Revisiting morphine-augmented hepatobiliary imaging for diagnosing acute cholecystitis: the potential pitfall of high false positive rate

Bor-Tau Hung,Katie S Traylor,Ching-Yee Oliver Wong

doi:10.1007/s00261-013-0067-8

Bor-Tau Hung, Katie S Traylor + Show 1 more

Open Access

https://doi.org/10.1007/s00261-013-0067-8

Copy DOI

Abstract

PurposeThe aim of this retrospective study was to investigate the efficacy of morphine-augmented hepatobiliary imaging (MAHBI) for diagnosing acute cholecystitis (AC).MethodsSixty-eight patients (Male:Female = 36:32, age = 54 ± 17 years) referred for diagnosis of AC by 30-min post-morphine MAHBI after the standard 1-h imaging were recruited. Non-visualization of gallbladder on 30-min post-morphine images by visual analysis was considered positive. Final diagnosis of pathological examination for all patients was used as the gold standard.ResultsThere was significant correlation of AC and MAHBI (p < 0.05). There were 45 true positive (TP), 19 false positive (FP), 4 true negative (TN), and no false negative (FN) cases using gallbladder visualization by 30-min post-morphine as the criteria, with a high false positive rate of 83%. The sensitivity, specificity, accuracy, positive and negative predictive values of MAHBI in detecting AC were 100%, 17%, 72%, 70%, and 100%, respectively.ConclusionsMAHBI is sensitive but may not specific for diagnosing AC due to the potential pitfall of high false positive rate. Correlation with other clinical findings is recommended for optimal patient management.

Highlights

The aim of this retrospective study was to investigate the efficacy of morphine-augmented hepatobiliary imaging (MAHBI) for diagnosing acute cholecystitis (AC)
Acute calculous cholecystitis (ACC) always starts with persistent obstruction of gallbladder outlet by a stone impacted in the neck of the gallbladder, Hartmann’s pouch, or the cystic duct
Gallstones are not found in 5% to 10% of patients with acute cholecystitis

Summary

Introduction

The aim of this retrospective study was to investigate the efficacy of morphine-augmented hepatobiliary imaging (MAHBI) for diagnosing acute cholecystitis (AC). Methods: Sixty-eight patients (Male:Female = 36:32, age = 54 ± 17 years) referred for diagnosis of AC by 30-min post-morphine MAHBI after the standard 1-h imaging were recruited. Non-visualization of gallbladder on 30-min post-morphine images by visual analysis was considered positive. Morphine-augmented hepatobiliary imaging (MAHBI) as well as traditional delayed imaging are susceptible to false positive results which, in turn, result in decreased specificity [5, 8,9,10]. Prolonging post-morphine imaging to reduce false positive rate has recently been proved effective in a retrospective study performed by Tang et al [9].

Methods

Results

Conclusion