胆囊炎及结石性胆囊炎^99Tc^m—EHIDA肝胆显像研究

目的探讨胆囊炎及结石性胆囊炎胆囊显像特点.方法对14例无肝胆疾病的正常对照者和均经手术病理检查证实的包括胆囊炎患者27例、结石性胆囊炎患者38例2个疾病组进行了99Tcm-二乙基乙酰苯胺基亚氨二乙酸(EHIDA)肝胆显像及半定量分析.结果与对照组比较,2个疾病组潜伏期(LP)延长,胆囊排胆分数(EF)及排胆率(ER)均明显降低,差异均有高度显著性(P均<0.01).胆囊平均排空曲线示2个疾病组脂餐后胆囊排空潜伏期延长,呈"再充盈”现象.急性胆囊炎及慢性胆囊炎急性发作6例、慢性胆囊炎8例以及结石性胆囊炎20例胆囊未见显影.结论核素肝胆显像可早期预测胆囊疾病的发生并指导治疗.     

胆囊炎及结石性胆囊炎99Tcm-EHIDA

目的　探讨胆囊炎及结石性胆囊炎胆囊显像特点。方法　对 14例无肝胆疾病的正常对照者和均经手术病理检查证实的包括胆囊炎患者 2 7例、结石性胆囊炎患者 38例 2个疾病组进行了99Tcm 二乙基乙酰苯胺基亚氨二乙酸 (EHIDA)肝胆显像及半定量分析。结果　与对照组比较 ,2个疾病组潜伏期 (LP)延长 ,胆囊排胆分数 (EF)及排胆率 (ER)均明显降低 ,差异均有高度显著性 (P均 <0 0 1)。胆囊平均排空曲线示 2个疾病组脂餐后胆囊排空潜伏期延长 ,呈“再充盈”现象。急性胆囊炎及慢性胆囊炎急性发作 6例、慢性胆囊炎 8例以及结石性胆囊炎 2 0例胆囊未见显影。结论　核素肝胆显像可早期预测胆囊疾病的发生并指导治疗     

Citrin缺陷所致婴儿肝内胆汁淤积症的肝胆显像特征

目的 探讨citrin缺陷导致的婴儿肝内胆汁淤积症（NICCD）患儿^99Tc^m-二乙基乙酰苯胺亚氨二醋酸（EHIDA）肝胆显像的特征.方法 回顾性分析28例（男16例,女12例,1～8月龄）经基因确诊、同时行^99Tc^m-EHIDA肝胆动态显像检查的NICCD患儿资料.肝胆动态显像时心、肝、肾按正常时序和强度显影定义为摄取功能正常,肝影模糊和（或）心肾影持续时间延长者为摄取功能差;60 min内肠道显影为排泄通畅,60 min后为排泄延迟,24 h肠道仍不显影为排泄受阻.分析肝胆显像特征与血清总胆红素（TB）、直接胆红素（DB）、ALT、总胆汁酸（TBA）等指标间的关系.数据分析采用Kruskal-Wallis秩和检验.结果 28例中,20例表现为摄取功能正常,其中10例排泄通畅,10例排泄延迟;8例表现为摄取功能差,其中4例排泄延迟,4例排泄受阻.与摄取功能正常组相比,摄取功能差组TB和DB明显增高[183.6（128.7～ 280.9） mmol/L和105.5（80.0～ 141.7） mmol/L,135.6（95.7～212.6） mmol/L和73.1（53.9～ 97.9） mmol/L;Z=-2.25和-2.73,均P＜0.05].与排泄通畅者相比,排泄延迟者TB、DB和TBA明显升高[分别为137.5（122.0～170.9） mmol/L和81.7（65.7～93.5） mmol/L,96.5（81.1～ 108.0） mmol/L和54.1（45.3～72.6） mmol/L,245.6（183.9～299.2） mmol/L和136.0（73.5 ～163.2） mmol/L;Z=-3.92、-3.74和-2.57,均P＜0.05];排泄受阻者TB[262.0（152.1 ～ 542.8） mmol/L]和DB[192.7（118.1～407.2） mmol/L]更高（均Z=-2.82,均P＜0.05）.与排泄延迟组相比,排泄受阻者ALT明显增高[71.5（48.5～144.8） U/L和20.0（16.5～27.7） U/L;Z=-2.66,P＜0.05）.结论 ^99Tc^m-EHIDA肝胆显像可反映NICCD患儿肝脏摄取和排泄功能受损的状况,摄取功能受损严重时,可出现排泄受阻的征象.     

