technetium-tc-99m-disofenin and Gangrene

Hepatobiliary scintigraphy evaluates the biliary clearance of Tc-99m-labeled iminodiacetic acid agents (Tc-99m IDA) and has a high sensitivity and specificity for the diagnosis of acute cholecystitis. False-negative studies are extremely rare. We describe an apparently normal nonmorphine-augmented hepatobiliary study in gangrenous acalculous cholecystitis. Based on clinical findings, computed tomography, and ultrasound demonstration of a dilated gallbladder, a cholecystectomy was performed. Pathologic examination of the gallbladder revealed acute gangrenous cholecystitis with culture positive for Klebsiella pneumoniae.

Topics: Acalculous Cholecystitis; Aged; False Negative Reactions; Female; Gallbladder; Gangrene; Humans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Disofenin

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

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

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