title: Revisiting morphine-augmented hepatobiliary imaging for diagnosing acute cholecystitis: the potential pitfall of high false positive rate.
abstract: OBJECTIVE
  The aim of this retrospective study was to investigate the efficacy of morphine-augmented hepatobiliary imaging (MAHBI) for diagnosing acute cholecystitis (AC).
  
  
  METHODS
  Sixty-eight patients (Male:Female = 36:32, age = 54 ± 17 years) referred for diagnosis of AC by 30-min post-morphine MAHBI after the standard 1-h imaging were recruited. Non-visualization of gallbladder on 30-min post-morphine images by visual analysis was considered positive. Final diagnosis of pathological examination for all patients was used as the gold standard.
  
  
  RESULTS
  There was significant correlation of AC and MAHBI (p < 0.05). There were 45 true positive (TP), 19 false positive (FP), 4 true negative (TN), and no false negative (FN) cases using gallbladder visualization by 30-min post-morphine as the criteria, with a high false positive rate of 83%. The sensitivity, specificity, accuracy, positive and negative predictive values of MAHBI in detecting AC were 100%, 17%, 72%, 70%, and 100%, respectively.
  
  
  CONCLUSIONS
  MAHBI is sensitive but may not specific for diagnosing AC due to the potential pitfall of high false positive rate. Correlation with other clinical findings is recommended for optimal patient management.
authors.affiliation: Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, bortau@adm.cgmh.org.tw.
authors.forename: Bor-Tau
authors.initials: BT
authors.lastname: Hung
authors.forename: Katie S
authors.initials: KS
authors.lastname: Traylor
authors.forename: Ching-yee Oliver
authors.initials: CY
authors.lastname: Wong
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001659:Biliary Tract / Q000000981:diagnostic imaging*; D041881:Cholecystitis, Acute / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008099:Liver / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013667:Technetium
chemical_list: D000701:Analgesics, Opioid; D019275:Radiopharmaceuticals; D013667:Technetium; D009020:Morphine