^99Tc^m-DTPA肾动态显像对狼疮肾炎肾功能及病理损害的评估

目的探讨^99Tc^m-DTPA肾动态显像对狼疮肾炎（LN）患者肾功能损害的早期评价及评价结果与病理类型的关系。方法健康对照组10名,病理资料完整的LN患者29例,其中包括无症状LN（SLN）组18例,有症状LN（OLN）组11例。行^99Tc^m-DTPA肾动态显像,计算双肾的肾小球滤过率（GFR）、高峰时间（tp）、半排时间（t1/2）及20min排泄率（R20）,由核医学科医师对肾功能是否受损及受损程度进行评估。统计学分析包括t检验、Fisher确切概率法分析和行×列表关联分析。结果SLN组及OLN组均较健康对照组出现tp延长（t=5．3,9．3,P均〈0．05）,t1／2延长（t=6．9,12．0,P均〈0．05）及R20下降（t=10．1,12．1,P均〈0．05）,OLN组出现GFR下降（t=4．1,P〈0．05）,SLN组GFR下降不显著（t=1．7,P〉0．05）;经关联性分析,肾动态显像诊断肾损害的严重程度与病理分型相关（r=0．2273,P〈0．05）。结论全面分析^99Tc^m-DTPA肾动态显像可对系统性红斑狼疮患者进行早期肾功能评价,有效检出无。肾损害症状的LN患者,并为无条件行。肾活组织检查的LN患者病理损害评估提供帮助。     

^99Tc^m-二亚乙基三胺五乙酸与^99Tc^m-奥曲肽眼眶显像在甲状腺相关性眼病中的对比研究

目的通过对比^99Tc^m-二亚乙基三胺五乙酸（^99Tc^m-DTPA）与^99Tc^m-奥曲肽（^99Tc^m-OCT）眼眶显像,比较两种显像方法在评估甲状腺相关眼病（TAO）患者眼部炎性反应活动度中的临床价值。方法26例TAO患者依据临床活动度评分（CAS）标准分为炎性反应活动组16例、非炎性活动组10例,另有14名正常志愿者作为对照组。静脉注射^99Tc^m-DTPA 740 MBq,0．5h后行眼眶平面及体层显像,隔日同一患者静脉注射^99Tc^m-OCT740MBq,1-2h后行眼眶平面及体层显像。获取各组两种眼眶显像剂的摄取率。对两种显像方法获得的半定量指标UROCT和URDTPA进行配对t检验并分别与CAS评分进行Spearman相关性分析。结果两种显像剂的眼眶摄取率未见明显差异（t=0．075,P〉0．05）。两种显像剂的眼眶摄取率（UROCT、URDTPA）与患者CAS评分之间具有很好的相关性（^99Tc^m-DTPA：r=0．835,P〈0．001;^99Tc^m-OCT：r=0．912,P〈0．001）。结论^99Tc^m-DTPA与^99Tc^m-OCT的眼眶显像有较好的一致性,证明^99Tc^m-DTPA眼眶显像是一种可行的、并可能成为一种很有发展前景的评价TAO炎性反应活动度的新方法。     

