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Neitzel E, Laskus J, Mueller PR, Kambadakone A, Srinivas-Rao S, vanSonnenberg E. Part 1: Current Concepts in Radiologic Imaging and Intervention in Acute Cholecystitis. J Intensive Care Med 2024:8850666241259421. [PMID: 38839258 DOI: 10.1177/08850666241259421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Acute calculous cholecystitis and acute acalculous cholecystitis are encountered commonly among critically ill, often elderly, patients. Multidisciplinary management of these conditions is essential, with intensivists, surgeons, diagnostic radiologists, interventional radiologists, infectious disease physicians, gastroenterologists, and endoscopists able to contribute to patient care. In this article intended predominantly for intensivists, we will review the imaging findings and radiologic treatment of critically ill patients with acute calculous cholecystitis and acute acalculous cholecystitis.
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Affiliation(s)
- Easton Neitzel
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Julia Laskus
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Peter R Mueller
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shravya Srinivas-Rao
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric vanSonnenberg
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
- Department of Radiology and Department of Student Affairs, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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2
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Sowmya SD, Gupta A, Narayan ML, Chauhan U, Jain J, Singla T, Chennatt JJ. Role of 99mTc-Mebrofenin Hepatobiliary Scintigraphy in the Diagnosis of Post Cholecystectomy Syndrome. World J Nucl Med 2022; 21:231-235. [PMID: 36060090 PMCID: PMC9436510 DOI: 10.1055/s-0042-1751038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background
Huge variation in the prevalence of post cholecystectomy syndrome (PCS) is because PCS can include a wide variety of disorders that can be both related and unrelated to cholecystectomy. Hepatobiliary scintigraphy (HBS) is a noninvasive nuclear medicine scan that can evaluate a delay in the transit of bile from the hepatic hilum to the duodenum using a radiotracer
99m
Tc-Mebrofenin that can be associated with a functional ampullary obstruction. The aim of this study was to assess the role of
99m
Tc-Mebrofenin HBS in the detection of the cause of PCS among the patients undergoing cholecystectomy.
Methods
Twenty-one patients who presented with PCS from September 2018 to February 2020 were included in the study. These patients were characterized based on history, examination, liver function test, and abdominal ultrasound. Sphincter of Oddi dysfunction (SOD) was diagnosed using the Rome 3 criteria and the Milwaukee classification. Magnetic resonance cholangiopancreatography (MRCP) and upper gastrointestinal endoscopy and biopsy were done when indicated, to establish the diagnosis. These patients were further subjected to
99m
Tc-Mebrofenin HBS, and the findings were analyzed.
Results
The most common symptom in PCS was biliary pain occurring in 85.7% of the patients. The average time of presentation since surgery was 1.9 years. The most common cause of PCS was SOD, occurring in 52.3% of the patients, followed by benign biliary stricture occurring in 23.8% of the patients. The mean bile duct (common bile duct) visualization time in patients with PCS was 25.2 minutes, the mean duodenal visualization time was 38.2 minutes, and the mean jejunal visualization time was 60.5 minutes. The mean bile duct to duodenum transit time was 12.7 minutes, while the mean bile duct to jejunum transit time was 30.1 minutes. HBS showed consistent findings with the final diagnosis made by other diagnostic modalities (clinical criteria/MRCP/intraoperative findings) in 80.9% of the patients.
Conclusion
99m
Tc-Mebrofenin HBS has a significant role in the evaluation of PCS.
