium-99m-diisopropyl iminodiacetic acid (DISIDA) scan showed a rim sign, but with normal gallbladder visualization. On restudy 72 hr later when the patient's WBC count was recovering, the 99mTc-DISIDA scan again showed a persistent rim sign, but now there was no gallbladder visualization at 1 hr, a pattern strongly predictive for acute complicated cholecystitis. Biliary drainage was performed by percutaneous cholecystotomy with clinical improvement. Semielective cholecystectomy performed 8 wk later confirmed both acute and chronic cholecystitis. We describe the rim sign and its variants, mechanisms of causation, prognostic importance and correlate our report with a review of the literature.

Topics: Acute Disease; Adult; Cholecystitis; Gallbladder; Humans; Imino Acids; Immunocompromised Host; Male; Organotechnetium Compounds; Predictive Value of Tests; Radionuclide Imaging; Technetium Tc 99m Disofenin; Time Factors

Topics: Abdomen, Acute; Acute Disease; Cholecystitis; Female; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Lidofenin; Ultrasonography

The 99mTc iminodiacetic acid analogues are a group of radiopharmaceuticals which are rapidly metabolized by the hepatocytes and excreted into the biliary tract. In essence, they function as bile markers and are therefore used to trace bile flow pathways by external imaging. There are various facets of liver and biliary tract disorders which can now be investigated with these new agents at a greater confidence level than heretofore possible with the older test agent, 131I-rose bengal. These include determination of cystic duct patency, assessment of the integrity of surgically altered biliary and gastrointestinal anatomy, disclosure of biliary gastric reflux, and distinction between medical and surgical jaundice.

Topics: Biliary Dyskinesia; Biliary Tract; Biliary Tract Diseases; Biliary Tract Surgical Procedures; Cholecystitis; Diagnosis, Differential; Digestive System; Digestive System Surgical Procedures; Humans; Imino Acids; Jaundice; Liver; Liver Diseases; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid; Technetium Tc 99m Disofenin; Technetium Tc 99m Lidofenin

Technetium-99m IDA cholescintigraphy has provided a new, noninvasive means of visualizing biliary tract function. It has become the procedure of choice in patients with suspected acute cholecystitis because of its ability to most accurately detect functional obstruction or patency of the cystic duct as opposed to ultrasound's ability to detect only anatomic changes such as the presence of calculi or a thickened gallbladder wall. These latter findings are more important in establishing the diagnosis of chronic cholecystitis where ultrasound shares a position of prime importance with the oral cholecystogram. Tc-99m IDA cholescintigraphy has also been particularly useful in evaluating bile leaks, biliary-enteric anastomosis patency and the post-cholecystectomy patient with recurrent pain. In the patient with cholestasis, ultrasound is usually the procedure of choice since it establishes whether or not ductal dilatation is present and frequently can determine the cause of obstruction. Cholescintigraphy has played an ancillary role in many cases by demonstrating the level of partial obstruction, but it does not have the anatomic resolution to visualize the cause of obstruction. Occasionally, in the evaluation of cholestasis, cholescintigraphy has proven to be the only modality which has identified the presence of acute common duct obstruction or localized intrahepatic ductal obstruction. All in all, Tc-99m IDA cholescintigraphy has had a dramatic impact upon hepatobiliary diagnosis.

Topics: Abdominal Injuries; Adolescent; Biliary Tract Diseases; Cholangiography; Cholecystitis; Cholestasis; Hepatic Duct, Common; Humans; Imino Acids; Male; Organotechnetium Compounds; Postoperative Period; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Lidofenin; Ultrasonography

Cholescintigraphy was performed after pharmacological manipulation in 60 patients with a clinical suspicion of acute cholecystitis and non-visualization of the gallbladder 1 h after 99Tcm-DISIDA cholescintigraphy. Thirty patients received an intravenous (i.v.) injection of morphine sulphate (group I) and the other 30 patients an i.v. injection of CCK (group II). The sensitivity, specificity, positive predictive value and negative predictive value were 94, 100, 100 and 93% in group I and 100, 84, 79 and 100% in group II, respectively. There was a significant difference between groups (P < 0.05). In conclusion, morphine-augmented cholescintigraphy could supply more reliable diagnostic information and is less time-consuming in patients with a clinical suspicion of acute cholecystitis.

Topics: Acute Disease; Adult; Aged; Cholecystitis; Cholecystokinin; False Negative Reactions; False Positive Reactions; Female; Humans; Imino Acids; Injections, Intravenous; Male; Middle Aged; Morphine; Organotechnetium Compounds; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Disofenin

99mTc-disofenin, a derivative of iminodiacetic acid, was used for cholescintigraphy in 6 volunteers (in addition to assessment of blood and urine clearance) and in 82 patients referred for evaluation of hepatobiliary tract disease. This radionuclide was cleared rapidly from the blood by the hepatocytes, which permitted satisfactory to excellent images of the hepatobiliary system; interference by renal activity was seen in only 9/82 patients (11%). Acute cholecystitis was correctly diagnosed in 20 patients, although 9 (45%) had jaundice; bilirubin levels ranged from 1.2 to 7.6 mg/dl. The biliary tract was normal in 16 of the 27 patients with jaundice (60%).

Topics: Bile Ducts; Cholangiography; Cholecystitis; Cholelithiasis; Cholestasis, Intrahepatic; Clinical Trials as Topic; Humans; Imino Acids; Liver; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Topics: Acute Disease; Biliary Tract; Cholecystitis; Gallbladder; Humans; Liver; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Disofenin; Tomography, X-Ray Computed

We describe a 41-year-old man with a 1-week history of nausea and vomiting 1 month after chemoembolization of a liver metastasis. The patient subsequently became febrile and developed right upper quadrant abdominal and midback pain. Findings of initial laboratory and imaging studies (a noncontrast computed tomographic [CT] scan and ultrasound) were not remarkable. Hepatobiliary scintigraphy, performed to rule out cholecystitis, revealed an abnormal area in the right lobe of the liver consistent with a focal bile leak into an abscess cavity. The patient was subsequently treated for liver abscess. In conclusion, hepatobiliary scintigraphy should be considered as a first-line test in the work-up of patients whenever a postchemoembolization complication is considered likely.

Topics: Bile; Cholecystitis; Diagnosis, Differential; Embolization, Therapeutic; Humans; Liver Abscess; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Disofenin; Tomography, X-Ray Computed; Ultrasonography

Topics: Acute Disease; Aged; Cholecystitis; Esophageal Neoplasms; Esophagoplasty; Gastroesophageal Reflux; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Disofenin

Hepatobiliary scintigraphy is a very accurate test in the diagnosis of acute cholecystitis. However, ultrasonography is extensively used for the diagnosis of this disease. In this study, we directly compare the diagnostic accuracy of these techniques for acute cholecystitis.. The diagnostic accuracy of scintigraphy and ultrasonography was evaluated in 107 consecutive patients with suspected acute cholecystitis who underwent both imaging modalities within one day. The incremental diagnostic value of each modality was determined.. The sensitivity, specificity, positive and negative predictive values, and accuracy for the diagnosis of acute cholecystitis in the entire cohort were superior for scintigraphy compared with ultrasonography. The accuracy was 92% for scintigraphy and 77% for ultrasonography. Similarly, if only surgically treated patients were considered, the accuracy of scintigraphy was 91% versus 61% for ultrasonography. The diagnostic value of scintigraphy for the entire cohort was significantly superior to ultrasonography (global, chi(2) = 58.1 vs 9.7, respectively); the addition of the information derived from the latter did not further improve the diagnostic value of scintigraphy (global, chi(2) = 58.2).. Hepatobiliary scintigraphy has superior diagnostic accuracy for acute cholecystitis compared with ultrasonography. The addition of ultrasonography does not further improve the diagnostic accuracy of scintigraphy alone.

Topics: Acute Disease; Adult; Aged; Biliary Tract; Cholecystitis; Female; Humans; Liver; Male; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Disofenin; Ultrasonography

Topics: Aged; Cholecystitis; False Positive Reactions; Gallbladder; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Sphincterotomy, Endoscopic; Technetium Tc 99m Disofenin

Our purpose was to identify clinical or radiologic features predictive of response to percutaneous cholecystostomy performed for the treatment of acute cholecystitis.. The clinical records and radiologic images of patients who underwent percutaneous cholecystostomy for suspected acute cholecystitis between January 1987 and July 1994 were retrospectively reviewed. A response to percutaneous cholecystostomy was defined as an improvement in clinical symptoms and signs or reduction in fever and WBC to normal within 72 hr of percutaneous cholecystostomy. The number and type of radiologic investigations were reviewed by two radiologists. The presence of gallstones, gallbladder wall thickening, distention, and pericholecystic fluid was recorded. The clinical and radiologic findings were analyzed for their relationship to response to percutaneous cholecystostomy.. Sixty-one percutaneous cholecystostomies were performed in 37 male and 24 female patients and were technically successful in 59. Thirty-one patients had gallstones, 28 did not. Thirty-one patients were in the intensive care unit, and 15 were ventilated. Complications occurred in six (10%): misplacement of the percutaneous cholecystostomy catheter in the colon (one), exacerbation of sepsis (three), and bile leakage (two). The mortality rate was 2%--one of the patients with septic shock succumbed to a cardiac arrest 3 days after the procedure. Forty-three patients (73%) responded to percutaneous cholecystostomy. Patients with gallstones and symptoms and signs localized to the right upper quadrant of the abdomen were more likely to respond (p = .006). The only individual radiologic feature predictive of a positive response was the presence of pericholecystic fluid in patients with gallstones (p = .03). The presence of all four radiologic findings was also associated with a positive response (p = .039). The results of bile cultures were not predictive of response. Of the 16 nonresponders, six had documented biliary sepsis and cholecystitis.. Clinical symptoms and signs referable to the gallbladder, the presence of pericholecystic fluid in patients with gallstones, and the presence of an increasing number of radiologic findings in any one patient are predictive of a positive response to percutaneous cholecystostomy.