运动试验18F-FDG心肌代谢显像诊断心肌缺血

目的 探讨运动试验同时行^18F-脱氧葡萄糖（FDG）心肌代谢和^99Tc^m-甲氧基异丁基异腈（MIBI）心肌灌注显像判断心肌缺血的可行性和诊断价值.方法 26例既往无心肌梗死病史的确诊或怀疑冠心病患者,在运动试验高峰或出现终止指标时注射^99Tc^m-MIBI和^18F-FDG,进行心肌灌注和代谢显像,随后进行静息^99Tc^m-MIBI心肌灌注显像以及冠状动脉造影.比较运动^18F-FDG心肌代谢显像和^99Tc^m-MIBI心肌灌注显像及冠状动脉造影结果.结果 22例有1支及其以上冠状动脉狭窄≥50%的患者中,18例出现血流灌注异常,灵敏度为82%,20例患者有明显^18F-FDG摄取,灵敏度为91%,两者比较差异无显著性（x^2=1.497,P=0.338）.静息^99Tc^m-MIBI心肌灌注显像示完全（12例）或部分（3例）可逆性心肌灌注缺损（心肌缺血）的患者同时行运动试验^99Tc^m-MIBI心肌灌注、^18F-FDG心肌代谢显像,表现为血流灌注减低的心肌节段^18F-FDG摄取增加.与冠状动脉造影对比,22例患者共51个病变血管（管腔狭窄≥50%）支配的心肌节段中,运动试验^99Tc^m-MIBI心肌灌注显像发现了25个节段,灵敏度为49%,而运动^18F-FDG心肌代谢显像发现了34个节段,灵敏度为67%（x^2=7.30,P=0.008）.结论 运动试验引起心肌缺血可以进行^18F-FDG心肌代谢显像.且与单纯运动/静息心肌灌注显像比较,同时行运动试验^99Tc^m-MIBI心肌灌注和^18F-FDG心肌代谢显像对诊断局部缺血心肌节段有更高的准确性.     

99Tcm-MIBI显像评价非小细胞肺癌三维适形放疗疗效的临床研究

目的 探讨99Tcm-甲氧基异丁基异腈（MIBI）显像评价非小细胞肺癌（NSCLC）三维适形放疗疗效的价值.方法 将102例NSCLC患者根据胸部CT检查结果分为放疗有效组（完全缓解＋部分缓解）和无效组（病情稳定＋病情进展）.患者于放疗前行99Tcm-MIBI早期（10～30 min）及延迟（2～3 h）显像,用感兴趣区（ROI）的方法分别获得早期相肿瘤/正常肺组织放射性摄取（T/N）比值（ER）和延迟相T/N比值（DR）,并计算出滞留指数[RI=（DR-ER）/ER×100%].采用SPSS 13.0软件进行统计学处理,检验方法为两独立样本t检验和秩和检验（Mann-Whitney U）.结果 99Tcm-MIBI显像结果中,放疗有效组的ER和DR分别为2.36±0.17和2.48±0.20,均高于放疗无效组的1.82±0.14和1.94±0.16,差异均有统计学意义（t=-13.1,-12.7,P均＜0.05）.放疗有效组的RI中位值为6.60%,高于放疗无效组的5.13%,差异有统计学意义（z=-6.83,P＜0.05）.结论 99Tcm-MIBI显像在评价NSCLC三维适形放疗疗效、为临床制订合适的放疗方案方面具有重要的临床价值.     

Citrin缺陷所致新生儿肝内胆汁淤积症的99Tcm-EHIDA肝胆动态显像

目的 研究citrin缺陷导致的新生儿肝内胆汁淤积症(NICCD)99Tcm-EHIDA肝胆动态显像特点及临床价值.方法 分别对NICCD组(12例)和NICCD阴性对照组(5例,4例婴儿肝炎综合征和1例脂类代谢异常)患儿[年龄分别为(127±27)d和(164±15)d]进行99Tcm-EHIDA肝胆动态显像,观察注射显像剂后肝脏及肠道放射性分布,并采用秩和检验比较2组肝影持续时间及肠道显影时间.结果 NICCD组肠道显影时间和肝影持续时间均在180～1440min(中位数均为360min),而对照组肠道显影时间在15～30min(中位数为15min),肝影持续时间在60～180min(中位数为60min).NICCD患儿肝影持续时间及肠道显影时问均明显延长(Z=-3.20和-3.17,P均＜0.05).3例NICCD患儿肝显影不清晰,其中1例NICCD患儿胆囊及肠道在24h内始终未见显影,治疗后该患儿肝胆动态显像示肝摄取及排泄功能明显改善,15min肠道显影.结论 99Tcm-EHIDA肝胆动态显像示NICCD患儿肝脏摄取和排泄功能降低,提示99Tcm-EHIDA肝胆动态显像在NICCD诊断中可作为辅助检查手段.     

