SNM Practice Guideline for Hepatobiliary Scintigraphy 4.0

Tülchinsky, Mark; Ciak, Brian W.; Delbeke, Dominique; Hilson, A. J.W.; Holes-Lewis, Kelly Anne; Stabin, Michael G.; Ziessman, Harvey A.

doi:10.2967/jnmt.110.082289

Cited by 99 publications

(62 citation statements)

References 75 publications

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“…Proposing that longer duration of infusion is more physiologic, Ziessman et al [37] and Ziessman [38] described the infusion of 0.02 μg/kg of Sincalide® (synthetically prepared C-terminal octapeptide of CCK) over 30 min in patients fasting for 3-4 h. A multicenter study conducted to investigate the optimal method of infusing CCK concluded that Sincalide infusion over 60 min offered the least amount of variability in GBEF [39]. Current practice guidelines developed by the Society of Nuclear Medicine Task Force [40], with input from both the American College of Radiology and the European Association of Nuclear Medicine, recommend the infusion of 0.02 μg/kg of Sincalide over a 60-min period with a normal value of at least 38%. However, the effectiveness of this method in chronic gallbladder disease has not been well documented to date.…”

Section: Diagnostic Modalitiesmentioning

confidence: 99%

Gallbladder Dysfunction: How Much Longer Will It Be Controversial?

Goussous¹,

Kowdley²,

Sardana³

et al. 2014

Digestion

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Background: Motility disorders of the biliary tree [biliary dyskinesia, including both gallbladder dysfunction (GBD), and sphincter of Oddi dysfunction] are difficult to diagnose and to treat. Summary: There is controversy in the literature in particular regarding the criteria that should be used to select patients for cholecystectomy (CCY) in cases of suspected GBD. The current review covers the history, diagnosis, and treatment of GBD. Key Messages: Only >85% of patients with suspected GBD have relief following CCY, a much lower rate than the nearly 100% success rate following CCY for gallstone disease. Unfortunately, the literature is lacking, and there are no universally agreed-upon criteria for selecting which patients to refer for operation, although cholecystokinin (CCK)-enhanced hepatobiliary iminodiacetic acid scan is often used, with emphasis on an abnormally low gallbladder ejection fraction or pain reproduction at CCK administration. There is a clear need for large, well-designed, more definitive, prospective studies to better identify the indications for and efficacy of CCY in cases of GBD. i 2014 S. Karger AG, Basel

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Section: Diagnostic Modalitiesmentioning

confidence: 99%

Gallbladder Dysfunction: How Much Longer Will It Be Controversial?

Goussous¹,

Kowdley²,

Sardana³

et al. 2014

Digestion

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“…However, there are several pitfalls in this examination. False-positivity in some conditions, including insufficient or prolonged fasting state, severe hepatocellular disease, bile duct obstruction, or severe chronic cholecystitis, could lead to the inaccurate diagnosis [13]. The most important drawback is that nonvisualized gallbladder is estimated at zero % of GBEF.…”

Section: Discussionmentioning

confidence: 99%

“…If no radioactivity was detected in the gallbladder area at 4 hours after the infusion, the patient was classified as having nonvisualization of the gallbladder and the scintigraphic recording was stopped. For the calculation of gallbladder ejection fraction (GBEF), standard nuclear medicine software was used based on the following equation: GBEF (%) = (net gallbladder max ) − (net gallbladder min ) × 100/net gallbladder max [13]. The nonvisualization of gallbladder after 4 hours on scintigraphy was defined as zero % of GBEF.…”

