Cholecystokinin-Stimulated mebrofenin (99mTc-Choletec) hepatobiliary scintigraphy in asymptomatic postcholecystectomy individuals: assessment of specificity, interobserver reliability, and reproducibility.
OBJECTIVE
Cholecystokinin-stimulated hepatobiliary scintigraphy (CCK-HBS) is a noninvasive method reported to be highly accurate in the diagnosis of sphincter of Oddi dysfunction. Our primary aim was to assess the specificity of CCK-HBS by evaluating its ability to exclude disease in 20 asymptomatic postcholecystectomy individuals. Secondary aims were to assess the interobserver reliability in scoring the CCK-HBS examinations between three blinded observers and to assess reproducibility of CCK-HBS repeated in the same individuals.


METHODS
Twenty asymptomatic postcholecystectomy individuals with normal liver serum chemistries underwent CCK-HBS on two separate occasions. Three nuclear medicine specialists read each CCK-HBS study in a blinded fashion.


RESULTS
There was good agreement between the three observers reading the same scans for both the first scan (kappa = 0.554) and the second scan (kappa = 0.507). There was poor agreement between the first and second scans on the same patient, read by the same nuclear medicine specialist (kappa = 0.062-0.385). The overall specificity of the CCK-HBS score was 77.5%; however, the specificity was only 60% when a true negative was defined as two negative CCK-HBS examinations.


CONCLUSIONS
Quantitative CCK-HBS is of poor specificity in asymptomatic postcholecystectomy individuals. Hence, it is of questionable value in excluding sphincter of Oddi dysfunction in patients suspected to suffer from this disorder.
Pineau
B C
BC
Section of Gastroenterology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
Knapple
W L
WL
Spicer
K M
KM
Gordon
L
L
Wallace
M
M
Hennessy
W S
WS
Hawes
R H
RH
Cotton
P B
PB
D000328:Adult; D000368:Aged; D000814:Aniline Compounds; D002763:Cholecystectomy; D003135:Common Bile Duct / Q000000981:diagnostic imaging*; D005260:Female; D005765:Gastrointestinal Agents; D005998:Glycine; D006801:Humans; D007098:Imino Acids; D008099:Liver / Q000000981:diagnostic imaging*; D008875:Middle Aged; D015588:Observer Variation; D015609:Organotechnetium Compounds; D011182:Postoperative Care; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012844:Sincalide; D009803:Sphincter of Oddi / Q000000981:diagnostic imaging
D000814:Aniline Compounds; D005765:Gastrointestinal Agents; D007098:Imino Acids; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C034837:technetium Tc 99m mebrofenin; D012844:Sincalide; D005998:Glycine