^99Tc^m-TP5-3 microSPECT/CT探测乳腺癌化疗后细胞凋亡的实验研究

目的 合成新型凋亡显像剂^99Tc^m-半胱氨酸-膜联蛋白V（TP5-3）,研究其在小鼠体内生物分布和药代动力学特点,探讨^99Tc^m-TP5-3 microSPECT/CT检测乳腺癌单次化疗后肿瘤早期细胞凋亡的可行性.方法 以直接还原法对TP5-3进行^99Tc^m标记,HPLC检测产物的标记率;进行正常小鼠体内^99Tc^m-TP5-3的生物分布及药代动力学研究.建立荷MDA-MB-231人乳腺癌裸鼠模型,取10只分为2组,化疗组单次腹腔内注射紫杉醇（每只40 mg/kg）,对照组注射等体积生理盐水,48 h后由尾静脉注射37 MBq ^99Tc^m-TP5-3,进行microSPECT/CT图像采集,显像后立即处死、取材,比较2组肿瘤的放射性摄取（％ID/g）、T/NT（NT取肌肉）;采用流式细胞术和病理学检测肿瘤凋亡细胞.采用单因素方差分析、两样本t检验和直线相关分析数据.结果^99Tc^m-TP5-3标记率＞95％,室温放置4h放化纯仍保持在（96.0±1.5）％,稳定性好.正常小鼠注射显像剂后30 min肾脏放射性摄取最高[（8.48±1.07） ％ID/g],其他脏器分布较少;血液清除快,注射后4h血液放射性摄取[（2.07±0.35） ％ID/g]较注射后5 min[（13.74±4.21） ％ID/g]减少了85％（F=11.310,P＜0.05）;显像剂主要浓聚于肾、肝和胃,经肾脏排泄.化疗后99^Tc^m-TP5-3 microSPECT/CT显像示化疗组T/NT为4.21±0.06,对照组T/NT仅1.57±0.67（f=12.820,P＜0.05）;化疗后生物分布实验示,化疗组肿瘤放射性摄取明显高于对照组,分别为（4.82±0.54） ％ID/g和（1.44±0.38） ％ID/g（t=0.679,P＜0.05）.肿瘤放射性摄取与流式细胞仪测定的凋亡细胞百分比呈正相关（r=0.985,P＜0.05）.HE染色示化疗后肿瘤组织有大量凋亡细胞,而对照组仅有少量.结论 ^99Tc^m-TP5-3标记方法简单,生物分布理想,具备优良的药代动力学特性;^99Tc^m-TP5-3 microSPECT/CT可用于早期检测荷乳腺癌裸鼠模型化疗后的肿瘤细胞凋亡水平.     

肾动态显像法与双血浆法在移植肾GFR测定中的对比

目的比较肾动态显像法与双血浆法测定的移植肾^99Tc^m-DTPA肾小球滤过率（dGFR和tGFR），以评价dGFR反映移植肾滤过功能的可靠性。方法选取73例肾移植患者，分别采用肾动态显像法和双血浆法测定其^99Tc^m-DTPA GFR。分析经体表面积标准化的dGFR与tGFR间的关系，并建立直线回归方程。结果dGFR均值略低于tGFR均值（t=-2．010，P〈0．05），dGFR与tGFR呈显著正相关（r=0．759，P〈0．01），直线回归方程：tGFR=0．6455XdGFR＋25．514。结论dGFR与tGFR具有较好的一致性，肾动态显像法能够准确评价移植肾的滤过功能。     

