Cholecystokinin and morphine pharmacological intervention during 99mTc-HIDA cholescintigraphy: A rational approach

Normal Values for Sincalide Cholescintigraphy: Comparison of Two Methods

“…Some investigators reporting on the clinical utility of sincalide cholescintigraphy (5-8), Krishnamurthy and Krishnamurthy (11,12), and Fink-Bennett (19,20) state, without equivocation, that an abnormal GBEF is less than 35% with 1-3-minute infusions of 0.01-0.02 g/kg; sometimes these authors cite specific references (21)(22)(23) to this information. Scrutiny of these articles reveals that in one study a fatty meal was used as a stimulus (23), while in the others, few subjects were included and mixed dose rates were used (21,22).…”

“…The 0.01 g/kg dose had the highest mean GBEF (Table 4). This is the basis for the assertion that 0.01 g/kg infused for 3 minutes is the optimal dose rate for sincalide infusion and that a GBEF less than 35% is abnormal (11,12). However, only seven subjects received this dose rate, far too few to establish reliable normal values.…”

“…Krishnamurthy and Krishnamurthy (11,12) state that 0.02 g/kg infused for 3 minutes is a nonphysiologic dose rate but assert that 0.01 g/kg infused for 3 minutes is the optimal Nuclear Medicine dose rate for sincalide and that this dose rate does not have the problems reported with 0.02 g/kg for a 3-minute infusion, which makes a longer infusion unnecessary (11,12). However, published data to support this assertion are limited.…”

Evidence-Based Management of Common Gallstone-Related Emergencies

“…24 Patients should have fasted for a minimum 4 hours and opioid derivatives should be avoided prior to imaging as these can decrease the gallbladder ejection fraction. 28 Nonvisualization of the gallbladder indicates acute cholecystitis, and morphine may be administered to induce delayed filling and differentiate acute cholecystitis from abnormal gallbladder emptying. If the gallbladder is observed, administration of cholecystokinin allows measurement of ejection faction, with values less than 38% being abnormal.…”

Noninvasive Imaging of the Biliary System

“…On occasion, images are obtained 2 to 4 hours later to ensure the diagnosis. Morphine sulfate can be used to shorten the examination time; by contracting the sphincter of Oddi, it results in preferential flow of bile through the cystic duct into the gallbladder [102,103]. Ancillary findings such as increased blood flow to the gallbladder fossa and increased hepatic parenchymal uptake in the gallbladder fossa ("rim" sign) increase the specificity of this exam (Fig.…”