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Affiliation(s)
- S. Durga Sowmya
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Amit Gupta
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Manishi L. Narayan
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Udit Chauhan
- Department of Radiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Jaydeep Jain
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Tanuj Singla
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Jaine John Chennatt
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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3
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Billington S, Shoner S, Lee S, Clark-Snustad K, Pennington M, Lewis D, Muzi M, Rene S, Lee J, Nguyen TB, Kumar V, Ishida K, Chen L, Chu X, Lai Y, Salphati L, Hop CECA, Xiao G, Liao M, Unadkat JD. Positron Emission Tomography Imaging of [ 11 C]Rosuvastatin Hepatic Concentrations and Hepatobiliary Transport in Humans in the Absence and Presence of Cyclosporin A. Clin Pharmacol Ther 2019; 106:1056-1066. [PMID: 31102467 DOI: 10.1002/cpt.1506] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/25/2019] [Indexed: 01/16/2023]
Abstract
Using positron emission tomography imaging, we determined the hepatic concentrations and hepatobiliary transport of [11 C]rosuvastatin (RSV; i.v. injection) in the absence (n = 6) and presence (n = 4 of 6) of cyclosporin A (CsA; i.v. infusion) following a therapeutic dose of unlabeled RSV (5 mg, p.o.) in healthy human volunteers. The sinusoidal uptake, sinusoidal efflux, and biliary efflux clearance (CL; mL/minute) of [11 C]RSV, estimated through compartment modeling were 1,205.6 ± 384.8, 16.2 ± 11.2, and 5.1 ± 1.8, respectively (n = 6). CsA (blood concentration: 2.77 ± 0.24 μM), an organic-anion-transporting polypeptide, Na+ -taurocholate cotransporting polypeptide, and breast cancer resistance protein inhibitor increased [11 C]RSV systemic blood exposure (45%; P < 0.05), reduced its biliary efflux CL (52%; P < 0.05) and hepatic uptake (25%; P > 0.05) but did not affect its distribution into the kidneys. CsA increased plasma concentrations of coproporphyrin I and III and total bilirubin by 297 ± 69%, 384 ± 102%, and 81 ± 39%, respectively (P < 0.05). These data can be used in the future to verify predictions of hepatic concentrations and hepatobiliary transport of RSV.
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Affiliation(s)
- Sarah Billington
- Department of Pharmaceutics, University of Washington, Seattle, Washington, USA.,Drug Metabolism and Pharmacokinetics, Vertex Pharmaceuticals (Europe) Ltd., Abingdon-on-Thames, UK
| | - Steven Shoner
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Scott Lee
- Inflammatory Bowel Disease Program, University of Washington, Seattle, Washington, USA
| | - Kindra Clark-Snustad
- Inflammatory Bowel Disease Program, University of Washington, Seattle, Washington, USA
| | - Matthew Pennington
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA
| | - David Lewis
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Mark Muzi
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Shirley Rene
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Jean Lee
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Tot Bui Nguyen
- Department of Pharmaceutics, University of Washington, Seattle, Washington, USA
| | - Vineet Kumar
- Department of Pharmaceutics, University of Washington, Seattle, Washington, USA
| | - Kazuya Ishida
- Department of Pharmaceutics, University of Washington, Seattle, Washington, USA.,Pharmacokinetics and Drug Metabolism, Amgen, Cambridge, Massachusetts, USA
| | - Laigao Chen
- Early Clinical Development, Worldwide Research and Development, Pfizer Inc., Cambridge, Massachusetts, USA
| | - Xiaoyan Chu
- Pharmacokinetics, Pharmacodynamics, and Drug Metabolism, Merck & Co., Kenilworth, New Jersey, USA
| | - Yurong Lai
- Department of Drug Metabolism, Gilead Sciences, Inc., Foster City, California, USA
| | - Laurent Salphati
- Drug Metabolism and Pharmacokinetics, Genentech, Inc., South San Francisco, California, USA
| | - Cornelis E C A Hop
- Drug Metabolism and Pharmacokinetics, Genentech, Inc., South San Francisco, California, USA
| | - Guangqing Xiao
- Drug Metabolism and Pharmacokinetics, Biogen, Cambridge, Massachusetts, USA.,Department of Drug Metabolism and Pharmacokinetics, Takeda Pharmaceuticals International Co., Cambridge, Massachusetts, USA
| | - Mingxiang Liao
- Department of Drug Metabolism and Pharmacokinetics, Takeda Pharmaceuticals International Co., Cambridge, Massachusetts, USA
| | - Jashvant D Unadkat
- Department of Pharmaceutics, University of Washington, Seattle, Washington, USA
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4