Precision of the gallbladder ejection fraction obtained with Tc-99m-pyridoxyl-5-methyl-tryptophan (99mTc-PMT) hepatobiliary scintigraphy as compared with the contraction ratio in three-dimensional computed tomography

The gallbladder ejection fraction (GBEF) obtained with Tc-99m-pyridoxyl-5-methyl-tryptophan (^99mTc-PMT) hepatobiliary scintigraphy has been used as a parameter of gallbladder function. To determine the accuracy of GBEF, the relationship with the contraction ratio of the gallbladder (GBCR) obtained with three-dimensional helical computed tomography (3D-CT) was studied.Patients and methods: A normal volunteer, 8 patients suffering from cholecystolithiasis and a patient with gallbladder dyskinesia were examined. The percent initial dose (%ID) for the gallbladder and GBEF with hepatobiliary scintigraphy were used to compare the volume of the gallbladder and GBCR which was measured by 3D-CT.Results: The %ID of the gallbladder was correlated with the volume of the gallbladder by 3D-CT (Y=1.000X? 1.818, r= 0.928). GBEF was correlated well with GBCR by 3D-CT (Y= 0.916X + 6.296, r = 0.975).Conclusions: The %ID of the gallbladder obtained with hepatobiliary scintigraphy may be a good indicator of the volume of the gallbladder. The accuracy of GBEF was confirmed by comparison with 3D-CT examination. GBEF is considered a useful parameter of pathophysiological gallbladder function.     

Diagnosis of gallbladder dyskinesia by quantitative hepatobiliary scintigraphy

AIM: The aim of the present study was to develop a new pharmacologic method during hepatobiliary scintigraphy by which patients with functional and organic forms of gallbladder (GB) dysfunction can be differentiated. METHODS: Quantitative hepatobiliary scintigraphy (QHBS) was performed on 31 patients with impaired GB motility selected by cerulein-augmented ultrasonography. Nineteen patients had acalculous biliary pain (ABP) and suspected GB dyskinesia, 6 patients had celiac disease, and 6 patients had type II diabetes mellitus. Sixty minutes after the isotope administration, 1 ng/bwkg/min cerulein (CCK10) was infused for 10 minutes, and then from the 90th minute, an equivalent dose of CCK10 was infused in the presence of 0.5 mg sublingual glyceryl trinitrate (GTN) in 12 or placebo in 7 consecutive patients. The GB ejection fraction (GBEF) was calculated repeatedly in time periods from 60 to 90 and from 90 to 120 minutes. RESULTS: In the majority of patients with ABP and suspected GB dyskinesia, CCK10 and GTN coadministration normalized the previously impaired GB-emptying. When the cumulative results of all 12 patients were calculated, we demonstrated significant differences (P=0.003) in the GBEF between the first (CCK10) versus the second (CCK10 plus GTN) stimuli: 19+/-11% versus 40+/-17%, respectively. In contrast, in 12 patients with celiac sprue and diabetes mellitus, no differences in the GBEF were detected when the first (CCK10 alone) versus the second (CCK10 plus GTN) stimuli was compared: 21+/-10% versus 22+/-13%, respectively. Finally, placebo and CCK10 coadministration in 7 consecutive patients with ABP and suspected GB dyskinesia did not influence the GBEF as compared with CCK10 alone: 13+/-9% versus 15+/-10%, respectively. CONCLUSION: GTN and CCK10 coadministration induces a significant improvement of the GBEF in patients with GB dyskinesia. The application of this new pharmacologic test during QHBS permitted the noninvasive separation of those patients with secondary impaired GB-emptying as a result of GB dyskinesia from those with primary forms of GB hypokinesia.     

Estimation of gallbladder ejection fraction utilizing cholecystokinin-stimulated magnetic resonance cholangiography and comparison with hepatobiliary scintigraphy.