Section: Cholescintigraphymentioning

confidence: 99%

Acute Cholecystitis after Screening Colonoscopy

Jeong¹,

Jung²

2016

Korean J Pancreas Biliary Tract

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Objective. Contractility of gallbladder is known to be decreased in fatty gallbladder diseases. However, clinical estimation data about this relationship is still lacking. The aim of this study was to investigate the association between steatocholecystitis and contractility of gallbladder. Methods. Patients with cholecystitis (steatocholecystitis versus nonsteatocholecystitis) who underwent cholescintigraphy before cholecystectomy were retrospectively evaluated in a single teaching hospital of Korea. The association of steatocholecystitis with contractility of gallbladder, measured by preoperative cholescintigraphy, was assessed by univariable and multivariable analysis. Results. A total of 432 patients were finally enrolled (steatocholecystitis versus nonsteatocholecystitis; 75 versus 357, calculous versus acalculous cholecystitis; 316 versus 116). In the multivariable analysis, age (OR: 0.94, 95% CI: 0.90-0.99, = 0.01) and total serum cholesterol (OR: 1.02, 95% CI: 1.01-1.04, = 0.04) were related to steatocholecystitis in patients with acalculous cholecystitis. Only age (OR: 0.97, 95% CI: 0.94-0.99, = 0.004) was significantly related to steatocholecystitis in patients with calculous cholecystitis. However, ejection fraction of gallbladder reflecting contractility measured by cholescintigraphy was not related to steatocholecystitis irrespective of presence of gallbladder stone in patients with cholecystitis. Conclusion. Ejection fraction of gallbladder measured by cholescintigraphy cannot be used for the detection or confirmation of steatocholecystitis.

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“…The imaging protocol for cholescintigraphy has become fairly standardized (12). A 60-s blood flow phase (1-to 3-s frames) is optional.…”

Section: Scintigraphic Protocolmentioning

confidence: 99%

Hepatobiliary Scintigraphy in 2014

Ziessman

2014

J Nucl Med

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CE Credit: For CE credit, you can access the test for this article, as well as additional JNMT CE tests, online at https://www.snmmilearningcenter.org. Complete the test online no later than December 2017. Your online test will be scored immediately. You may make 3 attempts to pass the test and must answer 80% of the questions correctly to receive 1.0 CEH (Continuing Education Hour) credit. SNMMI members will have their CEH credit added to their VOICE transcript automatically; nonmembers will be able to print out a CE certificate upon successfully completing the test. The online test is free to SNMMI members; nonmembers must pay $15.00 by credit card when logging onto the website to take the test. Participants who have already taken the exam using JNM and passed cannot retake the exam.Cholescintigraphy with 99m Tc-hepatobiliary radiopharmaceuticals has been an important, clinically useful diagnostic imaging study for almost 4 decades. It continues to be in much clinical demand; however, the indications, methodology, and interpretative criteria have evolved over the years. This review will emphasize state-of-the-art methodology and diagnostic criteria for various clinical indications, including acute cholecystitis, chronic acalculous gallbladder disease, high-grade and partial biliary obstruction, and the postcholecystectomy pain syndrome, including sphincter-of-Oddi dysfunction and biliary atresia. The review will also emphasize the use of diagnostic pharmacologic interventions, particularly sincalide. Now almost 4 decades old, 99m Tc cholescintigraphy continues to be a radionuclide imaging study in much clinical demand. Its strength lies in the fact that the diagnostic information provided defines pathophysiology rather than anatomy.123 I-and 123 I-rose bengal were the first clinically useful cholescintigraphic agents; however, image quality was relatively poor (Fig. 1). 99m Tc-hepatobiliary radiopharmaceuticals began to be widely used by the early 1980s.The discovery of 99m Tc-hepatobiliary (HIDA) radiopharmaceuticals was by chance. During investigation for a cardiac imaging radiopharmaceutical, it was found that 99m Tclabeled lidocaine was not a good cardiac imaging agent but cleared through the hepatobiliary system. With chemical modification, 99m Tc-HIDA imaging agents were born. Loberg et al. reported on this in 1976 (1). Its structure is simply that of 2 lidocaine analogs bichelated to 99m Tc by iminodiacetic acid (IDA) (Fig. 2). HIDA (hepatoiminodiacetic acid) has long been used as a generic term for cholescintigraphy.Modifications of the benzene ring of the lidocaine analogs resulted in an alphabet soup of hepatobiliary radiopharmaceuticals (PIPIDA, BIDA, EIDA, DIDA, DISIDA, etc.), each with different rates of hepatic uptake and clearance. The first 99m Tc-HIDA radiopharmaceutical was approved for clinical use by the Food and Drug Administration in 1982. Dimethyl IDA (lidofenin [Technescan; Mallinckrodt]) was a major advance, but image quality and diagnostic utility were suboptimal in patients with seru...

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SNM Practice Guideline for Hepatobiliary Scintigraphy 4.0

Cited by 99 publications

References 75 publications

Gallbladder Dysfunction: How Much Longer Will It Be Controversial?

Gallbladder Dysfunction: How Much Longer Will It Be Controversial?

Acute Cholecystitis after Screening Colonoscopy

Hepatobiliary Scintigraphy in 2014

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