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Currie GM. Pharmacology, Part 3A: Interventional Medications in Renal and Biliary Imaging. J Nucl Med Technol 2018; 46:326-334. [DOI: 10.2967/jnmt.118.215038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/16/2018] [Indexed: 11/16/2022] Open
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5
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Bates DDB, Tamayo-Murillo D, Kussman S, Luce A, LeBedis CA, Soto JA, Anderson SW. Biliary and pancreatic ductal dilation in patients on methadone maintenance therapy. Abdom Radiol (NY) 2017; 42:884-889. [PMID: 27770163 DOI: 10.1007/s00261-016-0946-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine whether the diameter of intrahepatic and extrahepatic bile ducts and pancreatic ducts in patients on methadone maintenance therapy is increased when compared with control subjects. METHODS Between January 1, 2000 and March 15, 2013, a total of 97 patients (mean age 49.9, range 22-79, 65 male, 32 female) were identified who were receiving chronic methadone maintenance therapy (MMT) when they underwent imaging with abdominal MRI or a contrast-enhanced abdominopelvic CT. A group of 97 consecutive non-MMT control patients (mean age 51.4, range 21-86, 45 male, 52 female) who underwent imaging with abdominal MRI or contrast-enhanced abdominopelvic CT were identified. Patients with known pancreaticobiliary pathology that may confound biliary ductal measurements were excluded. Blinded interpretation was performed, documenting the diameters of the intrahepatic and extrahepatic bile ducts and pancreatic ducts. Descriptive statistics were performed. RESULTS Patients on MMT demonstrated increased bile duct diameter, with an average increase in duct diameter of 2.39 mm for the common bile duct (p < 0.001; 95% CI 1.88-2.90 mm), 1.43 mm for the intrahepatic bile ducts (p < 0.001; 95% CI 1.12-1.74 mm), and 0.90 mm for the pancreatic duct (p < 0.001; 95% CI 0.64-1.16 mm). No statistically significant correlation was found between ductal diameters and the daily dose of methadone. CONCLUSION Patients on methadone maintenance therapy demonstrate significantly increased intra- and extrahepatic bile duct and pancreatic duct diameter when compared with controls. There was no correlation between the dose of methadone and ductal diameter.
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Affiliation(s)
- David D B Bates
- Department of Radiology, Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA, 02118, USA.
| | - Dorathy Tamayo-Murillo
- Department of Radiology, Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA, 02118, USA
| | - Steven Kussman
- Renaissance Imaging Medical Associates, 18436 Roscoe Boulevard, Northridge, CA, 91325, USA
| | - Adam Luce
- Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, 5621, Stanford, CA, 94305-5105, USA
| | - Christina A LeBedis
- Department of Radiology, Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA, 02118, USA
| | - Jorge A Soto
- Department of Radiology, Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA, 02118, USA
| | - Stephan W Anderson
- Department of Radiology, Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA, 02118, USA
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6
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Demehri FR, Alam HB. Evidence-Based Management of Common Gallstone-Related Emergencies. J Intensive Care Med 2014; 31:3-13. [DOI: 10.1177/0885066614554192] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/23/2014] [Indexed: 12/15/2022]
Abstract
Gallstone-related disease is among the most common clinical problems encountered worldwide. The manifestations of cholelithiasis vary greatly, ranging from mild biliary colic to life-threatening gallstone pancreatitis and cholangitis. The vast majority of gallstone-related diseases encountered in an acute setting can be categorized as biliary colic, cholecystitis, choledocholithiasis, and pancreatitis, although these diagnoses can overlap. The management of these diseases is uniquely multidisciplinary, involving many specialties and treatment options. Thus, care may be compromised due to redundant tests, treatment delays, or inconsistent management. This review outlines the evidence for initial evaluation, diagnostic workup, and treatment for the most common gallstone-related emergencies. Key principles include initial risk stratification of patients to aid in triage and timing of interventions, early initiation of appropriate antibiotics for patients with evidence of cholecystitis or cholangitis, patient selection for endoscopic biliary decompression, and growing evidence in favor of early laparoscopic cholecystectomy for clinically stable patients.