PURPOSE: To evaluate the utility of magnetic resonance cholangiography (MRC) in estimation of gallbladder ejection fraction (GBEF) and to comparing this value to the conventional method, hepatobiliary scintigraphy (HBS). MATERIALS AND METHODS: Twenty-one healthy volunteers were imaged on sequential weeks to determine GBEF using MRC and HBS. GBEF was calculated by HBS after infusion of 20 ng/kg of sincalide following injection of 111 Mbq of Tc 99(m) mebrofenin. For estimation by MRC, imaging of the gallbladder was performed before and after slow infusion of sincalide every 5 minutes, for a total of 60 minutes. Gallbladder imaging was performed using a heavily T2-weighted 2D fast spin echo (FSE) sequence. Data was analyzed using a variance component analysis technique. RESULTS: Mean GBEF by HBS was 65.7%, with an SD of +/-27.3%. Mean GBEF by MRC was 62.7%, with an SD of +/- 20.4%. If minimum normal GBEF is set at 35%, two of the cases showed discordance, with HBS calculating an abnormally low average GBEF compared to MRC. Additionally, two cases showed abnormally low GBEF for both modalities. The coefficient of correlation between HBS and MRC was 0.72. Inter- and intraobserver variance is acceptable within the two modalities with <1.1% variation. CONCLUSION: GBEF can be calculated with MRC, yielding similar values when a group of volunteers are considered. Further study with symptomatic patients is needed to determine the validity of this technique for clinical diagnosis.     

Gallbladder response to a second dose of cholecystokinin during the same imaging study.

Patients on total parenteral nutrition or after prolonged fasting may require treatment with cholecystokinin (CCK) prior to hepatobiliary imaging. Some may also require evaluation of gallbladder (GB) contractility, and the need for a second dose of CCK may arise. It is not clear whether gallbladder function can be adequately evaluated with CCK when a previous CCK dose had already been administered. We studied ten normal subjects to evaluate GB response to a second CCK injection. The subjects received 20 micrograms/kg sincalide in a 3-min infusion prior to administration of technetium-99m disofenin. They then received an identical sincalide dose at 60 min postinjection, and imaging was continued for another 30 min to quantify GB contraction. Gallbladder ejection fraction (GBEF) values ranged from 42-98% (mean: 71.5 +/- 19%). Pretreatment with CCK does not preclude GB contraction evaluation with a second dose of CCK. Expected GBEF values are similar to those obtained with single CCK injections.     

Cholelithiasis demonstrated on hepatobiliary scintigraphy as a photopenic defect within the inferior portion of the liver

A 47-year-old man presented with the clinical findings of acute cholecystitis. During hepatobiliary scintigraphy using Tc-99m DISIDA, a persistent photopenic defect was noted within the inferior portion of the liver in the region of the gallbladder. Abdominal ultrasonography revealed large gallstones with acoustic shadowing within a normal-sized gallbladder. Eleven large gallstones were found within a normal-sized intrahepatic gallbladder at surgery.     

Enterogastric reflux mimicking gallbladder disease: detection, quantitation and potential significance.

OBJECTIVE: Visualization of enterogastric reflux (EGR) may be present during hepatobiliary imaging. Reflux of bile may damage the gastric mucosa, altering its function, and cause such symptoms as epigastric pain, heartburn, nausea, intermittent vomiting and abdominal fullness. These symptoms also are associated with gallbladder disease. The aim of this study was to quantitate the EGR index (EGRI) and to determine if a difference exists in normal and abnormal responses using standard cholecystokinin (CCK)-augmented hepatobiliary imaging. METHODS: This study used 129 patients. LAO dynamic data on a 128 x 128 matrix at a rate of 1 frame/min were obtained. After the gallbladder ejection fraction (GBEF) was determined, the EGRI (%) was calculated by relating the counts in the gastric ROI to the counts in the hepatobiliary ROI at a specified time. The results were compared with the patient's final clinical diagnosis. RESULTS: Normal responders (GBEF > or = 35%) had a higher EGRI than abnormal responders with a P = 0.001 EGR observed in 75 patients (58.1%). Significant reflux (EGRI > or = 14.2% at 15 min) was observed in 29 additional patients (22.5%). Patients with EGRI > or = 24.5% showed a strong association with the pathophysiologic syndrome of gastritis, alkaline reflux, gastric ulcer and gastro esophageal reflux disease. There was no EGR observed in the remaining 25 patients (19.4%). CONCLUSION: This simple addition to the CCK-augmented hepatobiliary imaging may both detect and quantitate abnormal EGR as the cause of the patient's symptoms in the presence of a normal GBEF result, and/or those patients with risk factors for gastritis.     

