title: Morphine augmentation increases gallbladder visualization in patients pretreated with cholecystokinin.
abstract: The purpose of this study was to determine if a combination of cholecystokinin (CCK) pretreatment followed by morphine augmentation improved the detection of cystic duct patency compared with CCK pretreatment only.
  
  
  METHODS
  One hundred fifty-five patients with suspected acute cholecystitis had scintigraphy performed with 185-481 MBq (5-13 mCi) 99mTc-mebrofenin adjusted to the patients' total bilirubin levels. All patients were pretreated with 0.02 microgram/kg sincalide injected intravenously over 3-5 min. Sequential imaging was performed until gallbladder activity was identified or up to 90 min postinjection of mebrofenin. If no gallbladder was identified, a second dose of mebrofenin was given as necessary to have tracer in the biliary system. Then, 0.04 mg/kg intravenous morphine sulfate was administered, followed by imaging for up to 30 min or until gallbladder visualization.
  
  
  RESULTS
  Twenty-eight percent (43/155) of the patients pretreated with CCK had nonvisualization of the gallbladder at 90 min postinjection of radiotracer. After intravenous morphine, the gallbladder was identified in 42% (18/43) of these patients (p = 0.0001).
  
  
  CONCLUSIONS
  Hepatobiliary imaging with CCK pretreatment and imaging for 90 min was insufficient to identify all patent cystic ducts. Morphine augmentation significantly increased the frequency of gallbladder visualization in patients pretreated with CCK.
authors.affiliation: Department of Diagnostic Radiology, University of Maryland Medical System, Baltimore, USA.
authors.forename: C C
authors.initials: CC
authors.lastname: Chen
authors.forename: L E
authors.initials: LE
authors.lastname: Holder
authors.forename: C
authors.initials: C
authors.lastname: Maunoury
authors.forename: C I
authors.initials: CI
authors.lastname: Drachenberg
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000814:Aniline Compounds; D002764:Cholecystitis / Q000000981:diagnostic imaging; D002766:Cholecystokinin / Q000008:administration & dosage* / Q000494:pharmacology; D003549:Cystic Duct / Q000000981:diagnostic imaging / Q000187:drug effects; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging*; D016473:Gallbladder Emptying / Q000187:drug effects; D005998:Glycine; D006801:Humans; D007098:Imino Acids; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000494:pharmacology; D015609:Organotechnetium Compounds; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity
chemical_list: D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; D009020:Morphine; D002766:Cholecystokinin; C034837:technetium Tc 99m mebrofenin; D005998:Glycine