Topics: Acute Disease; Cholecystitis; Cholecystostomy; Female; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Predictive Value of Tests; Retrospective Studies; Technetium Tc 99m Disofenin; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography

Topics: Adult; Bile Ducts; Cholecystitis; Diagnosis, Differential; Duodenogastric Reflux; Female; Gallbladder; Humans; Pyloric Antrum; Radionuclide Imaging; Stomach; Technetium Tc 99m Disofenin; Time Factors; Tomography, X-Ray Computed

Topics: Acute Disease; Bile Ducts, Intrahepatic; Cholecystitis; False Negative Reactions; Female; Gallbladder; Gangrene; Humans; Ischemia; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Disofenin; Telangiectasia, Hereditary Hemorrhagic; Tomography, X-Ray Computed

A compartmental model describing the extraction and disposition of 99mTc-acetanilidoiminodiacetic acid (IDA) compounds by the liver has been applied to 5 adult patients admitted for cholecystitis investigations and 29 jaundiced infants the majority of whom were clinically differentiable into neonatal hepatitic and biliary atretic groups.. In each case kinetic rate constants were calculated to describe hepatocyte extraction of 99mTc-IDA structural analogs from blood pool (k21) and subsequent elimination (k3) of this compound into biliary tract. Also modeled was the reverse-binding constant (k12) describing the return of such radiotracer to the systemic circulation and the blood fraction (f) which accounted for the composite vasculature forming a matrix in the liver.. It was shown that these indices could be used to determine accurate compartmental mean residence times (MRT(c)s) for each patient by correlation with values obtained by deconvolutional analysis and independent measurement of leading edge parenchymal transit times. For the adult patients the following indices, typical of good hepatocyte function, were derived: k21 = 0.933 +/- 0.488 min-1, k12 = 0.0277 +/- 0.0340 min-1, k3 = 0.1610 +/- 0.0531 min-1, f = 0.3519 +/- 0.3048 and MRTc = 11.19 +/- 3.13 min. Analysis of the pediatric group revealed no significant differences in their respective MRT(c)s. However, significant differences in the extraction (p < 0.01) and excretion (p < 0.001) coefficients were prominent.. This method can be applied to provide accurate and meaningful intercompartmental rate parameters and MRT(c)s for adults, nonobstructed and obstructed infants.

Topics: Aged; Aniline Compounds; Biliary Atresia; Cholecystitis; Glycine; Hepatitis; Humans; Imino Acids; Infant; Infant, Newborn; Jaundice, Neonatal; Liver; Models, Biological; Models, Theoretical; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

Drug related false-positive hepatobiliary imaging is uncommon. The authors present a case of a 54-year-old woman who was treated with intravenous ceftriaxone for bacterial meningitis. Symptoms of acute cholecystitis subsequently developed and a sonogram revealed a gallstone. A Tc-99m DISIDA hepatobiliary study was positive for cystic duct obstruction. After discontinuation of ceftriaxone, the patient's clinical condition improved and, 2 weeks later, a repeat hepatobiliary scan was normal. High doses of ceftriaxone and prolonged administration may lead to formation of pseudocholelithiasis and signs of acute cholecystitis. Although this condition is usually benign and reversible, discontinuation of the drug is warranted when symptoms of acute cholecystitis are accompanied by a positive hepatobiliary scan.

Topics: Ceftriaxone; Cephalosporins; Cholecystitis; Cholelithiasis; False Positive Reactions; Female; Gallbladder; Humans; Imino Acids; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

Intravenous morphine sulfate has been used in conjunction with cholescintigraphy. We studied the variations in the degree and duration of the effects of 2 mg morphine on biliary kinetics in patients with gallbladder nonvisualization and undertook a comparison with biliary kinetics in patients not given morphine. Of 24 morphine-augmented cholescintigrams that were obtained without additional injection of technetium-99m diisopropyl-iminodiacetic acid (DISIDA), 19 showed continued gallbladder nonvisualization. Time-activity curves (TACs) of the liver parenchyma and common bile/hepatic duct (CD) of the entire study (before and after morphine) were obtained. In two patients, the CD was not sufficiently visualized to define a region of interest. In 17 patients, the peak CD activity was observed between 14 and 47 min after injection of 99mTc-DISIDA. In these 17, the TAC of the CD was declining essentially in parallel with the TAC of the liver parenchyma at the end of the first hour before morphine. After morphine injection, CD activity slowly increased for a variable duration in nine patients, while it continued to decrease in eight. CD activity between 1 h and 2 h showed a continuously decreasing pattern in another group of 20 patients who did not receive morphine despite gallbladder nonvisualization at 1 h. In summary, no significant effect of 2 mg of intravenous morphine on biliary kinetics was detected scintigraphically in a considerable proportion of patients. Also, there was considerable variation in the duration of the effect of morphine, when such an effect was present. This observation may have significant clinical implications for morphine-augmented cholescintigraphy.

Topics: Bile; Case-Control Studies; Cholecystitis; Common Bile Duct; Female; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Morphine; Organotechnetium Compounds; Radionuclide Imaging; Sphincter of Oddi; Technetium Tc 99m Disofenin; Time Factors

Intravenous radionuclide cholescintigraphy (IVRC) provides a very specific picture for choledochal cysts. However, the clinical significance of the non-visualization of the gall-bladder (GB) activity in these cases is unclear. In this study, we reviewed 27 patients with choledochal cysts who underwent IVRC within 7 days prior to operation and correlated the GB findings on IVRC with the histopathological results. In 18 of the 27 patients (66.7%), there was non-visualization of the GB at 4 h post injection. Among these, two had histopathological features of acute cholecystitis (AC), 11 had chronic cholecystitis (CC), and five had normal GBs. In the other nine patients with visualization of the GB, there were five cases of CC and four normal GBs. If we apply the finding of non-visualization of the GB at 4 h post injection as the criterion for the diagnosis of AC, the diagnostic accuracy was only 40.7% (11/27). We concluded that: (1) GB disease (AC and CC) was common (66.7%: 7.4% and 59.3% respectively) in choledochal cyst patients. (2) Non-visualization of the GB on IVRC did not necessarily indicate AC in choledochal cyst cases, and the diagnostic accuracy was low. (3) GB disease is not the only cause of GB non-visualization on IVRC. A huge choledochal cyst causing a mass or reservoir effect may be a cause of GB compression and result in non-visualization of the GB.

Topics: Child; Cholecystitis; Choledochal Cyst; Female; Gallbladder; Humans; Imino Acids; Male; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Disofenin; Technetium Tc 99m Lidofenin; Time Factors

To determine the efficacy of morphine enhanced radionuclide cholescintigraphy (MC) in the diagnosis of acute cholecystitis (AC) in critically ill patients.. Retrospective chart review.. 2 university hospitals.. Records of all ICU patients who underwent MC as part of an evaluation for AC over an 8 year period were reviewed (n = 45). All patients initially had standard radionuclide cholescintigraphy (RC) performed which showed nonvisualization of the gallbladder (GB) and were then given morphine sulfate (0.05-0.1 mg/kg i.v.).. The mean age was 54 years (range 18-84 years). Risk factors for AC included fasting in 41 patients (mean 12.4 days) and total parenteral nutrition in 32 patients. Signs of biliary sepsis included temperature > 100 degrees F in 38 patients, WBC > 10,000/ml3 in 40 patients, abdominal pain in 29 patients, and abnormal liver function tests in 42 patients. 23 patients had GB ultrasonography, with 7 showing stones. MC was positive (non-visualization) in 16 patients and negative (GB visualized) in 29, including 4 with gallstones. All patients in whom the GB was visualized did so within 1 h. There were 13 patients with positive MC who underwent operation; 12 had AC (9 acalculous, 3 calculous). Three patients were treated medically and recovered (false positive). All 29 patients with negative MC were true negatives. Overall, MC had an accuracy of 91%, sensitivity of 100%, specificity of 88%, positive predictive value of 75%, and negative predictive value of 100%.. MC is a useful test in the evaluation of critically ill patients for suspected AC, particularly in patients with known risk factors or documented gallstones.

Topics: Acute Disease; Biliary Tract; Cholecystitis; Critical Illness; False Negative Reactions; False Positive Reactions; Female; Humans; Imino Acids; Male; Middle Aged; Morphine; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Disofenin

Endoscopic sphincterotomy has been used for the treatment of many biliary disorders, including extraction of obstructing common bile duct stones. Manometric studies of the sphincter of Oddi and the common bile duct have shown a marked decrease in biliary tract pressures after sphincterotomy. A prospective study of 12 patients with intact gallbladders using hepatobiliary imaging before and after sphincterotomy was performed to assess changes in bile dynamics. Nonfilling of the gallbladder occurred in 9 of the 12 patients after sphincterotomy, indicating significant alteration of bile flow. Such changes in bile dynamics may have serious implications in patients selected for medical dissolution of gallstones. It may also adversely affect specificity of cholescintigraphy in diagnosing acute cholecystitis.

Topics: Adult; Aged; Aged, 80 and over; Bile; Cholecystitis; Cholelithiasis; Cholestasis, Extrahepatic; Common Bile Duct; Common Bile Duct Diseases; Female; Gallbladder; Gallstones; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Pressure; Prospective Studies; Radionuclide Imaging; Sphincter of Oddi; Sphincterotomy, Endoscopic; Technetium Tc 99m Disofenin

Classically, the "rim sign" has been described throughout the hepatobiliary scan. The authors present a case of a late rim sign visualized at 25 minutes postinjection that proved to be acute upon chronic acalculous cholecystitis without gangrene.

