technetium-tc-99m-mebrofenin and Acute-Disease

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

Topics: Abdominal Pain; Acalculous Cholecystitis; Acute Disease; Aniline Compounds; Fever; Gallbladder; Glycine; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Pancreatitis; Parenteral Nutrition, Total; Posture; Radionuclide Imaging; Radiopharmaceuticals; Supine Position; Ultrasonography

A 58-year-old woman underwent emergent hepatobiliary imaging for evaluation of possible acute calculous cholecystitis. Intravenous morphine was administered 10 minutes after small bowel activity was first seen. The gallbladder visualized promptly after morphine administration, effectively excluding cystic duct obstruction and acute cholecystitis. The entire imaging procedure was completed and a final diagnosis made within 30 minutes.

Topics: Acute Disease; Aniline Compounds; Cholecystitis; Female; Gallbladder; Glycine; Humans; Imino Acids; Injections, Intravenous; Middle Aged; Morphine; Narcotics; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Time Factors

Nuclear medicine hepatobiliary scintigraphy is well established for the evaluation of right upper quadrant pain in cases of possible acute cholecystitis. The authors present a case of type II choledochal cyst shown on a hepatobiliary scan in a patient with possible acute cholecystitis.

Topics: Acute Disease; Aniline Compounds; Cholecystitis; Choledochal Cyst; Female; Glycine; Humans; Imino Acids; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals

Radiographic diagnosis of acute cholecystitis can be established using ultrasonography (US), cholecystoscintigraphy (HIDA), or both. Although both modalities have been effective in diagnosing acute cholecystitis (AC), physicians from the emergency department and admitting surgeons continue to request both tests in an attempt to increase the diagnostic accuracy of AC. This article reports the institutional experience of a large tertiary care health care facility, with respect to the sensitivity of US, HIDA, and combined US and HIDA.. We conducted a retrospective review of 132 patients diagnosed with AC who underwent laparoscopic cholecystectomy during the same hospitalization. Patients were stratified into three groups: Group 1 (Gp1, n = 50) included patients who underwent US alone, group 2 (Gp2, n = 28) included patients who underwent HIDA scan alone, and group 3 (Gp3, n = 54) included patients who underwent both US and HIDA.. The three groups did not differ with respect to age, liver chemistry, time to operation, and hospital length of stay. The sensitivity of US, HIDA, and combined US/HIDA as diagnostic modalities for acute cholecystitis was referenced to histopathologic confirmation. Sensitivity was 24 of 50 (48%), 24 of 28 (86%), and 49 of 54 (90%) for US, HIDA, and the combination of US/HIDA, respectively.. HIDA scan is a more sensitive test than US in diagnosing patients with AC. Based on the results of this study, we recommend that HIDA scan should be used as the first diagnostic modality in patients with suspected acute cholecystitis; US should be used to confirm the presence of gallbladder stones rather than to diagnose AC.

Topics: Acute Disease; Adult; Aged; Aniline Compounds; Cholecystectomy, Laparoscopic; Cholecystitis; Cholelithiasis; Female; Glycine; Humans; Imino Acids; Length of Stay; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Ultrasonography

To assess the value of imaging rejection-induced apoptosis with technetium 99m and annexin V, a human protein-based radiopharmaceutical used in the diagnosis of acute rejection of a liver transplant, in a well-characterized rodent model of orthotopic liver transplantation.. 99mTc-radiolabeled annexin V was intravenously administered to six allografted (immunologically mismatched) and five isografted (immunologically matched) recipient rats on days 2, 4, and 7 after orthotopic liver transplantation. Animals were imaged 1 hour after injection of 0.2-2.0 mCi (8.0-74.0 MBq) of radiolabeled annexin V by use of clinical nuclear scintigraphic equipment.. All animals in the allografted group demonstrated marked increases of 55% and 97% above the activity in the isografted group in hepatic uptake of annexin V on days 4 and 7, respectively. Severe acute rejection was histologically detected in all allografted livers on day 7. There was no histologic evidence of acute rejection in isografted animals. Dynamic hepatobiliary imaging with 99mTc and mebrofenin, an iminodiacetic acid derivative, demonstrated no correlation with the presence or absence of acute rejection or with annexin V uptake.. Noninvasive imaging with radiolabeled annexin V is more sensitive and specific than imaging with 99mTc-mebrofenin in the diagnosis of acute rejection of a liver transplant.