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Affiliation(s)
- Farokh R. Demehri
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Hasan B. Alam
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
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7
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Single-photon emission computed tomography/computed tomography as a problem-solving tool in patients with suspected acute cholecystitis. J Comput Assist Tomogr 2013; 37:844-8. [PMID: 24270104 DOI: 10.1097/rct.0b013e3182a604ae] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study was to evaluate our institutional experience with single-photon emission computed tomography/computed tomography (SPECT/CT) hepatobiliary imaging as a problem-solving tool in the workup of suspected acute cholecystitis. METHODS We queried our radiology information system database for cases in which SPECT/CT had been performed as part of the routine hepatobiliary technetium Tc 99m iminodiacetic acid studies done for the evaluation of acute cholecystitis. Fifty-three consecutive patients who had SPECT/CT after planar imaging were included. This cohort represents cases that were considered problematic by the initial interpreting physician on the basis of planar images. The planar and SPECT/CT images were retrospectively reviewed independently and separately by 2 experienced nuclear medicine specialists who evaluated the planar images for visualization of the gallbladder on a binary scale (yes or no) and rated their level of confidence on an ordinal scale(unsure, somewhat sure, and sure). RESULTS Single-photon emission CT/CT would have led to change in the management for interpreter 1 in a total of 23 cases (41%), with change from normal to abnormal scan findings (28%) and from abnormal to normal scan findings (13%). Similarly, SPECT/CT would have led to change in the management for interpreter 2 in a total of 23 cases (43%), with change from normal to abnormal scan findings (13%) and from abnormal to normal scan findings (30%). CONCLUSIONS Although planar hepatobiliary scanning is usually sensitive and specific, there are occasionally problematic cases. In our experience, we found that the addition of SPECT/CT improved the interobserver agreement and may change management in patients with superimposed bowel activity and/or unusual gallbladder anatomy that can confound the planar interpretation.
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9
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Abstract
Technologic advancements have allowed imaging modalities to become more useful in the diagnosis of hepatobiliary and pancreatic disorders. Computed tomography scanners now use multidetector row technology with contrast-delayed imaging for quicker and more accurate imaging. Magnetic resonance imaging with cholangiopancreatography can more clearly delineate liver lesions and the biliary and pancreatic ducts, and can diagnose pathologic conditions early in their course. Newer technologies, such as single-operator cholangioscopy and endoscopic ultrasonography, have sometimes shown superiority to traditional modalities. This article addresses the literature regarding available imaging techniques in the diagnosis and treatment of common surgical hepatobiliary and pancreatic diseases.
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10
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Abstract
Acute acalculous cholecystitis (ACC) can develop with or without gallstones after surgery and in critically ill or injured patients. Diabetes mellitus, malignant disease, abdominal vasculitis, congestive heart failure, cholesterol embolization, shock, and cardiac arrest also have been associated with AAC. The pathogenesis of AAC is complex and multifactorial. Ultrasound of the gallbladder is most accurate for the diagnosis of AAC in the critically ill patient. CT is probably of comparable accuracy, but carries both advantages and disadvantages. Rapid improvement may be expected when AAC is diagnosed correctly and cholecystostomy is performed timely.
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Affiliation(s)
- Philip S Barie
- Division of Critical Care and Trauma, Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY 0065, USA.
