title: Right upper quadrant pain with normal hepatobiliary ultrasound: can hepatobiliary scintigraphy define the cause?
abstract: OBJECTIVE
  The objective of this study was to assess the value of hepatobiliary scintigraphy (HS) for the diagnosis of right upper quadrant (RUQ) abdominal pain in patients with normal hepatobiliary ultrasound (HU). This is an observational study with a retrospective analysis of data from March 2008 to August 2010.
  
  
  METHODS
  We reviewed the HS results of 30 patients, aged 29-69 years (average 45.8 years); 12 male and 18 female patients. Patient selection to perform the HS was RUQ abdominal pain, suspected hepatobiliary disorder, and negative HU. All patients had gone through the standard procedure of HS.
  
  
  RESULTS
  Based on predefined interpretation criteria, HS results were divided into 2 patterns: Normal (n=8, 25.8%) and abnormal (n=22, 73%): 18 patients (81.8%) having early gallbladder (GB) and common bile duct visualization, and delayed transit to small bowel (SB), which can be seen only after a fatty meal with normal or abnormal GB ejection fraction (GBEF) pattern characteristic of Oddi's sphincter dyskinesia. The remaining 4 patients (8.18%) had acalculous cholycystitis pattern: Delayed GB visualization with activity appearing in SB before GB.
  
  
  CONCLUSIONS
  HS with fatty meal stimulation and GBEF estimation seems to be a reliable test, which may reveal a biliary cause in more than 70% of patients with RUQ abdominal pain and normal HU. Normal results exclude functional biliary cause. The decision for invasive or noninvasive therapeutic approach may depend on the results of HS.
authors: Department of Radiology and Medical Imaging, King Khalid University Hospital and College of Medicine, King Saud University, Riyadh, Saudi Arabia. sothman@ksu.edu.sa
authors: Saleh A
authors: SA
authors: Othman
mesh_terms: D015746:Abdominal Pain / Q000000981:diagnostic imaging* / Q000209:etiology*; D000328:Adult; D000368:Aged; D000814:Aniline Compounds; D003137:Common Bile Duct Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D005998:Glycine; D006785:Hospitals, University; D006801:Humans; D007098:Imino Acids; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D009803:Sphincter of Oddi; D014463:Ultrasonography
chemical_list: D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C034837:technetium Tc 99m mebrofenin; D005998:Glycine