Topics: Acute Disease; Aniline Compounds; Animals; Annexin A5; Glycine; Graft Rejection; Imino Acids; Liver; Liver Transplantation; Male; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Rats; Rats, Inbred Lew; Rats, Inbred Strains; Sensitivity and Specificity; Technetium Tc 99m Aggregated Albumin

The purpose of this study was to determine if a combination of cholecystokinin (CCK) pretreatment followed by morphine augmentation improved the detection of cystic duct patency compared with CCK pretreatment only.. One hundred fifty-five patients with suspected acute cholecystitis had scintigraphy performed with 185-481 MBq (5-13 mCi) 99mTc-mebrofenin adjusted to the patients' total bilirubin levels. All patients were pretreated with 0.02 microgram/kg sincalide injected intravenously over 3-5 min. Sequential imaging was performed until gallbladder activity was identified or up to 90 min postinjection of mebrofenin. If no gallbladder was identified, a second dose of mebrofenin was given as necessary to have tracer in the biliary system. Then, 0.04 mg/kg intravenous morphine sulfate was administered, followed by imaging for up to 30 min or until gallbladder visualization.. Twenty-eight percent (43/155) of the patients pretreated with CCK had nonvisualization of the gallbladder at 90 min postinjection of radiotracer. After intravenous morphine, the gallbladder was identified in 42% (18/43) of these patients (p = 0.0001).. Hepatobiliary imaging with CCK pretreatment and imaging for 90 min was insufficient to identify all patent cystic ducts. Morphine augmentation significantly increased the frequency of gallbladder visualization in patients pretreated with CCK.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Aniline Compounds; Cholecystitis; Cholecystokinin; Cystic Duct; Female; Gallbladder; Gallbladder Emptying; Glycine; Humans; Imino Acids; Male; Middle Aged; Morphine; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity

Topics: Acute Disease; Aged; Aniline Compounds; Aortic Aneurysm, Abdominal; Bile Ducts, Intrahepatic; Cholecystitis; Glycine; Humans; Imino Acids; Liver; Male; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Tomography, X-Ray Computed

This study investigated the value of morphine-augmentation in patients who demonstrated gallbladder nonvisualization with a pericholecystic rim sign at 1 hr, a cholescintigraphic pattern considered highly predictive of acute cholecystitis.. Retrospectively, 170 consecutive morphine-augmented cholescintigrams were analyzed for the presence of a pericholecystic rim sign, marked or mild, associated with gallbladder nonvisualization at 1 hr (before morphine); those with a pericholecystic rim sign were further evaluated for persistent gallbladder nonvisualization versus gallbladder visualization after morphine. Scintigraphic interpretations were correlated with surgical pathology or clinical diagnosis.. Before morphine, 43/170 (25%) patients demonstrated gallbladder nonvisualization with a pericholecystic rim sign. Since only 31 had acute cholecystitis, a diagnosis based solely on that scintigraphic pattern would have resulted in 12 false-positives. After morphine, gallbladder visualization correctly excluded acute cholecystitis in seven; a single false-negative was encountered; five false-positives remained. Morphine-augmentation improved the positive predictive value from 72% (gallbladder nonvisualization with pericholecystic rim sign before morphine) to 86% (gallbladder nonvisualization after morphine). Of 24 patients with marked pericholecystic rim signs, 21 had acute cholecystitis. Of 31 with acute cholecystitis, however, 10 (32%) had a mild pericholecystic rim sign.. Morphine-augmented cholescintigraphy optimizes the diagnosis of acute cholecystitis in patients with the suggestive, but not pathognomonic, cholescintigraphic pattern at 1 hr of gallbladder nonvisualization with a pericholecystic rim sign, regardless of its intensity.