Topics: Acute Disease; Cholecystitis; Chronic Disease; Female; Gallbladder; Humans; Imino Acids; Liver; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Disofenin; Time Factors

A hepatobiliary scan was performed on a patient presenting with symptoms of acute cholecystitis. In addition to cystic duct obstruction, there was a focal area of intense uptake in the left lobe of the liver. Additional imaging studies confirmed a solid mass in the left lobe of the liver, which proved to be a hepatocellular carcinoma on surgery.

Topics: Acute Disease; Adult; Carcinoma, Hepatocellular; Cholecystitis; Humans; Imino Acids; Liver Neoplasms; Male; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

Morphine-augmented radionuclide hepatobiliary imaging has been used as an alternative to delayed imaging for the diagnosis of acute cholecystitis. Previous studies have indicated that the morphine-augmentation is as useful as, or more useful than, delayed imaging. A careful comparison of the efficacy of the two techniques appears warranted because: (1) most early studies did not compare the efficacy of the two techniques in a single report using comparable patient populations; (2) the reported efficacy of morphine-augmentation is based primarily on study designs which excluded cases of early gallbladder visualization without morphine, while most delayed imaging protocols included these cases; and (3) there were concerns about the potential consequences of a false-negative morphine examination. This study compared the efficacy of morphine-augmentation with delayed imaging in those cases in which the gallbladder was not visualized during the first hour of study. Of 306 consecutive patients who were scanned to rule out acute cholecystitis, the gallbladder was visualized within 1 hr in 215 cases. In the remaining 91 cases, 46 patients had delayed imaging (17 true-positive, 10 true-negative, 19 false-positive and 0 false-negative), and 45 had morphine-augmentation (24 true-positive, 15 true-negative, 4 false-positive and 2 false-negative). The data indicate that delayed imaging has a significantly lower specificity and positive-predictive value for acute cholecystitis than morphine-augmentation and a slightly higher (statistically insignificant) sensitivity and negative-predictive value. These results appear to be supported by a reanalysis of the data that has already been reported in the literature.

Topics: Acute Disease; Cholecystitis; Gallbladder; Humans; Imino Acids; Methods; Morphine; Organotechnetium Compounds; Predictive Value of Tests; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Disofenin; Time Factors

Nonvisualization of the gallbladder associated with the rim sign of enhanced pericholecystic hepatic activity has been established as a useful and highly specific sign of acute cholecystitis. This study's purpose was to determine the pathophysiologic cause of the rim sign. Thirty-seven surgery-bound patients with a clinical diagnosis of acute cholecystitis were studied. A group of 20 patients with a definite rim sign were compared to a group of 17 patients without a rim sign; all with nonvisualization of the gallbladder. Radionuclide, surgical, and pathologic findings were correlated. In patients with the rim sign and in those without the rim sign, microscopic review of all surgical specimens revealed transmural reaction of the gallbladder wall in 95% and 59% of cases, respectively. The surgeon found inflammation extending beyond the gallbladder wall in 75% of rim sign cases, but in only 35% of case without the rim sign. Liver tissue was attached to the gallbladder specimen in three cases, and the findings support the association of hepatic inflammation with the presence of a rim sign. Pathologic correlation and surgical evidence suggest that the rim sign is caused by the spread of inflammation through the gallbladder wall and into adjacent liver tissue. Transmural reaction is required before the inflammatory process can reach the liver. A high-count, high-intensity technique seems to best demonstrate the rim sign. Once demonstrated, further delayed imaging is unnecessary.

Topics: Acute Disease; Cholecystitis; Cholecystostomy; Imino Acids; Organotechnetium Compounds; Predictive Value of Tests; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Disofenin

Biliary scans of 84 hospitalized patients believed to likely have acute cholecystitis, including 55 scans that had a radionuclide angiography phase, were retrospectively evaluated to determine the frequency of the rim sign and hyperperfusion, and to test the hypothesis that more intense hyperperfusion or rim sign is associated with a greater severity of gallbladder pathology ("complicated" acute cholecystitis). In 65 of the 84 cases there was surgical intervention (including 43 from the 55 cases whose scans had a radionuclide angiography phase). "Complicated" acute cholecystitis was considered present if there was gangrene, perforation, empyema, necrosis, ulceration, or fibrous exudation. Each scan was evaluated for the presence of a rim sign and arterial hyperperfusion to the region of the gallbladder fossa. The intensities of these secondary signs of acute cholecystitis were then graded as "mild" or "marked." Subdividing the rim sign and hyperperfusion into a "marked" category considerably improved the specificity, positive predictive value, and likelihood ratio (positive) for the diagnosis of acute cholecystitis, but even more so for the complicated subgroup when marked hyperperfusion or marked rim sign were the criteria used for a positive study. Approximately 50% of the patients with acute cholecystitis had hyperperfusion and a rim sign, and approximately 15% had marked hyperperfusion and a marked rim sign. Of the patients with acute cholecystitis, the only ones with marked hyperperfusion or a marked rim sign were those who had complicated acute cholecystitis. The data demonstrate an association between greater intensity of the rim sign or hyperperfusion and greater severity of gallbladder pathology in patients with acute cholecystitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Cholecystitis; Humans; Imino Acids; Organotechnetium Compounds; Radionuclide Angiography; Retrospective Studies; Technetium Tc 99m Disofenin

Morphine-augmented radionuclide cholescintigraphy (MC) is a useful adjunctive diagnostic tool for the identification of acute cholecystitis (AC) in patients who are hospitalized and critically ill with occult sepsis. The results of previous studies have demonstrated a reduction in false-positive rates, that is, nonvisualization, from 40 percent with standard radionuclide cholescintigraphy to 5 percent with MC in these high-risk patient groups, with an overall accuracy of 92 percent. This study was performed to determine the significance of a positive test result from MC in patients with occult sepsis. We reviewed the records of all 20 patients at high risk in whom MC was positive during the 35-month period ending 31 May 1992. AC was confirmed by laparotomy in all 16 patients who underwent surgical treatment. There were two patients who recovered with antibiotic therapy alone (considered false-positives) and two additional patients who died without operation or a confirmed diagnosis of AC (excluded from analysis). Thus, in this series, MC was associated with a positive predictive value of 0.89, confirming that it is a valuable adjunct in establishing the diagnosis of AC in patients who are seriously ill and hospitalized with occult sepsis.

Topics: Acute Disease; Adult; Aged; Cholecystitis; False Positive Reactions; Female; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Morphine; Organotechnetium Compounds; Predictive Value of Tests; Radionuclide Imaging; Technetium Tc 99m Disofenin

Topics: Acute Disease; Biliary Tract; Cholecystitis; Humans; Imino Acids; Liver; Male; Middle Aged; Morphine; Organotechnetium Compounds; Radionuclide Imaging; Sphincter of Oddi; Technetium Tc 99m Disofenin; Time Factors

Topics: Adult; Cholecystitis; Congenital Abnormalities; Humans; Imino Acids; Kidney; Male; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

Laparoscopic cholecystectomy has become a popular alternative to traditional open cholecystectomy for uncomplicated, acute cholecystitis. At some centers, laparoscopic cholecystectomy is already the more frequently performed procedure. The presence or suspicion of common bile duct (CBD) stones or obstruction may necessitate conventional surgery or additional procedures. This report describes a patient with acute cholecystitis for whom the surgical management changed based on biliary scintigraphy. The demonstration of an unsuspected CBD obstruction by biliary imaging allowed the surgeon to change the initial plan for laparoscopic cholecystectomy to conventional open surgery. Stones in the common bile duct were removed.

Topics: Acute Disease; Aged; Aged, 80 and over; Cholecystectomy; Cholecystectomy, Laparoscopic; Cholecystitis; Female; Gallstones; Humans; Imino Acids; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Cholecystitis; Female; Gallbladder; Humans; Imino Acids; Liver Function Tests; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

Topics: Acute Disease; Adult; Cholecystitis; Cholestasis; Humans; Imino Acids; Male; Organotechnetium Compounds; Radionuclide Imaging; Syndrome; Technetium Tc 99m Disofenin

One hundred eighty-seven patients who presented with symptoms consistent with biliary colic but had no ultrasonic evidence of cholelithiasis were observed in an effort to identify those with a functional gallbladder disorder that might benefit from surgical intervention. All patients underwent quantitative evaluation of gallbladder emptying using cholecystokinin biliary scanning, and ejection fractions less than 35% were considered abnormal. One hundred twenty-nine patients (69%) had abnormal ejection fractions, and 88 (68%) of these subsequently underwent cholecystectomy. Sixty of the surgical specimens revealed pathologic changes. Eighty-four percent of patients successfully contacted for follow-up experienced complete relief, and another 13% had partial relief of preoperative symptoms. Only two patients reported no change in symptom complex. Twenty-nine patients with abnormal ejection fractions elected not to undergo surgery. Fifty-nine percent of these patients continued to experience symptoms of biliary colic at a mean follow-up of 22 months. Of the 44 patients with normal ejection fractions, 35 (80%) reported resolution of symptoms during follow-up of medical treatment. Cholecystokinin biliary scanning can help identify patients with acalculous, functional gallbladder disease who may benefit from cholecystectomy.