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11
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Saad WEA, Wilson IJ, Davies MG, Westesson KE, Darwish WM, Waldman DL. Intravenous morphine for augmentation of postoperative T-tube cholangiograms in liver transplant recipients with choledocho-choledochal anastomoses. J Vasc Interv Radiol 2009; 20:1320-8. [PMID: 19716711 DOI: 10.1016/j.jvir.2009.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 06/24/2009] [Accepted: 07/13/2009] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To determine the effectiveness of augmenting T-tube cholangiography by using intravenous morphine in orthotopic liver transplant recipients with choledocho-choledochostomies and poor filling of intrahepatic biliary ducts and to determine factors that may increase the likelihood of nonfilling of intrahepatic ducts. MATERIALS AND METHODS A retrospective review of T-tube cholangiograms obtained in orthotopic liver transplant recipients was performed. Intravenous morphine had been given by two of five operators to augment T-tube cholangiograms with poor filling of bile ducts. Patients with malpositioned tubes and decompressive bile leaks were excluded from morphine diagnostic efficacy evaluation but were included in the overall cholangiogram diagnostic yield. Anastomotic narrowing, if present, was graded as follows: >50%, 20%-50%, and <20% diameter reduction. Patients with intrahepatic bile duct filling were compared to those without filling with regard to age, sex, time from transplantation, and clinically significant (>50%) stenoses. RESULTS One hundred sixty-eight cholangiograms were obtained in 127 recipients. Twenty-three of the 168 cholangiograms (13.7%) had malpositioned/blocked T-tubes and five (3%) had decompressive leaks; 140 cholangiograms had well-positioned tubes and no leaks. Twenty-two of the 140 cholangiograms with well-positioned tubes and no leaks (15.7%) had nonfilling of peripheral bile ducts. Morphine (range, 2-6 mg; mean, 4 mg) had been used in 13 cases. Adequate filling after morphine was noted in 12 of the 13 cases (92%), and no complications occurred. Morphine improved adequate diagnostic examination of well-positioned patent T-tubes from 85% (123/145) to 93% (135/145). No parameters helped predict inadequate filling in well-positioned tubes (P > .05). CONCLUSIONS In 92% of cases, intravenous morphine was successful in opacifying the biliary tract without complications. In well-positioned T-tubes, the use of morphine increased diagnostic yield from 85% to 93%. No predictors for inadequate filling were found.
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Affiliation(s)
- Wael E A Saad
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA.
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12
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Zuckier LS, Freeman LM. Liver, Spleen and Biliary Tree. Clin Nucl Med 2008. [DOI: 10.1007/978-3-540-28026-2_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Anderson S, Shah NP, Zajick D, Cross M, Oates ME. A Positional Maneuver to Augment Conventional Cholescintigraphy in the Evaluation of Acute Acalculous Cholecystitis. Clin Nucl Med 2006; 31:409-11. [PMID: 16785811 DOI: 10.1097/01.rlu.0000222953.86070.9b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Stephan Anderson
- Boston University Medical Center, Nuclear Radiology Section, Department of Radiology, Boston, Massachusetts 02118, USA
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14
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Abstract
Acute cholecystitis can develop without gallstones in critically ill or injured patients. However, the development of acute acalculous cholecystitis is not limited to surgical or injured patients, or even to the intensive care unit. Diabetes, malignant disease, abdominal vasculitis, congestive heart failure, cholesterol embolization, and shock or cardiac arrest have been associated with acute acalculous cholecystitis. Children may also be affected, especially after a viral illness. The pathogenesis of acute acalculous cholecystitis is a paradigm of complexity. Ischemia and reperfusion injury, or the effects of eicosanoid proinflammatory mediators, appear to be the central mechanisms, but bile stasis, opioid therapy, positive-pressure ventilation, and total parenteral nutrition have all been implicated. Ultrasound of the gallbladder is the most accurate diagnostic modality in the critically ill patient, with gallbladder wall thickness of 3.5 mm or greater and pericholecystic fluid being the two most reliable criteria. The historical treatment of choice for acute acalculous cholecystitis has been cholecystectomy, but percutaneous cholecystostomy is now the mainstay of therapy, controlling the disease in about 85% of patients. Rapid improvement can be expected when the procedure is performed properly. The mortality rates (historically about 30%) for percutaneous and open cholecystostomy appear to be similar, reflecting the severity of illness, but improved resuscitation and critical care may portend a decreased risk of death. Interval cholecystectomy is usually not indicated after acute acalculous cholecystitis in survivors; if the absence of gallstones is confirmed and the precipitating disorder has been controlled, the cholecystostomy tube can be pulled out after the patient has recovered.
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Affiliation(s)
- Philip S Barie
- Department of Surgery, NewYork-Presbyterian Hospital, Weill Medical College of Cornell University, 525 East 68th Street, P-713A, New York, NY 10021, USA.
