title: Prognostic value and pathophysiologic significance of the rim sign in cholescintigraphy.
abstract: This study reviews 27 patients with nonvisualization of the gallbladder on cholescintigraphy. The preoperative diagnosis of acute cholecystitis was confirmed pathologically in 23. A rim of increased hepatic activity (RIHA) adjacent to the gallbladder fossa was seen throughout the study in 35% with acute cholecystitis and in no patients with chronic cholecystitis. Nine patients with "complicated" cholecystitis (defined pathologically as a late stage of the spectrum of acute cholecystitis) had a positive RIHA in contrast to no patients with "noncomplicated acute cholecystitis" (p less than 0.05). The sensitivity/specificity of the RIHA for "complicated" acute cholecystitis was 45%/100% and the positive/negative predictive value was 100%/39%. Liver tissue that was attached to the gallbladder by adhesions and removed at surgery was reviewed histologically and correlated with the presence or absence of a RIHA. The RIHA seems to be a useful indicator of patients presenting at a later stage of the pathologic spectrum of acute cholecystitis and perhaps at increased risk for complications.
authors: Department of Radiology, Georgetown University Medical Center, Washington, DC 20007.
authors: G K
authors: GK
authors: Meekin
authors: H A
authors: HA
authors: Ziessman
authors: R S
authors: RS
authors: Klappenbach
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002764:Cholecystitis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002908:Chronic Disease; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007098:Imino Acids; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D011379:Prognosis; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D019785:Technetium Tc 99m Disofenin
chemical_list: D007098:Imino Acids; D009942:Organometallic Compounds; D019785:Technetium Tc 99m Disofenin