Cholescintigraphy in acute cholecystitis: use of intravenous morphine.

Abstract

Conventional cholescintigraphy (60 patients) and a modified protocol (59 patients) were compared in 74 females and 45 males with acute cholecystitis. In the modified protocol, intravenous morphine (0.04 mg/kg) was administered whenever the gallbladder was not seen 40 minutes after injection of Tc-99m-pyridoxylideneglutamate (36/59). Accuracy was 98% with morphine, compared with 88% for the conventional protocol; specificity improved from 83% to 100% with no loss of sensitivity (96% in both groups). Low doses of morphine are well tolerated and can result in a highly accurate diagnosis of acute cholecystitis without the need for delayed imaging.

Contribution of ultrasonography and cholescintigraphy to the diagnosis of acute acalculous cholecystitis in intensive care unit patients

“…These risk factors lead to abnormal uptake, excretion of scanning agents, and impaired visualization of the biliary tree, limiting the usefulness of cholescintigraphy in critically ill patients [10,11,27]. Choy et al [12] suggested using morphine to increase common bile duct pressure by contraction of the sphincter of Oddi. This may overcome partial or functional cystic duct obstruction, decreasing the rate of false positives.…”

“…US is the most accurate noninvasive test for identifying gallbladder disease but is reported to be inconclusive in critically ill patients owing to a high false-negative rate [8,9]. Cholescintigraphy, an alternative diagnostic tool, has a high false-positive rate in critically ill patients [10,11], but when used with morphine sulfate (MC) it has shown improved diagnostic accuracy [12,13]. Numerous retrospective studies have compared US and cholescintigraphy [2,3,9].…”

Progress and direction of gastrointestinal nuclear medicine

“…Many studies have now confirmed the original work of Choy et al [1] and proven that MS-augmented cholescintigraphy is at least as accurate as the delayed imaging method [2][3][4][5]. If the cystic duct is patent, gallbladder filling begins within 5-10 rain of infusing 0.02 mg/kg MS and the entire study can be completed in 60-90 rain, depending on when the drug is infused.…”

Enlarged common hepatic duct secondary to morphine in a neonate

“…Morphine has also been used to increase the pressure in the c o m m o n bile duct and thereby increase the likelihood of filling the gallbladder with radiotracer if there is no obstruction in the cystic duct [2].…”