Cholescintigraphy In Patients Research Articles

Biliary Motility Measured by Fatty Meal Cholescintigraphy in Patients After Endoscopic Treatment for Choledocholithiasis

Background: Endoscopic methods are well accepted as important treatments to clear the bile duct in patients with choledocholithiasis. However, little is known about bile dynamics after endoscopic treatment. Objective: The aim of this study was to assess the hepatic clearance and gallbladder function using fatty meal Cholescintigraphy (CS) in patients after endoscopic treatment for choledocholithiasis. Methods: Fatty meal CS was performed after intravenous injection of 8 mCi Tc-99m DISIDA. Hepatic clearance was calculated at 45 minutes (E45) after radiotracer injection. Gallbladder Ejection Fraction (GBEF) values were obtained at 30, 45, 60 and 75 minutes after fatty meal ingestion. Results: Thirty-nine patients were recruited. E45 was 39.5 ± 12.7%, which was significantly lower than that in the cholecystectomized asymptomatic controls (66.2 ± 9%, p < 0.001) in our prior study. The gallbladder was not properly filled in 13 patients. The GBEF values at 30, 45, 60 and 75 minutes were 82.7 ± 14.6%, 90.4 ± 12.8%, 90.4 ± 11.1%, and 93.9 ± 9.2%, respectively. GBEF was lower in the presence of gallstones, which reached statistical significance at 45 minutes and 60 minutes in the comparison of patients with and without gallstones (p < 0.05). Conclusion: Hepatic clearance in patients after endoscopic treatment for choledocholithiasis was generally lower. One-third of gallbladders lose their usual function. The GBEF was significantly reduced in the patients with gallstones. We suggested that GBEF with fatty meal stimulation could be used to follow patients after endoscopic treatment for choledocholithiasis. Keywords: Choledocholithiasis, cholescintigraphy, gallbladder, ejection fraction, endoscopic, intravenous injection.

Tu1957 The Association Study Between Histopathologic Features of the Gallbladder Wall and Cholescintigraphy in Patients With Atypical Biliary Pain

Background/Aims: Endoscopic papillary large balloon dilation (EPLBD) can be used as a treatment of removing the difficult common bile duct (CBD) stone. However, we still experience cases of recurrence after an EPLBD. The aim of this study was to evaluate the risk factors of recurrence of CBD stone after an EPLBD. Methods: From March 2004 to October 2010, a total of 262 patients with CBD stones were treated by EPLBD at Gangnam Severance and Daegu Catholic University Hospital. Clinical and endoscopic parameters were analyzed to determine the risk factors of CBD stone recurrence. Results: Of the 262 patients (men 100, women 162, mean age 72.0±11.8 years), the recurrence rate was 19.8% ( 52/ 262). Mean duration between treatment and recurrence was 13.5 months (1.4~64.8 months). In univariate analysis, multiple stones (≥3), large stone (≥14mm), diameter of the CBD (≥ 20mm), and angulated CBD (angle≤145°) were identified as the significant predictors of recurrence. In multivariate analysis, multiple stones (≥3, P=0.015, OR 2.26, 95% CI 1.174.36), diameter of CBD (≥ 20mm, P < 0.001, OR 4.67, 95% CI 2.23-9.80) and angulated CBD (angle≤145°, P < 0.001, OR 4.98, 95% CI 2.36-10.54) were identified as the significant predictors of recurrence. Gender, age, periampullary diverticulum and previous cholecystectomy did not influence the recurrence rate. Conclusions: The recurrence of CBD stone after EPLBD was strongly associated with multiple stones (≥3), diameter of the CBD (≥ 20mm), and angulated CBD (angle≤145°). Close and meticulous follow-up may be required in patients with these parameters.

PWE-153 Sincalide cholescintigraphy in patients with suspected gall-bladder dyskinesia: assessment of alternative functional parameters and possible role in patient selection

IntroductionGallbladder ejection fraction (GBEF) from sincalide cholescintigraphy is frequently used as an index for referring patients with gallbladder dyskinesia for cholecystectomy. Many studies have reported the cut-off point used (GBEF...

CHOLECYSTOKININ CHOLESCINTIGRAPHY: Clinical Indications and Proper Methodology

Cholecystokinin is a useful diagnostic adjunct to cholescintigraphy. Clinical indications include contracting the gallbladder before cholescintigraphy in patients fasting greater than 24 hours, during cholescintigraphy to diagnose sphincter of Oddi dysfunction, and after cholescintigraphy to exclude acute acalculous cholecystitis, differentiate common duct obstruction from normal variation, and to confirm the diagnosis of chronic acalculous cholecystitis. Proper methodology is mandatory for a diagnostically useful test. Data presented shows that a 3-minute infusion of 0.01 or 0.02 microg/kg is nonphysiologic and often results in ineffective contraction similar to that seen with a bolus infusion. Normal gallbladder ejection (GBEF) values cannot be established using a 3-minute infusion because of the wide variability in response. Instead, infusions of 30 or 60 minutes are required. Normal GBEF values have been established for these methods and are 30% and 40%, respectively.

Prediction of recurrent choledocholithiasis by quantitative cholescintigraphy in patients after endoscopic sphincterotomy

Background—Endoscopic sphincterotomy (EST) is widely used for the removal of stones from the bile duct, but stones recur in about one fifth of patients.Aims—To investigate hepatic clearance by quantitative cholescintigraphy...