Topics: Adult; Biliary Dyskinesia; Cholecystectomy; Cholecystitis; Cholecystokinin; Cholelithiasis; Diagnosis, Differential; Female; Follow-Up Studies; Gallbladder; Gallbladder Diseases; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Disofenin

Radionuclide cholescintigraphy is used to help establish the diagnosis of acute cholecystitis and is thought to provide additional information regarding the patency of the biliary duct system. Nonvisualization of the extrahepatic biliary duct system and lack of excretion into the duodenum despite uptake in the liver (a positive study) is considered indicative of common bile duct obstruction. The authors retrospectively reviewed 281 hepatobiliary cholescintigrams done at Stamford Hospital from July 1, 1987 to June 30, 1989. Previous authors have demonstrated a false-positive rate of eight to 15 per cent in those cases that have a documented normal extrahepatic biliary system at operation. Of those patients explored after a common bile duct obstruction pattern depicted by cholescintigram in the authors' series, 46 per cent of patients were found to have normal extrahepatic biliary systems. Factors possibly contributing to this high false-positive rate are discussed. The utility of radionuclide hepatobiliary scans may be limited for diagnosis of biliary duct obstruction.

Topics: Cholecystitis; Cholestasis, Extrahepatic; Common Bile Duct Diseases; False Positive Reactions; Humans; Imino Acids; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Disofenin

Enterogastric reflux occurs in normal and abnormal conditions. When pronounced, it is a nonspecific indicator of pathology. There are relatively few published reports discussing enterogastric reflux as a prominent finding on cholescintigraphy. A unique case of pronounced enterogastric reflux from an obstructing duodenal hematoma is presented.

Topics: Aged; Cholecystitis; Duodenal Diseases; Duodenogastric Reflux; Female; Hematoma; Humans; Imino Acids; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

The rim sign of increased activity in the gallbladder fossa during nuclear hepatobiliary imaging has been described, with one exception, only in conjunction with a nonvisualizing gallbladder, and it strongly suggests acute complicated cholecystitis. A case is presented in which a rim sign was present despite later visualization of the gallbladder in presumed chronic cholecystitis.

Topics: Adult; Cholecystitis; Chronic Disease; Female; Gallbladder; Humans; Imino Acids; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin; Time Factors

Cholescintigrams were performed in 158 patients suspected of having acute cholecystitis after administration of 185 Mbq (5 mCi) of 99mTc-mebrofenin or disofenin. Morphine sulfate, 0.04 mg/kg was given intravenously if there was nonvisualization of the gallbladder at 40-60 min provided that radiotracer was seen within the small bowel. Acute cholecystitis was deemed present if there was nonvisualization of the gallbladder 30 min post-morphine administration; no cystic duct obstruction was present if the gallbladder was demonstrated pre- or post-morphine administration. A final diagnosis was estimated in 51 postoperative patients histologically, the remainder having their final diagnosis gleaned from their medical records. The sensitivity, specificity, positive and negative predictive value of morphine-augmented cholescintigraphy in detecting acute cholecystitis was 94.6, 99.1, 97.2, and 98.3%, respectively. These findings indicate that morphine-augmented cholescintigraphy detects acute cholecystitis with as high a degree of accuracy as conventional hepatobiliary scintigraphy, yet requires only 1.5 hr to establish the diagnosis.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Aniline Compounds; Cholecystitis; Female; Glycine; Humans; Imino Acids; Injections, Intravenous; Male; Middle Aged; Morphine; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Disofenin

Hepatobiliary imaging has an established diagnostic role in adults with acute cholecystitis but is underutilized in children. The authors report two children with acute cholecystitis, whose condition was diagnosed with the aid of a 99m-technetium-labeled iminodiacetic acid (IDA) derivative. The diagnosis was confirmed surgically.

Topics: Acute Disease; Child, Preschool; Cholecystitis; Female; Humans; Imino Acids; Infant; Male; Organotechnetium Compounds; Radiography; Radionuclide Imaging; Technetium Tc 99m Disofenin; Ultrasonography

Radionuclide cholescintigraphy provides useful information about the dynamics of bile flow through the liver, gallbladder, bile ducts, and intestines. Besides helping to diagnose acute cholecystitis, it may provide other meaningful information to effectively alter the patient's management. Preoperative diagnosis of intestinal obstruction was made on routine cholescintigraphy and was proved subsequently at surgery.

Topics: Adult; Aged; Bile Reflux; Biliary Tract; Cholecystitis; Duodenal Obstruction; Female; Humans; Imino Acids; Intestinal Obstruction; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

Topics: Cholecystitis; Cholecystokinin; Gallbladder; Humans; Imino Acids; Intestines; Morphine; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Disofenin

The authors assessed the influence of cholecystokinin (CCK), administered before cholescintigraphy, on the biliary-to-bowel transit time (BBTT) of technetium-99m disofenin. Fourteen healthy volunteers underwent two separate cholescintigraphic studies with and without CCK treatment. BBTT was less than 1 hour in all 14 studies of subjects not treated with CCK. In 14 subjects treated with CCK, there was no tracer activity in the bowel up to 2 hours in seven (50%) (P = .006). Eighty-three cholescintigrams obtained in patients with suspected acute cholecystitis were also retrospectively analyzed. In 53 of 83 patients in whom the gallbladder was visualized within 1 hour, significantly delayed BBTT was found in 14 of 29 (48%) who received CCK, compared with the BBTT in one of 24 patients (4%) who did not receive CCK (P less than .001). In the 30 patients in whom the gallbladder was never visualized (n = 28) or was visualized after 1 hour (n = 2), BBTT was less than 30 minutes, regardless of whether patients were treated with CCK. Results show that CCK treatment causes significantly delayed BBTT in many cases, and this finding should not be interpreted as abnormal.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cholecystitis; Cholecystokinin; Female; Gallbladder; Humans; Imino Acids; Intestines; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Disofenin; Time Factors

A case of acute gangrenous cholecystitis due to cystic duct obstruction by a metastasis from malignant melanoma detected by cholescintigraphy is presented.

Topics: Acute Disease; Adult; Bile Duct Neoplasms; Cholecystitis; Cholestasis, Extrahepatic; Cystic Duct; Humans; Imino Acids; Male; Melanoma; Organometallic Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid

Morphine sulfate has been used in hepatobiliary imaging to cause contraction of the sphincter of Oddi, thereby increasing pressure in the biliary tree. If the cystic duct is patent, the increased pressure usually causes bile to flow into the cystic duct with filling of the gallbladder. Using this technique, the authors have encountered two false-negative cases. Both patients received 0.04 mg/kg of morphine sulfate intravenously, 40 minutes after the intravenous administration of 5 mCi of technetium 99m-DISIDA. Although both patients filled their gallbladders within 1 hour, they both underwent surgical exploration because of high clinical suspicion of acute cholecystitis. Both were found to have acute cholecystitis.

Topics: Biliary Tract; Cholecystitis; False Negative Reactions; Female; Gallbladder; Humans; Imino Acids; Liver; Male; Middle Aged; Morphine; Organometallic Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

These are the first human experiments with 97Ru-DISIDA, a potentially new alternative to 131I-rose bengal where delayed imaging is indicated. 97Ru has a convenient half life. A DISIDA labeling kit was utilized to prepare the radiotracer for 17 patients (age 6 weeks-84 years). The cholescintigraphic data correlated well with other imaging procedures and with clinical findings. Dosimetric calculations were carried out and were compared with the radiation burden associated with the use of 99mTc-DISIDA and 131I-rose bengal.

Topics: Biliary Tract Diseases; Cholecystitis; Humans; Imino Acids; Liver Diseases; Organometallic Compounds; Radiation Dosage; Radionuclide Imaging; Reagent Kits, Diagnostic; Ruthenium Radioisotopes; Technetium Tc 99m Disofenin

Critical review of cholescintigraphy in critically ill patients suggests the examination will not conclusively prove or disprove the diagnosis of acute cholecystitis. Of 17 scans performed in critically ill patients with clinical evidence of acute cholecystitis, 7 were true-negative, 1 was false-negative, 6 were false-positive, and 3 were nondiagnostic. Cholestasis and hepatocyte dysfunction, common in the critically ill, result in abnormal clearance of hepatobiliary radionuclide imaging agents, decreasing the usefulness of cholescintigraphy in this patient population. Diagnosing acute cholecystitis in a critically ill patient remains difficult.

Topics: Acute Disease; Cholecystitis; Critical Care; Gallbladder; Humans; Imino Acids; Organometallic Compounds; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Disofenin

The cholecystographic pattern and the contractile response of the gallbladder (GB) to cholecystokinin (CCK) were studied in 101 consecutive patients with uncomplicated chronic cholecystitis confirmed by pathology. Sequential GB images were obtained after administration of 5 mCi 99mTc-Disofenin and the ejection fraction was determined following a 15 min infusion of CCK. Sixteen of 101 (16%) GB failed to visualize up to 4 h; of the remaining patients, 3/85 (4%) showed delayed visualization beyond 1 h, and 82/85 visualized within 1 h. The mean ejection fraction (EF) in 67 patients was 56.9% +/- 27.5% compared to 74.8% +/- 19.8% in a normal control group of 27 subjects (P less than 0.005). However, there was a large overlap as 76% of chronic cholecystitis patients had EF values falling within the full normal range. GB disease could be identified with confidence when the EF was less than 35%, i.e. below the 2 standard deviation range of normal. On the basis of radionuclide kinetic studies alone, the majority of patients with chronic cholecystitis cannot be distinguished from normal.

