technetium-tc-99m-mebrofenin and Cholecystitis

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

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

The aim of the project was to study hepatic bile entry into and the transit pattern within the gallbladder lumen during fasting and to introduce a new quantitative scintigraphic test for measurement of its concentration function.. Each of 10 control subjects and 10 chronic acalculous cholecystitis (CAC) patients received 111-185 MBq 99mTc-mebrofenin as a hepatic bile marker. Gamma-camera image data were collected in the anterior view on a 128 x 128 x 16 computer matrix at 1 frame per minute for 60 min for the hepatic phase and 30 min for the gallbladder phase. The radiolabeled hepatic bile area within the gallbladder lumen was traced, and the net transit area and transit time were noted. The hepatic bile transit rate was calculated (as mm2/min) and normalized to 1,000 mm2 of the anterior gallbladder area. The cholecystokinin-8-induced ejection fraction was calculated nongeometrically using counts.. Hepatic bile entered the gallbladder continuously during fasting with a mean +/- SD of 71% +/- 20% in control subjects and 59% +/- 27% in CAC patients, which were not significantly different (P > 0.05). The maximum frontal gallbladder area was 1,699 mm2 in control subjects and 1,610 mm2 in CAC patients (P > 0.05). Radiolabeled hepatic bile entered the gallbladder first along its central long axis in both groups, at a mean of 15 min and 16 min, respectively, and traveled toward the periphery in a lamellar fashion at a normalized mean rate of 38 mm2/min and 40 mm2/min in control subjects and CAC patients, respectively. The mean ejection fraction of 17% in CAC patients was significantly lower than the mean value of 56% in control patients (P < 0.00001).. Hepatic bile enters the gallbladder continuously during fasting. In patients with CAC, the gallbladder maintains the normal concentration function but the contraction and emptying are reduced significantly. This new cholescintigraphic technique enables measurement of both functions sequentially with a single dose of 99mTc-mebrofenin.

Topics: Adult; Aniline Compounds; Bile; Biological Transport; Case-Control Studies; Cholecystitis; Fasting; Female; Gallbladder; Gallbladder Emptying; Glycine; Humans; Imino Acids; Liver; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals

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

Topics: Aged; Aged, 80 and over; Aniline Compounds; Cholecystitis; Gallbladder; Glycine; Humans; Imino Acids; Male; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Rupture, Spontaneous; Tomography, X-Ray Computed; Ultrasonography

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

We retrospectively reviewed the medical records of 107 patients in two community hospitals who had undergone cholecystokinin-stimulated cholescintigraphy with ejection fraction to determine whether this test is reliable in identifying patients whose symptoms will improve following cholecystectomy. Patients with cholelithiasis or incomplete medical records and patients who could not be interviewed were excluded from the study. Forty-two of 58 study patients (72%) had an abnormal ejection fraction (defined as 35% or less); 27 of 42 patients (64%) underwent cholecystectomy. Twenty-six of 27 (96%) reported lessening of or resolution of symptoms following cholecystectomy. Sixty-seven per cent of the surgical specimens from the 27 patients demonstrated chronic cholecystitis. Fifteen of 42 patients (36%) with abnormal ejection fractions did not undergo cholecystectomy; 12 of 15 (80%) also reported lessening or resolution of symptoms. Of the 16 of 58 patients with a normal ejection fraction, 2 underwent cholecystectomy and reported resolution of symptoms. Five of 14 (36%) with normal ejection fractions who did not undergo cholecystectomy reported improvement. In this series, most patients with an abnormal ejection fraction had lessening of symptoms regardless of whether they underwent cholecystectomy.

Topics: Adult; Aniline Compounds; Case-Control Studies; Cholecystectomy; Cholecystitis; Chronic Disease; Female; Gallbladder; Gallbladder Emptying; Glycine; Humans; Imino Acids; Logistic Models; Male; Middle Aged; Organotechnetium Compounds; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sincalide

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

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

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

A HIV-infected 37-year-old man with diffuse mid-abdominal pain and elevated liver enzymes was sequentially studied by sonography, computed tomography (CT), 99mTc-trimethyl-BrIDA scintigraphy and endoscopic retrograde cholangiopancreatography (ERCP). CT and sonography did not lead to a final diagnosis. Cholescintigraphy showed signs of cholecystitis and sclerosing cholangitis with intra- and extrahepatic bile duct dilatation. These findings could be confirmed by ERCP, rendering HIV-associated cholepathy probable. Cytomegalovirus infection was demonstrated by polymerase chain reaction from bile fluid and the presence of cryptosporidia infection in a histology specimen isolated by ERCP. Therefore, biliary scintigraphy seems promising for screening for HIV-associated cholangio- and cholecystopathy, being less invasive and less bothering for the patient than ERCP.

