The clinical utility of quantitative cholescintigraphy: the significance of gallbladder dysfunction.
OBJECTIVE
Cholelithiasis is a common disorder occurring in over 20 million people in the United States and resulting in approximately 600,000 cholecystectomies annually. Although over 95% of biliary tract disease is caused by gallstones, the vast majority (>80%) of cholelithiasis cases are asymptomatic. The purpose of this study is to evaluate the utility of quantitative cholescintigraphy in detecting symptomatic biliary tract disease and predicting clinical relief after cholecystectomy.


METHODS
Fifty-two patients with clinical symptoms of chronic cholecystitis were evaluated by cholescintigraphy with a gallbladder ejection fraction calculated after the intravenous administration of cholecystokinin. A gallbladder ejection fraction of > or =35% was considered a normal physiologic response. Forty-one of the patients subsequently underwent cholecystectomy, whereas the remaining 11 subjects were diagnosed and treated for non-biliary disorders that did not require cholecystectomies. After clinical follow-up including histopathological gallbladder findings, all subjects' final diagnoses were established and correlated with their quantitative cholescintigram study.


RESULTS
Twenty-six of twenty-eight patients who had an abnormal quantitative cholescintigram demonstrated evidence of chronic cholecystitis by histopathologic criteria after cholecystectomy. Furthermore, 27 of these 28 patients (96%) experienced complete relief of their clinical symptoms after surgery.


CONCLUSIONS
Functional cholescintigraphy is a safe, accurate, and useful test for detecting symptomatic gallbladder disease, and appears reliable in predicting symptomatic relief after cholecystectomy.
Klieger
P S
PS
Division of Nuclear Medicine, University of Rochester Medical Center, New York 14642, USA.
O'Mara
R E
RE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D002764:Cholecystitis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D002766:Cholecystokinin / Q000008:administration & dosage; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000601:surgery; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005704:Gallbladder / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D005765:Gastrointestinal Agents / Q000008:administration & dosage; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000187:drug effects; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D012074:Remission Induction; D015203:Reproducibility of Results; D012449:Safety; D012680:Sensitivity and Specificity
D005765:Gastrointestinal Agents; D002766:Cholecystokinin