Topics: Adult; Aged; Cholecystitis; Cholecystokinin; Chronic Disease; Female; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

Topics: Adolescent; Adult; Aged; Cholecystitis; Cholecystography; Cholelithiasis; Chronic Disease; Female; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Organometallic Compounds; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Disofenin

The most urgent diagnosis addressed by cholescintigraphy is acute cholecystitis. By administering low-dose intravenous morphine sulfate to patients undergoing cholescintigraphy (who demonstrate visualization of both the common bile duct and intestine and nonvisualization of the gallbladder), the time required to complete the study has been reduced to a maximum of 90 minutes. One hundred twenty-eight patients underwent cholescintigraphy for clinically suspected acute cholecystitis. Forty patients received intravenous morphine sulfate during the procedure. In patients who received morphine sulfate during the examination, the sensitivity of cholescintigraphy for the diagnosis of acute cholecystitis was 100%; the specificity was 85%.

Topics: Acute Disease; Cholecystitis; Humans; Imino Acids; Injections, Intravenous; Morphine; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin; Time Factors

Prolonged fasting (NPO) and total parenteral nutrition (TPN) have been reported to result in an unacceptable number of false-positive hepatobiliary scintigrams for acute cholecystitis. Based on these reports, the clinical usefulness of the hepatobiliary scan in diagnosing acute cholecystitis in the critically ill postoperative patient who has been NPO or on TPN has been questioned. Patients who were either on prolonged fasting or total parenteral nutrition and who had no history of hepatobiliary disease were prospectively studied to assess the value of the Tc-99m diisopropyl-iminodiacetic acid (DISIDA) scan without pretreatment with cholecystokinin (CCK) in such a setting. Of the 17 persons studied, nine had been on total parenteral nutrition for at least five days and eight had been fasting for at least five days prior to imaging. Seven of the nine individuals on TPN (78%) and six of the eight individuals who were NPO (75%) had normal hepatobiliary scintigraphy. The results suggest that hepatobiliary imaging with Tc-99m DISIDA has a lower false-positive rate in individuals on TPN or NPO than previously has been reported and that it has clinical efficacy in ruling out the diagnosis of acute cholecystitis in these individuals.

Topics: Acute Disease; Biliary Tract; Cholecystitis; Fasting; Female; Humans; Imino Acids; Liver; Male; Middle Aged; Organometallic Compounds; Parenteral Nutrition, Total; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Time Factors

Hepatobiliary scanning is considered to be a highly accurate method for the diagnosis of acute cholecystitis. False-positive scans (failure to visualize the gallbladder in the absence of cholecystitis) have been reported to occur in fasted patients receiving total parenteral nutrition (TPN). To determine the prevalence of false-positive scans in this patient population and identify factors that might be associated with scan outcome, hepatobiliary imaging was performed in fasted patients receiving TPN and without clinical evidence of acute cholecystitis. Gallbladder nonvisualization occurred in 18 of 50 (36%) patients. In the group whose gallbladders did not visualize, a significantly higher male to female ratio (15:3 versus 17:15; p = 0.016), alkaline phosphatase (346 +/- 84 IU/L versus 212 +/- 32 IU/L, p less than 0.04), total bilirubin (1.7 +/- 0.3 mg/dl versus 1.0 +/- 0.2 mg/dl, p less than 0.02), and lower serum albumin (2.4 +/- 0.01 gm/dl versus 2.8 +/- 0.2 gm/dl, p less than 0.02) levels were noted. In 18 patients, gallbladder ultrasonography was also performed, and the presence of sludge or a thickened gallbladder wall did not correlate with scan outcome. The prevalence of false-positive hepatobiliary scans in fasted patients receiving TPN is significant and does not always correlate with a syndrome of acute gallbladder inflammation. The results of such scans must therefore be interpreted with caution in these patients.

Topics: Adult; Cholecystitis; False Positive Reactions; Female; Gallbladder; Humans; Imino Acids; Liver; Liver Function Tests; Male; Middle Aged; Organometallic Compounds; Parenteral Nutrition, Total; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Disofenin

Nonvisualization of the gallbladder is the primary finding in cholescintigraphy for acute cholecystitis. Recent investigators have described a useful secondary finding of increased pericholecystic hepatic activity (PCHA). A case of acute cholecystitis is presented in which the PCHA was round in configuration and appeared in the first 5 minutes of the study. This may be a source of diagnostic error if it is interpreted as visualization of the normal gallbladder. Appearance of the PCHA has not been previously described before 30 minutes. This case of early appearance raises the possibility that hyperemia may play a role as the cause in some forms of the PCHA. The phantom gallbladder was correctly identified as PCHA by observing the peak of activity of the PCHA occurring before the appearance of intrahepatic biliary radicals.

Topics: Acute Disease; Aged; Aged, 80 and over; Cholecystitis; Diagnosis, Differential; False Negative Reactions; Gallbladder; Humans; Imino Acids; Liver; Male; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin; Time Factors; Ultrasonography

During the intestinal phase of hepatobiliary imaging studies in four patients, unusual small intestinal abnormalities were noted. These findings were correlated with surgery in three patients. Recognition of these patterns gives additional clinical information of significant diagnostic value. Further attention to small intestinal pattern and/or radionuclide evaluation of small intestine is a promising method of noninvasive evaluation of clinically suspected small intestinal infarction and obstruction.

Topics: Adult; Aged; Cholecystitis; Cholelithiasis; Cholestasis, Intrahepatic; Diagnosis, Differential; Female; Humans; Imino Acids; Infarction; Intestinal Diseases; Intestinal Obstruction; Intestinal Perforation; Intestine, Small; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Thrombosis

Scintiangiography and hepatobiliary scintigraphy were performed in 45 patients with abdominal trauma. There were 18 gunshot wounds, six stab wounds, and 21 blunt injuries. Thirty-one of 45 patients showed abnormalities (69%). There were nine bilomas (4 with leaks), three leaks without biloma, (7 total leaks), five liver hematomas, three liver infarcts, one liver abscess, four renal injuries, one post-traumatic hepatic artery aneurysm, one acute acalculus cholecystitis, and four bowel injuries including one fistula, two obstructions, and one stricture. Two of the renal injuries and the hepatic artery aneurysm were identified only during scintiangiography. Eighteen of 38 gallbladders were not visualized despite normal bowel transit and delayed views to 4 hours (47%). Fourteen of 16 gallbladders were grossly normal at surgery, one had gallstones, and one had post-traumatic acalculus cholecystitis (6%). Hepatobiliary scintiangiography showed unique characteristics of vascular and renal lesions that were not seen on routine images. Sulfur colloid had no advantage over disofenin in evaluating liver injuries in nine cases. A high percentage of nonvisualized gallbladders (47%) were noted in acutely traumatized patients, and caution is recommended in diagnosing acute cholecystitis in the face of trauma.

Topics: Abdominal Injuries; Adolescent; Adult; Aged; Biliary Fistula; Biliary Tract; Child; Cholecystitis; Extravasation of Diagnostic and Therapeutic Materials; Female; Humans; Imino Acids; Liver; Male; Middle Aged; Organometallic Compounds; Radionuclide Angiography; Technetium Tc 99m Disofenin; Wounds, Gunshot; Wounds, Nonpenetrating; Wounds, Stab

Topics: Acute Disease; Cholecystitis; Drug Synergism; Evaluation Studies as Topic; Humans; Imino Acids; Morphine; Organometallic Compounds; Technetium; Technetium Tc 99m Disofenin

Ninety patients undergoing Tc-99m disofenin hepatobiliary scintigraphy for suspected acute cholecystitis were assessed for enterogastric reflux. Seventy-seven cases showed bowel activity by one hour and were included in the study. Twenty-six percent (20/77) showed definite enterogastric reflux. The gastric activity tended to clear rapidly, even though patients remained supine during examination. Six of 20 patients (30%) with enterogastric reflux had gallbladder visualization. Of these six, one had acute cholecystitis and one had resolving acute cholecystitis with gallstone pancreatitis. There was one case each of pancreatitis, amebic abscess, sepsis, and one normal. Thus, of 20 patients with enterogastric reflux, 16 had acute cholecystitis (80%). Twenty-three of seventy-seven patients (30%) had surgically proven acute cholecystitis: of these, 16 of 23 (70% sensitivity) had gastric reflux, and 50 of 54 without acute cholecystitis did not have reflux (93% specificity). The overall accuracy of enterogastric reflux for acute cholecystitis is 86%. Gastric reflux seen on cholescintigraphy is a secondary sign of acute cholecystitis. Reflux may be related to duodenal irritation from the adjacent inflamed gallbladder.

Topics: Acute Disease; Cholecystitis; Duodenogastric Reflux; Humans; Imino Acids; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

A focal hot spot in the liver, seen on radiocolloid imaging, has been reported in several conditions. A patient with acute cholecystitis who had a hot spot in the liver on both radiocolloid and hepatobiliary scintigraphy is described. The hepatobiliary finding disappeared following cholecystectomy.

Topics: Acute Disease; Aged; Cholecystitis; Female; Humans; Imino Acids; Liver; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid

Thirty-one patients suspected of acute cholecystitis were studied prospectively using hepatobiliary imaging in conjunction with intravenous morphine. If persistent nonvisualization of the gallbladder occurred post-morphine, delayed 4 hour imaging was performed. Intravenous morphine correctly diagnosed acute cholecystitis in 94% of cases. Through the use of intravenous morphine, imaging time can be decreased from 4 to 1.5 hours.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Cholecystitis; Chronic Disease; Humans; Imino Acids; Injections, Intravenous; Middle Aged; Morphine; Organometallic Compounds; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Disofenin; Time Factors

Nine patients who had surgically proven acute gangrenous cholecystitis and Tc-99m DISIDA scintigrams were reviewed retrospectively. Three types of scintigraphic findings were presented: 1) nonvisualization of the gallbladder, three cases; 2) nonvisualization of the gallbladder plus a rim sign, two cases; and 3) nonvisualization of the gallbladder plus an enlarged photon deficient area corresponding to the gallbladder fossa, four cases. A rim sign or an enlarged gallbladder fossa reflect the direct spread of inflammation from the gallbladder into the liver, causing impaired hepatocyte function. An enlarged gallbladder fossa may represent a later stage of a rim sign. Presumably tracer excretion by hepatocytes is affected initially by the inflammatory process, followed by impairment of tracer concentrating ability. Since the gallbladder may be suspended occasionally by a mesentery and not in contact with the liver, the secondary signs may be absent in acute gangrenous cholecystitis.