Topics: Acute Disease; Aniline Compounds; Case-Control Studies; Cholecystitis; Chronic Disease; False Positive Reactions; Female; Gallbladder; Glycine; Humans; Imino Acids; Liver; Male; Middle Aged; Morphine; Organotechnetium Compounds; Predictive Value of Tests; Radionuclide Imaging; Retrospective Studies; Time Factors

Topics: Acute Disease; Adult; Aniline Compounds; Cholecystitis; Gallbladder; Glycine; Heart; Humans; Imino Acids; Male; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Sestamibi

Morphine intervention in cholescintigraphy decreases imaging time to diagnose acute cholecystitis. Not infrequently we observe duodenogastric reflux during scintigraphy with and without morphine intervention. To evaluate occurrence of duodenogastric reflux related to morphine, we reviewed 55 patients who underwent cholescintigraphy with (32) and without (23) morphine intervention. Morphine was injected when there was bowel activity with non-visualization of the gallbladder at 60 min. Duodenogastric reflux was identified by the appearance of activity in the area just below or immediately adjacent to the tip of the left hepatic lobe laterally. Among 32 patients with morphine intervention, 19 had acute cholecystitis and 13 chronic cholecystitis. Eleven of 19 (58%) with acute cholecystitis had duodenogastric reflux and 6 of 13 (46%) had duodenogastric reflux in chronic cholecystitis. The total of duodenogastric reflux in the group with morphine injection was 53%. Two patients' duodenogastric reflux occurred before morphine injection and was more apparent after morphine was given. In the without morphine group, 3 had acute cholecystitis and 20 had chronic cholecystitis; 2 (one acute and one chronic cholecystitis) of these 23 (9%) had duodenogastric reflux. Our results indicate: (1) occurrence of DG reflux in morphine augmented cholescintigraphy is not significantly different in cholecystitis from that in chronic cholecystitis; (2) duodenogastric reflux in morphine augmentation occurs significantly more often than without morphine intervention (p < 0.001). We conclude that cholescintigraphy with morphine enhances duodenogastric reflux. The degree of duodenogastric reflux in the acute cholecystitis patients has been more severe than in the chronic cholecystitis patients.

Topics: Acute Disease; Aniline Compounds; Cholecystitis; Chronic Disease; Duodenogastric Reflux; Evaluation Studies as Topic; Gallbladder; Glycine; Humans; Imino Acids; Morphine; Organotechnetium Compounds; Radionuclide Imaging

Cholescintigraphy has proven useful in diagnosis of acute and chronic cholecystitis and evaluation of common bile duct obstruction. Common bile duct obstruction may be due to mechanical obstruction such as impact stone in the common duct or functional obstruction due to sepsis with intra-hepatic cholestasis or acute viral hepatitis. We present a cholescintigram of a patient with acute pancreatitis showing complete common bile duct obstruction.

Topics: Acute Disease; Aged; Aniline Compounds; Cholestasis, Extrahepatic; Common Bile Duct Diseases; Diagnosis, Differential; Gallstones; Glycine; Humans; Imino Acids; Male; Organotechnetium Compounds; Pancreatitis; Radionuclide Imaging

Topics: Acute Disease; Adult; Aniline Compounds; Fatty Liver; Female; Glycine; Hepatitis, Alcoholic; Humans; Imino Acids; Organotechnetium Compounds; Radionuclide Imaging

The utility of morphine-augmented cholescintigraphy was reviewed in 32 patients with suspected acute cholecystitis. All patients were administered 2 mg morphine sulfate intravenously when the gallbladder failed to visualize 30 minutes into the study, and imaging continued for up to 60 minutes. Sensitivity for detection of acute cholecystitis was 93% (13 out of 14). Specificity was 78% (14 out of 18). Three of four false-positives occurred in the setting of prolonged fasting and chronic cholecystitis. Cumulative experience suggests that the technique is diagnostically equivalent to imaging for up to 4 hours and that specificity remains incomplete in the setting of prolonged fasting, chronic cholecystitis and other conditions known to affect conventional cholescintigraphy.

Topics: Acute Disease; Aniline Compounds; Cholecystitis; Fasting; Female; Gallbladder; Glycine; Humans; Imino Acids; Male; Middle Aged; Morphine; Organotechnetium Compounds; Radionuclide Imaging; Sensitivity and Specificity; Time Factors

Acute pancreatitis is a dreaded complication of biliary calculus disease, and several radiographic signs have been reported in association with this condition. We report a new sign demonstrated on hepatobiliary scintigraphy, the duodenal cut off sign, seen in a patient being evaluated for stone disease and later found to have acute pancreatitis. Hepatobiliary scans are commonly performed during the initial evaluation of patients with suspected calculus disease, and visualization of this sign may indicate to the clinician that he is dealing with a more serious condition.

Topics: Acute Disease; Adult; Aniline Compounds; Duodenum; Female; Glycine; Humans; Imino Acids; Organotechnetium Compounds; Pancreatitis; Radionuclide Imaging

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