Gallbladder contractility in patients with spinal cord injuries: a sonographic investigation

Approximately 30% of all patients who have spinal cord injuries have gastrointestinal symptoms. One cause is gallstone disease; indeed the literature suggests that gallstones are more common in patients with spinal cord injuries because these patients have impaired contractility of the gallbladder with a reduced ejection fraction. To test this hypothesis, we obtained gallbladder sonograms in 30 patients with spinal cord injuries (16 quadriplegics and 14 paraplegics) and in 32 uninjured age-matched control subjects. Four patients and four asymptomatic control subjects had gallstones and were excluded. The remaining 26 patients and 28 control subjects fasted for 12 hr. Longitudinal and transverse sonograms of the gallbladder were made immediately before the ingestion of 25 g of fat, and at 10, 20, 30, 45, and 60 min thereafter. Gallbladder volumes were measured by using the ellipsoid method. Resting and residual volumes and the emptying times were determined and the ejection fractions were calculated. The ejection fractions were significantly lower (p = .003) in the patients than in the control subjects because the resting volumes were lower than in the control subjects (p = .013). However, the emptying times and residual volumes were the same in the two groups. We conclude that gallbladder contractility is normal in patients with spinal cord injuries and that the lower ejection fraction found in such patients is due to a smaller resting volume.     

Diagnostic accuracy of 99Tcm-HIDA with cholecystokinin and gallbladder ejection fraction in acalculous gallbladder disease

The diagnostic accuracy and clinical impact of 99Tcm hepatic iminodiacetic acid (HIDA) imaging with cholecystokinin (CCK) was investigated in a prospective study of 359 patients over an 11 year period. All patients presented with right upper quadrant biliary type pain and had a normal ultrasound investigation prior to imaging. CCK was administered as a 3 min infusion at peak gallbladder uptake of HIDA. A gallbladder ejection fraction (GBEF) was used to quantify the gallbladder response to CCK. Two hundred and forty-four of 359 (68%) patients had an abnormal GBEF (< or = 35%). One hundred and thirty-four of 141 (95%) patients who underwent cholecystectomy had abnormal surgical/histological findings and/or relief of symptoms on long-term (mean 5.7 years) follow-up. Clinical follow-up, mean of 5.9 years, of the patients with GBEF > 35% showed 73/79 (92%) of them with little evidence of gallbladder disease. For a total 261 patients with mean clinical follow-up of 5.7 years the sensitivity of GBEF measurement is 95%, specificity is 92% and overall accuracy is 94%. It is concluded that 99Tcm-HIDA imaging, with a 3 min infusion of CCK, is a highly accurate technique and valuable in the diagnostic management of patients with suspected acalculous gallbladder disease.     

Gallbladder response to a second dose of cholecystokinin during the same imaging study

Patients on total parenteral nutrition or after prolonged fasting may require treatment with cholecystokinin (CCK) prior to hepatobiliary imaging. Some may also require evaluation of gallbladder (GB) contractility, and the need for a second dose of CCK may arise. It is not clear whether gallbladder function can be adequately evaluated with CCK when a previous CCK dose had already been administered. We studied ten normal subjects to evaluate GB response to a second CCK injection. The subjects received 20 g/kg sincalide in a 3-min infusion prior to administration of technetium-99m disofenin. They then received an identical sincalide dose at 60 min postinjection, and imaging was continued for another 30 min to quantify GB contraction. Gallbladder ejection fraction (GBEF) values ranged from 42–98% (mean: 71.5±19%). Pretreatment with CCK does not preclude GB contraction evaluation with a second dose of CCK. Expected GBEF values are similar to those obtained with single CCK injections.