Topics: Acute Disease; Aged; Cholecystitis; Gangrene; Humans; Imino Acids; Liver Diseases; Male; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Disofenin

A patient with a normal DISIDA study underwent a laparotomy that revealed acute cholecystitis. Retrospective review of the DISIDA study showed pericholecystic hepatic activity.

Topics: Aged; Cholecystitis; Female; Gallbladder; Humans; Imino Acids; Liver; Organometallic Compounds; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Disofenin

This study reviews 27 patients with nonvisualization of the gallbladder on cholescintigraphy. The preoperative diagnosis of acute cholecystitis was confirmed pathologically in 23. A rim of increased hepatic activity (RIHA) adjacent to the gallbladder fossa was seen throughout the study in 35% with acute cholecystitis and in no patients with chronic cholecystitis. Nine patients with "complicated" cholecystitis (defined pathologically as a late stage of the spectrum of acute cholecystitis) had a positive RIHA in contrast to no patients with "noncomplicated acute cholecystitis" (p less than 0.05). The sensitivity/specificity of the RIHA for "complicated" acute cholecystitis was 45%/100% and the positive/negative predictive value was 100%/39%. Liver tissue that was attached to the gallbladder by adhesions and removed at surgery was reviewed histologically and correlated with the presence or absence of a RIHA. The RIHA seems to be a useful indicator of patients presenting at a later stage of the pathologic spectrum of acute cholecystitis and perhaps at increased risk for complications.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Cholecystitis; Chronic Disease; Female; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Organometallic Compounds; Prognosis; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Disofenin

A case of acute acalculous cholecystitis in which sequential hepatobiliary scintigraphy demonstrated apparent transient biliary obstruction is presented. An initial technetium-99m diisopropyliminodiacetic acid ([99mTc]DISIDA) study in a patient suspected of acute cholecystitis showed persistent hepatic activity, nonvisualization of the gallbladder, and minimal intestinal activity seen only at 24 hr. Following a second injection of [99mTc]DISIDA administered shortly after the 24-hr image from the first study, the gallbladder and bowel were both visualized within 75 min. At subsequent surgery, acute and chronic cholecystitis were present without evidence of choledocholithiasis or other source of obstruction. Intrahepatic cholestasis following clearance of biliary obstruction may result in late bowel visualization on delayed cholescintigraphic images similar to that seen in partial obstruction. Accurate reflection of the state of hepatobiliary function may require reinjection with [99mTc]DISIDA.

Topics: Acute Disease; Aged; Cholecystitis; Cholestasis; Humans; Imino Acids; Male; Organometallic Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Time Factors

Fasting and parenteral nutrition are associated with a spectrum of gallbladder disorders. We reviewed the use of hepatobiliary imaging in patients (N = 42) with fasting-induced gallbladder dysfunction. Intravenous morphine was administered in patients (N = 20) whose gallbladders did not visualize at 40 minutes after administration of diisopropyl iminodiacetic acid. In those patients whose gallbladders visualized with morphine (N = 8), the diagnosis of acute cholecystitis was excluded. Of those that did not visualize after morphine administration (N = 12), all were clinically diagnosed as acute cholecystitis. Although ultrasound is effective in demonstrating the anatomical features of prolonged gallbladder stasis including sludge, stones, and thickened gallbladder wall, it cannot detect cystic duct patency. Cholescintigraphy is an accurate test of cystic duct patency, but gallbladder stasis interferes with the ability of cholescintigraphy to visualize the gallbladder. From our experience, we propose that cholescintigraphy with intravenous morphine is beneficial in demonstrating cystic duct patency in fasting patients.

Topics: Acute Disease; Aged; Cholecystitis; Fasting; Humans; Imino Acids; Injections, Intravenous; Male; Middle Aged; Morphine; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

Biliary scintigraphy and ultrasound imaging were performed in 52 patients with suspected biliary tract pathology. Results were correlated with the findings of direct cholangiography. Several new innovations in scintigraphic technique were used. The combination of ultrasound imaging and scintigraphy correctly identified biliary tract obstruction in 17 of 19 patients, 12 of whom had dilated bile ducts on ultrasonography. Intrahepatic cholestasis was correctly diagnosed in 11 of 13 patients. Accurate discrimination between intrahepatic and extrahepatic cholestasis was achieved in 28 of 32 patients (88%) with the combined studies. Scintigraphy also provided a correct diagnosis of acute cholecystitis in all 9 patients with surgically confirmed disease. Eleven additional patients with gallbladder or pancreatic disease had normal bile ducts at scintigraphy, which was confirmed with cholangiography. When combined with ultrasound imaging, modern biliary scintigraphy can (a) provide excellent discrimination between intrahepatic and extrahepatic cholestasis and (b) help determine the need for subsequent invasive diagnostic studies in selected patients.

Topics: Adult; Aged; Biliary Tract; Cholangiography; Cholecystitis; Cholestasis, Extrahepatic; Cholestasis, Intrahepatic; Common Bile Duct Diseases; Female; Gallbladder Diseases; Humans; Imino Acids; Male; Middle Aged; Pancreatic Diseases; Prospective Studies; Radionuclide Imaging; Sincalide; Technetium; Technetium Tc 99m Disofenin; Ultrasonography

A case of acalculous cholecystitis in a 65-year-old man with underlying diabetes mellitus, hypertension, and peripheral arteriosclerosis is presented here. His case remained diagnostically puzzling for some time until symptoms and signs became more severe and very suggestive of acute cholecystitis. The clinical impression was then supported by an abnormal radioisotope biliary scan. The scan has fairly good sensitivity in detecting this condition but may not be totally dependable. Acalculous cholecystitis is an unusual but serious variant of a common disorder in which treatable gallbladder disease may masquerade as a less treatable liver malady. A common denominator among this disorder's many etiologies may be impairment of the gallbladder microcirculation in the presence of one or more conditions that lower the gallbladder's resistance to bacterial invasion. Prompt detection and treatment are desirable to reduce morbidity and mortality. However, early diagnosis is not always possible, because the clinical picture often is unclear, clear, gallstones are absent, and laboratory test results may be normal or equivocal. As in the case reported here, the vague clinical picture may dictate following a patient until the illness reaches an intensity acute enough to permit identification. The greatest aid to earlier diagnosis for the physician faced with circumstances similar to those described here is to think of cholecystitis and then to give strong weight to that clinical suspicion. At times, a recommendation for cholecystectomy may have to be made mainly on clinical judgment.

Topics: Acute Disease; Aged; Cholangiography; Cholecystitis; Gallbladder; Humans; Imino Acids; Liver Function Tests; Male; Technetium; Technetium Tc 99m Disofenin; Tomography, X-Ray Computed; Ultrasonography

Findings on cholescintigraphy in gallbladder carcinoma are described in five patients. Four patients presenting with acute cholecystitis had nonvisualization of the gallbladder with normal hepatoenteric transit time. One of these had a large portal mass and two had liver metastasis as additional findings. The fifth patient was jaundiced, and showed absence of bowel activity compatible with total biliary obstruction. Both the clinical and scintigraphic findings in gallbladder carcinoma are difficult to separate from findings in cholelithiasis and cholecystitis.

Topics: Adult; Aged; Cholecystitis; Female; Gallbladder; Gallbladder Neoplasms; Humans; Imino Acids; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Ultrasonography

Cholescintigraphy is a sensitive procedure for diagnosing or excluding acute cholecystitis. However, when rapid diagnosis is critical, the requirement for delayed images (4 hr or more after injection) to minimize the false-positive rate diminishes its utility. We prospectively evaluated 40 cholescintigraphic examinations that did not visualize the gallbladder 1 hr after injection of 99mTc diisopropyliminodiacetic acid. These examinations were then augmented by administration of IV morphine, followed by an additional 30 min of imaging. After the morphine, 18 of these examinations demonstrated visualization of the gallbladder; none subsequently required surgical exploration. Of the remaining 22, who demonstrated persistent nonvisualization of the gallbladder post-morphine, 11 were explored surgically and found to be abnormal. The 11 others were treated medically. Low-dose morphine administered when the gallbladder fails to visualize after 1 hr is a useful adjunct to conventional cholescintigraphy because it reduces the time required to obtain a diagnostic result and decreases the number of false-positive results.

Topics: Acute Disease; Biliary Tract; Cholecystitis; Cholelithiasis; False Negative Reactions; Humans; Imino Acids; Morphine; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Ultrasonography

In a retrospective analysis of 218 hepatobiliary studies in patients clinically suspected of acute cholecystitis, a rim of increased hepatic activity adjacent to the gallbladder fossa (the "rim sign") has been evaluated as a scintigraphic predictor of confirmed acute cholecystitis. Of 28 cases with pathologic confirmation of acute cholecystitis in this series, 17 (60%) demonstrated this sign. When associated with nonvisualization of the gallbladder at 1 hr, the positive predictive value of this photon-intense rim for acute cholecystitis was 94%. When the rim sign was absent, the positive predictive value of nonvisualization of the gallbladder at 1 hr for acute cholecystitis was only 36%. As this sign was always seen during the first hour postinjection, it can, when associated with nonvisualization, reduce the time required for completion of an hepatobiliary examination in suspected acute cholecystitis.