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Gall CA, Chambers KJ. Cholecystectomy for gall bladder dyskinesia: symptom resolution and satisfaction in a rural surgical practice. ANZ J Surg 2002; 72:731-4. [PMID: 12534385 DOI: 10.1046/j.1445-2197.2002.02531.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Gall bladder dyskinesia describes a clinical entity with symptoms of biliary colic but without objective evidence of gallstones. Recent work has suggested laparoscopic cholecystectomy as an effective treatment although this approach has not gained widespread acceptance in Australia. METHODS At the sole nuclear medicine facility in Mildura, Victoria, a retrospective search of patients with gallbladder ejection fractions </=35% on CCK-HIDA (cholecystokinin-99mTc hepatoiminodiacetic acid) scanning over a 3-year period from 1 January 1998 was undertaken. Twenty-eight patients proceeded to cholecystectomy by the author and case notes were reviewed for symptoms, preoperative investigation, operation, pathology and complications. Telephone follow-up was carried out assessing symptom response and overall satisfaction following operation. RESULTS Follow up was achieved in 100% of patients with a mean duration of 18 months. Twenty-five of 28 underwent chole-cystectomy by laparoscopic approach and there were no complications in the series. All gall bladders demonstrated an abnormality at histology. Overall, 79% of patients had some symptom improvement at follow-up with 29% completely symptom free. Six patients (21%) were not improved following cholecystectomy. Overall satisfaction was high with a median 8/10. CONCLUSION Laparoscopic cholecystectomy is recommended for gallbladder dyskinesia diagnosed on CCK-HIDA scanning, after other causes have been excluded and informed discussion regarding incomplete symptom resolution has been undertaken. Improvement without operation occurs only in the minority and is rarely complete. Cholecystectomy affords at least partial symptom relief in the majority with high levels of patient satisfaction.
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Affiliation(s)
- Carey Andrew Gall
- Department of Surgery, Mildura Base Hospital, Mildura, Victoria, Australia
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16
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Saremi F, Jadvar H, Siegel ME. Pharmacologic interventions in nuclear radiology: indications, imaging protocols, and clinical results. Radiographics 2002; 22:477-90. [PMID: 12006682 DOI: 10.1148/radiographics.22.3.g02ma20477] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Nuclear radiology is valuable in assessing pathophysiology of a variety of organ systems. Pharmacologic interventions are often employed in radionuclide imaging to monitor the physiologic changes, which in turn facilitate the diagnosis. Metoclopramide, erythromycin, and cisapride have been used for gastric emptying studies. To overcome false-negative results, cimetidine, pentagastrin, and glucagon have been used in imaging of Meckel diverticula. Pharmacologic intervention with either cholecystokinin-8 or morphine is used primarily for the assessment of diseases of the gallbladder, common bile duct, and sphincter of Oddi. Pharmacologic interventions performed during renography include diuretic administration, angiotensin-converting enzyme inhibition, and aspirin renography. Recombinant thyrotropin can be used in patients with previously treated thyroid carcinoma who require lifelong follow-up for recurrent disease. Cardiac pharmacologic stress agents fall into two categories: coronary vasodilating agents, such as dipyridamole and adenosine, and cardiac positive inotropic agents, such as dobutamine and arbutamine. Measurement of hemodynamic responses to pharmacologic flow augmentation with carbon dioxide or acetazolamide is valuable in cerebrovascular perfusion studies.
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Affiliation(s)
- Farhood Saremi
- Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine, University of Southern California, 1200 N State St, GNH 5250, Los Angeles, CA 90033, USA
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17
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Ziessman HA, Muenz LR, Agarwal AK, ZaZa AA. Normal values for sincalide cholescintigraphy: comparison of two methods. Radiology 2001; 221:404-10. [PMID: 11687683 DOI: 10.1148/radiol.2212010154] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To establish normal gallbladder ejection fraction (GBEF) values for two sincalide (cholecystokinin [CCK]) infusion dose rates, 0.01 microg per kilogram of body weight infused for 3 minutes and 0.01 microg/kg infused for 60 minutes. MATERIALS AND METHODS Twenty healthy subjects were examined. GBEFs were calculated for the 3-minute infusion and for each 15-minute interval for the 60-minute infusion. Normal values were determined by using the mean +/- 2 SDs and a more rigorous statistical analysis. RESULTS With the 3-minute infusion, GBEFs were significantly more variable than with the 45- and 60-minute values for the 60-minute infusion (P < .01, .002). With intervals including 95% of the population, the GBEF lower normal range was 16.8% for the 3-minute infusion but 31% and 41% for the 45- and 60-minute values, respectively. GBEFs of less than 35% were noted in six (30%) of 20 healthy subjects with the 3-minute infusion but in only one with the 60-minute infusion. Hepatobiliary ultrasonography was performed in six of seven subjects with GBEF of 36% or less, and US findings in all six were normal. CONCLUSION A 3-minute infusion of sincalide, 0.01 microg/kg, produces too variable a GBEF response to establish a clinically useful normal range. With 0.01 microg/kg infused for 60 minutes, clinically useful normal values were established at 45 and 60 minutes.
