Clinical analysis of contributors to the delayed gallbladder opacification following the use of water-soluble contrast medium

Abstract

Objectives Gallbladder opacification (GBO) on computed tomography (CT) imaging may obscure certain pathological or emergent conditions in the gallbladder, such as neoplasms, stones, and hemorrhagic cholecystitis. This study aimed to investigate the clinical contributing factors that could predict the presence of delayed GBO determined by CT. Methods This study retrospectively evaluated 243 consecutive patients who received enhanced CT or intravenous pyelography imaging and then underwent abdominal CT imaging within 5 days. According to the interval between imaging, the patients were divided into group A (1 day), group B (2 or 3 days), and group C (4 or 5 days). Three radiologists evaluated CT images to determine GBO. Fisher’s exact test and multivariate backward stepwise elimination logistic regression were performed. Results Positive GBO was significantly associated with the interval between imaging studies, contrast type, contrast volume, renal function, and hypertransaminasemia ( P <0.05). Multivariate backward stepwise elimination logistic regression analysis of the three groups identified contrast type and hypertransaminasemia as independent predictors of GBO in group B patients (odds ratio [OR], 13.52, 95% confidence interval [CI], 1.72–106.38 and OR, 3.43, 95% CI, 1.31–8.98, respectively; P <0.05). Hypertransaminasemia was the only independent predictor of GBO in group C patients with an OR of 7.2 (95% CI, 1.62–31.73). Hypertransaminasemia was noted in three patients (100%) who initially underwent imaging 5 days prior to GBO. Conclusion Delayed GBO on CT imaging may be associated with laboratory hypertransaminasemia, particularly in patients receiving contrast medium over a period of ≥4 days. A detailed clinical history, physical examination, and further workup are of paramount importance for investigating the underlying cause behind the hypertransaminasemia.

Octreotide-induced acute life-threatening gallstones after vicarious contrast medium excretion: A case report

“…VCME refers to the excretion of water-soluble CM through a route other than renal secretion, and is a well-known phenomenon, although the exact mechanism is still not fully understood. According to previous studies, these authors believed that possible factors promoting the heterotopic biliary (vicarious) excretion of CM included prolonged recirculation of the CM due to impaired renal function, hypovolemia and hypotension, and increased protein binding of CM in the presence of acidosis[ 1 , 3 ]. Higher doses, higher molecular weight and lower osmotic pressure of CM are also thought to be factors contributing to VCME[ 1 , 3 ].…”

“…According to previous studies, these authors believed that possible factors promoting the heterotopic biliary (vicarious) excretion of CM included prolonged recirculation of the CM due to impaired renal function, hypovolemia and hypotension, and increased protein binding of CM in the presence of acidosis[ 1 , 3 ]. Higher doses, higher molecular weight and lower osmotic pressure of CM are also thought to be factors contributing to VCME[ 1 , 3 ]. Although VCME can also occur in patients with normal renal function, studies have shown that patients with renal insufficiency have a higher incidence of VCME[ 1 ].…”

Computed Tomography in a Patient With Blunt Trauma

“…Earlier studies have demonstrated that VCME and its most common variant, gallbladder opacification, are associated with increased serum creatinine levels, unilateral renal pathologic findings, high-contrast dosing, frequent contrast loads secondary to multiple imaging studies, hypotension, and gallbladder stasis . Other studies have shown VCME and gallbladder opacification to be normal variants that may occur in patients with normal renal function . This patient had several risk factors for VCME, including unilateral renal disease, elevated serum creatinine levels, multiple contrast loads over a 48-hour period, and mild hypotension.…”

A young woman with right upper quadrant pain

“…Generally, contrast medium is excreted via the kidney. Vicarious excretion involves contrast medium being excreted via other organs, including the stomach, small intestine, or gallbladder 2 , 3 . Few cases of vicarious excretion via the gallbladder have been reported, 4 but several recent reports have suggested that vicarious excretion via the gallbladder occurs in patients with cholelithiasis.…”

“…Few cases of vicarious excretion via the gallbladder have been reported, 4 but several recent reports have suggested that vicarious excretion via the gallbladder occurs in patients with cholelithiasis. Vicarious excretion via the gallbladder is relatively common after intravenous contrast medium injection and may present as gallbladder opacification in delayed plain radiographs or APCT 2 . Bile, an enzymatic secretion made by hepatocytes, is modified by the bile duct epithelium and flows through the interlobular septa to the common bile duct; it is concentrated in the gallbladder, resulting in gallbladder opacification 5 …”