Topics: Acute Disease; Cholecystitis; Chronic Disease; Gallbladder; Gangrene; Humans; Imino Acids; Liver; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Disofenin

Forty-one proved cases of acute acalculous cholecystitis imaged with technetium-99m iminodiacetic acid (IDA) cholescintigraphy were retrospectively analyzed. After the exclusion of one indeterminate scan (showing poor initial hepatic uptake and excretion), the study yielded a 92.5% (37 of 40) sensitivity for the detection of cystic or common bile duct obstruction. Each of the three patients with false-negative scintigrams had other abnormal scintigraphic findings suggestive of biliary tract disease. Of the 20 patients (48.8%) with focal or diffuse gangrenous cholecystitis or perforation, seven (35%) exhibited either free peritoneal spill or increased pericholecystic activity to indicate the presence of advanced disease.

Topics: Acute Disease; Adult; Aged; Cholecystitis; False Negative Reactions; Female; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Disofenin

99mTc-iminodiacetic acid (IDA) compounds are concentrated by hepatocytes and excreted into the biliary system. The utility of 99mTc-IDA imaging in 116 patients with suspected acute cholecystitis was studied retrospectively over a 2-year period. Visualization of the gallbladder ruled out obstructed cystic duct and acute cholecystitis with a high degree of accuracy.

Topics: Acute Disease; Adult; Cholecystitis; Female; Humans; Imino Acids; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

An unusual cause of a cholescintigraphic, false-positive, erythromycin-induced hepatotoxicity is presented. This occurred in the presence of preservation of hepatic uptake and the normal appearance of gut activity. Serial scintigraphy and serum chemistries documented underlying gallbladder normalcy.

Topics: Acute Disease; Adult; Chemical and Drug Induced Liver Injury; Cholecystitis; Diagnosis, Differential; Erythromycin; Erythromycin Estolate; False Positive Reactions; Female; Humans; Imino Acids; Liver; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Hepatic artery infusion chemotherapy is used in the treatment of certain selected hepatic tumors, especially metastatic adenocarcinoma of the colon. Chemical cholecystitis has been recognized recently as a complication of hepatic artery infusion chemotherapy. We performed hepatobiliary scans on ten patients receiving hepatic artery infusion chemotherapy. All ten patients had abnormal hepatobiliary scintigraphy. We present case reports of three patients with abnormal hepatobiliary scans who have required cholecystectomy for symptoms of chemical cholecystitis to illustrate the clinical, scintigraphic, and pathologic findings in these patients.

Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Cholecystitis; Colonic Neoplasms; Doxorubicin; Floxuridine; Hepatic Artery; Humans; Imino Acids; Infusions, Intra-Arterial; Liver Neoplasms; Male; Middle Aged; Mitomycin; Mitomycins; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

To determine the sensitivity of hepatobiliary imaging (HBI) and strict- and liberal-criteria real-time ultrasonography (RTUS), we retrospectively analyzed 100 cases of pathologically proved acute cholecystitis (AC). A positive HBI was one in which there was nonvisualization of the gallbladder up to four hours after the administration of technetium Tc 99m-disofenin. In the absence of hypoalbuminemia, cirrhosis, or ascites, pathognomonic RTUS findings (strict criteria) for AC were wall edema and/or pericholecystic fluid. Findings indicative of AC (liberal criteria) included the demonstration of stones, a thick gallbladder wall, nonshadowing echoes, or the ultrasonographic Murphy's sign. Of the 100 cases of AC, 91 were calculous, and nine were acalculous. Four of 100 patients had associated choledocholithiasis. The sensitivities in detecting calculous AC were as follows: HBI, 97%; liberal-criteria RTUS, 86%; and strict-criteria RTUS, 24%. The sensitivities in detecting acalculous AC were as follows: HBI, 100%; liberal-criteria RTUS, 89%; and strict-criteria RTUS, 44%.

Topics: Acute Disease; Biliary Tract; Cholecystitis; Cholelithiasis; Gallstones; Humans; Imino Acids; Liver; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Ultrasonography

Topics: Acute Disease; Cholecystitis; Female; Gallbladder; Humans; Imino Acids; Middle Aged; Radionuclide Imaging; Rupture, Spontaneous; Technetium; Technetium Tc 99m Disofenin

The use of combined hepatobiliary-lung imaging in the diagnosis and evaluation of a subphrenic process is described.

Topics: Aged; Biliary Tract; Cholecystitis; Female; Humans; Imino Acids; Klebsiella Infections; Liver; Lung; Radionuclide Imaging; Subphrenic Abscess; Technetium; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Disofenin

The patterns of radionuclide hepatobiliary scans in nine children with sickle cell disease and acute right upper quadrant abdominal pain were reviewed. The most common pattern observed was delayed gall bladder visualization, consistent with chronic cholecystitis. The value of hepatobiliary imaging in distinguishing acute cholecystitis from crisis is presented.

Topics: Abdomen; Acute Disease; Adolescent; Anemia, Sickle Cell; Biliary Tract; Child; Cholecystitis; Diagnosis, Differential; Female; Humans; Imino Acids; Liver; Male; Pain; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Biloma resulting as a complication of cholcecystectomy is rarely reported. Infection and rupture of biloma into the peritoneal cavity is a reported complication that may need aggressive surgical management. A case of infected biloma is presented in which an active biliary leak was demonstrated on a hepatobiliary scan with Tc-99m DISIDA.

Topics: Bile; Biliary Tract Diseases; Cholecystectomy; Cholecystitis; Cholelithiasis; Drainage; Female; Humans; Imino Acids; Middle Aged; Peritoneal Cavity; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

A retrospective review was made of all radionuclide hepatobiliary studies performed in a major trauma center over a 27-month period and correlated with the patients' clinical course. In a population of 42 patients (27 of whom were on total parenteral nutrition [TPN]) who had severe intercurrent illness (primarily trauma), and an additional 18 patients who had hepatocellular dysfunction, hepatobiliary imaging confirmed a patent cystic duct in 43 of 60 patients (72%). Fourteen of these 43 patients (33%) had gallbladder visualization at later than one hour after radiotracer administration, and seven of these 14 required imaging from four to 24 hours. Of 17 patients who had nonvisualization of the gallbladder, four had surgically proved acute cholecystitis. Images of nine of the remaining 13 patients with gallbladder nonvisualization were not obtained for 24 hours. The presence of gallstones, wall thickening, or sludge on sonograms did not correlate with cystic duct patency, and was not specific for acute cholecystitis. Though gallbladder function is compromised in the population with severe intercurrent disease, radionuclide hepatobiliary imaging is still valuable; it can confirm a patent cystic duct in at least 72% of patients if routine imaging is continued for up to 24 hours.

Topics: Acute Disease; Cholecystitis; Diagnosis, Differential; Diagnostic Tests, Routine; Gallbladder; Hepatitis, Alcoholic; Hepatitis, Chronic; Humans; Imino Acids; Intestine, Small; Liver; Organotechnetium Compounds; Parenteral Nutrition, Total; Radionuclide Imaging; Respiratory Distress Syndrome; Retrospective Studies; Sincalide; Technetium; Technetium Tc 99m Disofenin; Time Factors; Ultrasonography; Wounds and Injuries

Topics: Abdomen; Acute Disease; Cholangiography; Cholecystitis; Cholecystography; Cholestasis; Common Bile Duct; Gallbladder; Humans; Imino Acids; Intestine, Small; Pain; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Ultrasonography

Hepatobiliary scans using Tc-IDA are reliable in making the diagnosis of acute cholecystitis. Commonly, opioid drugs are administered in patients with acute cholecystitis to relieve pain. Opioid drugs cause biliary sphincter spasm. Whether these drugs adversely affect hepatobiliary scans is unknown. We studied 13 healthy volunteer subjects, performing three hepatobiliary scans in each one. Scans were performed without opioid drugs and 30 minutes after intramuscularly administered meperidine, morphine, hydroxyzine, hydroxyzine plus meperidine, butorphanol, and nalbuphine. Opioid drugs markedly delayed clearance of Tc-IDA from the common bile duct, simulating common bile duct obstruction. Hydroxyzine alone caused an insignificant delay. We have concluded that opioid drugs cause bile duct obstruction in healthy persons. If opioid drugs are administered before a diagnostic hepatobiliary scan, delayed clearance of Tc-IDA from the common bile duct might lead to an erroneous diagnosis and indicate a potentially unnecessary common bile duct exploration. Opioid drugs should not be administered for several hours before a diagnostic hepatobiliary scan.

Topics: Acute Disease; Adult; Biliary Tract; Cholecystitis; Cholestasis; Female; Humans; Hydroxyzine; Imino Acids; Liver; Meperidine; Organotechnetium Compounds; Pain; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Time Factors

Cholescintigraphic diagnosis of acute cholecystitis requires accurate assessment of gallbladder nonvisualization. Confusion may occur when the gallbladder overlies the duodenal sweep or when labeled bile pools in the duodenum. Gallbladder activity could not be differentiated from duodenal activity in 21 patients. The oral ingestion of 225 ml of water permitted successful differentiation of the gallbladder from the duodenum. In 25 control subjects, it was demonstrated that that volume of water did not have a cholecystokinetic effect.

Topics: Acute Disease; Cholecystitis; Duodenum; Gallbladder; Humans; Imino Acids; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Time Factors; Water

Acute acalculous cholecystitis is a relatively rare but potentially lethal condition if not treated promptly. Since stones are not present, diagnostic procedures such as ultrasound or other radiological procedures are frequently not helpful. Tc-99m iminodiacetic acid scan results were analyzed in 11 proven cases of acute acalculous cholecystitis. All had positive tests with nonvisualization of the gallbladder giving a sensitivity of 100%. Tc-99m iminodiacetic acid cholescintigraphy is a highly reliable test and is easily performed even in acutely ill patients and should be the test of choice in all patients predisposed to and suspected of acute acalculous cholecystitis.