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Affiliation(s)
- H A Ziessman
- Division of Nuclear Medicine, Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007, USA.
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Ziessman HA. Cholecystokinin cholescintigraphy: clinical indications and proper methodology. Radiol Clin North Am 2001; 39:997-1006, ix. [PMID: 11587066 DOI: 10.1016/s0033-8389(05)70325-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- H A Ziessman
- Department of Radiology, Georgetown University Hospital, Washington, DC 20007, USA.
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Hervás Benito I, Monfort JA, García Sanchís L, Saura Quiles A, Bello Arques P, Rivas Sánchez A, González Cabezas P, Mateo Navarro A. [Hepatobiliary scintigraphy in a case of acute cholecystitis in childhood]. REVISTA ESPANOLA DE MEDICINA NUCLEAR 2000; 19:361-4. [PMID: 11062113 DOI: 10.1016/s0212-6982(00)71891-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Acute cholecystitis is an uncommon disease in childhood. Few cases in patients under 10 years of age have been found in literature. An eight-year old male patient with no history of interest who had acute acalculous cholecystitis was reported. Ultrasonographic and isotopic studies led to the diagnosis and control of the patient's evolution.
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Affiliation(s)
- I Hervás Benito
- Hospital Universitario La Fe. Servicio de Medicina Nuclear. Valencia
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Kim CK, Yun M, Lim JK, Lin X, Krynyckyi BR, Machac J. Refinement of the positive predictive value of gallbladder nonvisualization after morphine administration for acute cholecystitis based on the temporal pattern of common bile duct activity. Clin Nucl Med 2000; 25:603-7. [PMID: 10944014 DOI: 10.1097/00003072-200008000-00006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED The authors previously reported two major patterns in the time-activity curve of the common hepatic bile duct (BD) after morphine administration in patients with gallbladder nonvisualization. The first pattern consists of a gradual increase in BD activity (of variable duration) occurring during a simultaneous decrease in liver parenchymal activity (BD increase), representing the physiologic effects of morphine administration. The second pattern consists of a continuous decrease in BD activity that parallels the activity in the liver parenchyma (BD decrease), representing lower or no physiologic effects of morphine administration. The authors hypothesize that gallbladder nonvisualization associated with a continuous decrease in BD activity after morphine administration will have a lower positive predictive value (PPV) for acute cholecystitis than gallbladder nonvisualization associated with an increase in BD activity. METHODS Thirty-six patients who had morphine-augmented cholescintigraphy were divided into two groups: 19 with BD increase after morphine administration and 17 with BD decrease. RESULTS Of the 36 patients, 22 had acute cholecystitis. The positive predictive value (PPV) of gallbladder nonvisualization was 61%. All of the remaining 14 had chronic cholecystitis. Of 19 patients with BD increase, 15 had acute cholecystitis (PPV = 79%), whereas only 7 of 17 patients with BD increase (PPV = 41 %) had acute cholecystitis (P = 0.023 by the one-tailed and 0.038 by the two-tailed Fisher exact tests). CONCLUSIONS Gallbladder nonvisualization after morphine administration with the pattern of BD decrease is not as reliable (intermediate probability in this series) for the diagnosis of acute cholecystitis as is nonvisualization of the gallbladder in patients with a pattern of BD increase (high probability).
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Affiliation(s)
- C K Kim
- Department of Radiology, Mount Sinai School of Medicine, New York, New York, USA.
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