Cholescintigraphy in patients with acute cholecystitis before and after percutaneous gallbladder drainage

To investigate gallbladder function by use of cholescintigraphy in patients with acute cholecystitis before and after percutaneous gallbladder drainage. A cholescintigraphy was performed in 40 patients with acute cholecystitis before and after the performance of percutaneous gallbladder drainage. During the post-drainage cholescintigraphies, a cholecystokinin stimulation was performed to investigate gallbladder emptying in 12 selected patients. Gallbladder pressure and volume were measured before drainage in another group of 12 patients with acute cholecystitis. As expected, no gallbladder activity was observed in the cholescintigraphies before drainage, except in a patient with an occluding stone in the common bile duct. Cystic duct patency and gallbladder activity were seen in 80% of patients in cholescintigraphies performed after drainage but before any other treatment. Post-drainage cholescintigraphy revealed a mean gallbladder ejection fraction of 24%, which is significantly lower than the corresponding value in normal individuals and gallstone patients without cholecystitis (n = 12). Gallbladder pressure and volume were markedly increased compared with normal values. The relief of increased gallbladder pressure and volume appears to be important for the re-establishment of gallbladder function.

Prediction of recurrent choledocholithiasis by quantitative cholescintigraphy in patients after endoscopic sphincterotomy: [formula omitted], N.J. Peng 1, J.S. Cheng, G.H. Lo, I.M. Wang, N.M. Wang, R.L. Huang, C.F. Chang, S.M. Chen, C.K. Lin, J.S. Huang. Division of Gastroenterology & Nuclear Medicine 1, Veterans General Hospital-Kaohsiung, Taiwan, R.O.C.

Prediction of recurrent choledocholithiasis by quantitative cholescintigraphy in patients after endoscopic sphincterotomy: [formula omitted], N.J. Peng 1, J.S. Cheng, G.H. Lo, I.M. Wang, N.M. Wang, R.L. Huang, C.F. Chang, S.M. Chen, C.K. Lin, J.S. Huang. Division of Gastroenterology & Nuclear Medicine 1, Veterans General Hospital-Kaohsiung, Taiwan, R.O.C.

The evaluation of gallbladder function by quantitative radionuclide cholescintigraphy in patients with noninsulin-dependent diabetes mellitus.

Twenty-nine patients (24 males, 5 females; aged 62.8 +/- 10.1 years) with noninsulin-dependent diabetes mellitus (NIDDM) without gallstones and impaired liver function were included in our study. The patients were categorized by blood sugar control and disease duration. Twelve normal controls (10 males, 2 females; aged 62.8 +/- 12.4 years) were also studied for comparison. The gallbladder filling fraction (FF) and ejection fraction (EF) were calculated following the method of Krishnamurthy et al. The results showed no significant difference (P > 0.5) between (1) NIDDM and normal controls in FF (69.1 +/- 29.4 versus 67.5 +/- 24.0%) and EF (45.0 +/- 23.5 versus 54.8 +/- 10.0%) by a t-test, (2) good and poor blood sugar control in FF (64.9 +/- 30.9 versus 73.7 +/- 26.4%) and EF (42.0 +/- 25.4 versus 54.8 +/- 10.0%) by a Mann-Whitney U test, (3) long and short disease durations in FF (70.9 +/- 29.7 versus 67.9 +/- 28.7%) and EF (37.9 +/- 20.7 versus 50.0 +/- 24.1%) by a Mann-Whitney U test. In conclusion, the results challenge some previous reports and warrant further research.

Clinical evaluation of choledocho-duodenal bile flow with cholescintigraphy in patients before and after endoscopic sphincterotomy

Clinical evaluation of choledocho-duodenal bile flow with cholescintigraphy in patients before and after endoscopic sphincterotomy

Cholescintigraphy in extrahepatic biliary obstruction.

The effect of etiology on findings in cholescintigraphy in patients with extrahepatic obstruction was retrospectively evaluated in 29 patients. Of 11 patients with obstruction secondary to cancer, seven (78%) of nine had complete obstruction (delayed images were not obtained in two) and nine (82%) of 11 had a moderate to severe decreases in hepatocyte clearance. Of 12 patients with obstruction secondary to cholelithiasis, only four (36%) had complete obstruction (delayed images were not obtained in one) (p less than 0.05) and all 11 had normal or only midly decreased hepatocyte clearance (p less than 0.05). All five patients with obstruction secondary to pancreatitis had mild partial obstruction and normal or mildly decreased hepatocyte clearance. One patient had partial obstruction secondary to an abscess adjacent to the common bile duct; hepatocyte clearance was mildly decreased. Cancerous and noncancerous causes of biliary tract obstruction produce significantly different findings in hepatobiliary imaging.

The Value of Radionuclide Scintigraphy in Patients with Non-Visualized Gallbladders by Oral Cholecystography

This study evaluated the clinical usefulness of Tc-99m-PyG cholescintigraphy in patients who had nonvisualization of the gallbladder after OCG. Nineteen patients with non-visualized gallbladder with OCG subsequently had Tc-99m-PyG cholescintigraphy performed. In nine patients the gallbladder visualized, whereas in ten it did not. Statistical analysis of this limited number of patients showed that Tc-99m-PyG cholescintigraphy was able to separate those patients with clinically significant gallbladder disease from those patients without significant gallbladder disease (p less than 0.05).