Topics: Acute Disease; Adult; Aged; Cholecystitis; Female; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Ultrasonography

This paper assesses the value of hepatobiliary scanning and surgical treatment of acute cholecystitis in patients above the age of 60 years over a 3 year period (1980-1982). During this period 382 cholecystectomies for biliary disease were performed in 257 women and 125 men with mean ages of 55 X 6 and 61 X 1 years respectively. Of the 382, 208 were older than 60, with a female to male ratio of 1 . 3:1. Acute cholecystitis occurred in 74 of the 208 patients; they were subjected to early cholecystectomy. Biliary tract imaging using 99 m technetium-labelled diisopropyl-IDA (DISIDA) proved valuable in confirming the diagnosis of acute cholecystitis. Of 85 patients over 60 years who underwent hepatobiliary scanning with a presumptive diagnosis of acute cholecystitis, 74 had positive scans and acute cholecystitis was confirmed at subsequent operation in these cases. There were two false positive and nine negative scans showing that biliary scintigraphy proved to be a rapid non-invasive and sensitive method of diagnosing acute cholecystitis. The advent of hepatobiliary scanning has strengthened our surgical strategy in the management of acute cholecystitis in the elderly and allows early elective surgery with an acceptable morbidity and in this series no mortality.

Topics: Acute Disease; Aged; Biliary Tract; Cholecystectomy; Cholecystitis; Female; Humans; Imino Acids; Liver; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Time Factors

Hepatobiliary scintigraphy as an investigative procedure has a definite role in the investigation of the surgical patient with various biliary problems. As it outlines the functional anatomy of the biliary tract, it has been employed for some time in the diagnosis of acute cholecystitis. In addition, it has a place in the investigation of patients with chronic cholecystitis, common bile duct obstruction and biliary leaks and in evaluating the integrity of biliary bypass procedures.

Topics: Adult; Biliary Tract; Cholecystitis; Cholestasis, Extrahepatic; Common Bile Duct; Humans; Imino Acids; Liver; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

A new cholescintigraphic finding, the "hot rim" sign, is reported in a case of acute cholecystitis. Local inflammation in the gallbladder fossa may be the cause of this phenomenon.

Topics: Acute Disease; Cholecystitis; Humans; Imino Acids; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Topics: Cholecystitis; Common Bile Duct; Gallbladder; Humans; Imino Acids; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Ultrasonography

A 62-yr-old man with acalculous cholecystitis is presented. At different stages of his disease his cholescintigram was abnormal and then normal. The case demonstrates the variations of the cholescintigram that may occur during the disease and illustrates the difficulties that may be encountered in making the diagnosis.

Topics: Cholecystectomy; Cholecystitis; Cholecystography; False Negative Reactions; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Time Factors; Ultrasonography

Topics: Acute Disease; Cholecystitis; Gallbladder; Humans; Imino Acids; Liver; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Ultrasonography

The influence of scan and pathological criteria on the specificity of cholescintigraphy was assessed by a prospective study of 211 patients with suspected acute cholecystitis who underwent cholescintigraphy. Sufficient data were available in all to confirm a final diagnosis. Cholescintigraphy was performed in the standard fashion using 5 mCi of Tc-99m disofenin. Sixty patients had acute cholecystitis, 64 had chronic cholecystitis, and 87 had no demonstrable gallbladder disease. As the scan and pathological criteria for acute cholecystitis were varied from strict to liberal, the sensitivity of cholescintigraphy decreased (100% to 95.3%), the specificity increased (85.1% to 98.6%, and the predictive value increased (68.4% to 96.8%). The use of strict scan and pathological criteria for acute cholecystitis obscures the advantages that accrue from such early detection of acute cholecystitis by cholescintigraphy, and thus are to be avoided. To understand the disparate opinions voiced in the literature, an appreciation is required for the effects of changes in criteria on the specificity and predictive value of cholescintigraphy.

Topics: Acute Disease; Cholecystitis; Cholelithiasis; Gallbladder; Humans; Imino Acids; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Time Factors; Ultrasonography

Technetium-99m iminodiacetic acid (IDA) cholescintigraphy was performed in 15 patients with acute acalculous cholecystitis. Fourteen of the 15 patients with acute disease had positive findings, indicating the presence of cystic duct or common duct obstruction. One case in which the gallbladder was visualized failed to respond to sincalide stimulation; this was classified as a suggestive finding of disease. The diagnostic accuracy of 99mTc-IDA cholescintigraphy was far superior to the other imaging studies used (8 sonograms, 1 intravenous cholangiogram, 3 oral cholecystograms, 1 percutaneous transhepatic cholangiogram). The 99mTc-IDA study is recommended as the imaging procedure of choice for examining patients with suspected acute acalculous cholecystitis.

Topics: Acute Disease; Aged; Cholecystitis; Cholelithiasis; Cholestasis; Female; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Lidofenin

Normal gallbladder scintigraphy occurs in 2 to 5% of reported patients with acute cholecystitis. Gallbladder visualization is found in patients with acalculous cholecystitis and in those with recent relief of cystic duct obstruction but persistence of inflammation. A patient is reported who had clinical and pathologic findings of acute cholecystitis but normal gallbladder visualization. This reemphasizes that the diagnosis of acute cholecystitis cannot be excluded by normal gallbladder scintigraphy.

Topics: Acute Disease; Cholecystitis; False Negative Reactions; Female; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Topics: Biliary Tract; Biliary Tract Surgical Procedures; Cholecystitis; Cholestasis; Common Bile Duct Diseases; Edema; Gallbladder; Humans; Imino Acids; Intestine, Small; Liver; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Topics: Acute Disease; Cholecystitis; Humans; Imino Acids; Pancreatitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Topics: Biliary Tract; Biliary Tract Diseases; Cholecystectomy; Cholecystitis; Cholestasis, Extrahepatic; Cystic Duct; Gallstones; Humans; Imino Acids; Liver; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Topics: Acute Disease; Cholecystitis; Esophageal Diseases; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Humans; Imino Acids; Indium; Leukocytes; Meckel Diverticulum; Organotechnetium Compounds; Radioisotopes; Radionuclide Imaging; Stomach Diseases; Sulfur; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid; Technology, Radiologic

Topics: Biliary Tract; Cholecystitis; Cholelithiasis; Humans; Imino Acids; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Prospective analysis of the efficacy of 99mTc-IDA cholescintigraphy and cholecystosonography showed that both are excellent techniques for assessing patients with suspected acute cholecystitis (accuracy 84.7% and 88.1% respectively). Consequently, the choice of tests selected to evaluate patients with suspected acute cholecystitis depends on several factors including; (a.) quality of equipment available; (b.) capability of the technologist performing the examination; (c.) relative experience of the physician supervising the examination; and (d.) willingness of the surgical consultant to accept a positive examination as sufficient evidence to perform emergency surgery. The authors feel that cholecystosonography should be used to assess the presence of acute cholecystitis in jaundiced patients because of its capability in the assessment of bile duct dilatation, and because of the lower reliability of cholescintigraphy when bile duct obstruction is possible (i.e., in jaundice). Ancillary findings in cholecystosonography and cholescintigraphy can aid in the differential diagnosis of acute right upper quandrant pain syndromes.

Topics: Acute Disease; Cholecystitis; False Negative Reactions; Humans; Imino Acids; Organotechnetium Compounds; Prospective Studies; Technetium; Technetium Tc 99m Disofenin; Ultrasonography

Since the introduction of technetium-99m-labeled cholescintigraphic agents in the mid-1970s, there has been extensive investigation of their role in the evaluation of biliary tract disorders. These agents accurately assess the patency of the cystic and common bile ducts, and to date, their greatest impact has been on the diagnostic evaluation of suspected acute cholecystitis. This article reviews the use of 99mTc-iminodiacetic acid (IDA) derivatives in acute and chronic cholecystitis. Since acute cholecystitis is characterized by cystic duct obstruction, failure of the gallbladder to visualize following 99mTc-IDA administration is indicative of cystic duct obstruction and acute cholecystitis. Using this approach, cholescintigraphy has been shown to be highly sensitive, specific, and efficacious in the diagnosis of acute cholecystitis. Cholescintigraphy is now the procedure of choice for the detection of acute cholecystitis. Unlike its successful applications in acute cholecystitis, cholescintigraphy appears of limited value in chronic cholecystitis. Certain circumstances where cholescintigraphy is of value in chronic cholecystitis are discussed. Whether or not cholescintigraphy may play a greater role in the future in elucidating the pathogenesis of chronic cholecystitis by assessment of biliary kinetics remains unanswered.

Topics: Acute Disease; Cholecystitis; Chronic Disease; Gallbladder; Humans; Imino Acids; Methods; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Cholescintigraphy with 99m-Tc labeled iminodiacetic acid (IDA) derivatives has proved to be extremely reliable in the evaluation of suspected acute cholecystitis. The major diagnostic feature of the study is the presence (cystic duct patency) or absence (cystic duct obstruction) of gallbladder visualization. Secondary findings include degree and rate of liver uptake, visualization and caliber of the intrahepatic and common bile ducts, and the presence of intestinal activity as well as rapidity of biliary tract-to-bowel transit of the radiotracer. Various combinations of these secondary parameters result in a spectrum of cholescintigraphic patterns which can assist in determining the cause of the patient's acute clinical problem.

Topics: Acute Disease; Cholecystitis; Humans; Imino Acids; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Lidofenin