Topics: Adult; Aniline Compounds; Bile Ducts; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis, Sclerosing; Cholecystitis; Glycine; HIV Infections; Humans; Imino Acids; Liver; Male; Organotechnetium Compounds; Radionuclide Imaging; Tomography, X-Ray Computed; Ultrasonography

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

During the first hour of cholescintigraphy, both the gallbladder and small bowel are visualized in the majority of normal subjects and patients with chronic cholecystitis. Usually, radioactive bile flows initially into the gallbladder followed by passage into the small bowel. To determine whether a reversed sequence of bile flow (i.e., small bowel followed by gallbladder) could serve as an indicator of chronic cholecystitis, 141 hepatobiliary scans were reviewed retrospectively with attention to the relative order of gallbladder and small bowel appearance during the first hour. The scintigraphic findings were correlated with results from real-time gallbladder ultrasonography in all 141 patients and gallbladder histopathology in a subset of 35 (25%). The specificity of a reversed sequence for chronic cholecystitis was 79% using ultrasonography and 100% for histopathology. This phenomenon likely reflects altered biliary flow dynamics secondary to recurrent inflammation and fibrosis. In patients referred for possible biliary tract disease, visualization of the gallbladder after the small bowel appears to predict chronic cholecystitis.

Topics: Aniline Compounds; Bile; Cholecystitis; Chronic Disease; Female; Gallbladder; Glycine; Humans; Imino Acids; Intestine, Small; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Time Factors; Ultrasonography

Topics: Aged; Aniline Compounds; Cholecystitis; Congenital Abnormalities; Diverticulum; Duodenal Diseases; Glycine; Humans; Imino Acids; Intestine, Small; Male; Organotechnetium Compounds; Radionuclide Imaging

One hundred fourteen patients with suspected acute cholecystitis underwent morphine-augmented cholescintigraphy. The 115 studies were reviewed first to determine the incidence of enterogastric reflux under these conditions. Overall, enterogastric reflux was observed in 85/115 (74%), occurring only after intravenous morphine sulfate in the majority (59%, 50/85). Noted prior to morphine in 41% (35/85), the degree of enterogastric reflux increased noticeably directly following drug administration in over half of these cases. Surgical diagnoses were established in 73/114 (64%) patients as follows: 56 (77%) acute cholecystitis, 15 (20%) chronic cholecystitis, and 2 (3%) another entity (normal gallbladder and tumor encasement). These pathologically proven cases were examined more closely to address the diagnostic significance of enterogastric reflux during morphine-augmented cholescintigraphy. Enterogastric reflux was demonstrated in the majority of not only those with acute cholecystitis (48/56, 86%), but also those with chronic cholecystitis (12/15, 80%). A frequent but nonspecific finding, enterogastric reflux appears to be a pathophysiologic phenomenon that may be enhanced synergistically, at least to some degree, in patients requiring morphine-augmented cholescintigraphy.

Topics: Aniline Compounds; Bile Reflux; Cholecystitis; Female; Gallbladder; Glycine; Humans; Imino Acids; Incidence; Male; Middle Aged; Morphine; Organotechnetium Compounds; Predictive Value of Tests; Radionuclide Imaging

Intravenous morphine sulfate is commonly used to shorten study time and has been reported not to lower the specificity of hepatobiliary imaging. Although the false-negative rate is low, caution has to be taken in interpreting morphine-enhanced cholescintigraphy. The report presents a false-negative study in a patient with acute gangrenous cholecystitis.

Topics: Adult; Aniline Compounds; Cholecystitis; False Negative Reactions; Gallbladder; Gangrene; Glycine; Humans; Imino Acids; Male; Morphine; Organotechnetium Compounds; Predictive Value of Tests; Radionuclide Imaging

Morphine-augmented cholescintigraphy has been shown to be a highly sensitive and specific means of evaluating acute cholecystitis. False-negative results do occur infrequently, however, and such a case is reported. In addition, this case initially demonstrated an apparent ectopic gallbladder, and thus anomalies in location of the gallbladder will be discussed.

Topics: Adult; Aniline Compounds; Cholecystitis; Choristoma; Crohn Disease; False Negative Reactions; Gallbladder; Glycine; Humans; Imino Acids; Liver Neoplasms; Male; Morphine; Organotechnetium Compounds; Predictive Value of Tests; Radionuclide Imaging

The gallbladder and an infected pericholecystic biloma secondary to subacute perforation were visualized during morphine-augmented cholescintigraphy. Perforation of the gallbladder may relieve cystic duct obstruction and contribute to false-negative visualization in the setting of acute cholecystitis.

Topics: Aniline Compounds; Cholecystitis; False Negative Reactions; Gallbladder Diseases; Glycine; Humans; Imino Acids; Male; Middle Aged; Morphine; Organotechnetium Compounds; Radionuclide Imaging; Rupture, Spontaneous

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

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

A case of nonvisualization of the gallbladder in an adult patient with cystic fibrosis in the absence of acute cholecystitis is reported. Delayed images to 20 hours showed persistent nonvisualization. Review of the literature on cystic fibrosis suggests that nonvisualization of the gallbladder may be secondary to inspissated mucus rather than acute cholecystitis, and therefore a positive hepatobiliary scan in these patients should be interpreted with caution.

Topics: Adult; Aniline Compounds; Biliary Tract; Cholecystitis; Cystic Fibrosis; False Positive Reactions; Female; Glycine; Humans; Imino Acids; Liver; Organometallic Compounds; Organotechnetium Compounds; Radionuclide Imaging