Role of cholecystokinetic agents in 99mTc-IDA cholescintigraphy

Freeman, Leonărd M.; Sugarman, Leroy A.; Weissmann, Heidi S.

doi:10.1016/s0001-2998(81)80003-7

Cited by 25 publications

(5 citation statements)

References 19 publications

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“…Other literature suggests that abnormal function with CCK may be detected before histologic changes are found in the gallbladder wall (29). Thus, further investigation of fMRC in conjunction with CCK administration constitutes a future direction of research.…”

Section: Discussionmentioning

confidence: 95%

Functional magnetic resonance cholangiography (fMRC) of the gallbladder and biliary tree with contrast‐enhanced magnetic resonance cholangiography

Fayad

Holland

Bergin

et al. 2003

Magnetic Resonance Imaging

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Purpose:To determine the diagnostic performance of functional magnetic resonance cholangiography (fMRC) for the evaluation of anatomic and functional biliary disorders.Materials and Methods: At 1.5 T, 39 MR examinations with conventional MRC and mangafodipir trisodium-enhanced fMRC were retrospectively reviewed by three observers who recorded anatomic (duct dilation, stricture, filling defects) and functional (cholecystitis, obstruction) abnormalities in three modes: MRC alone, fMRC alone, and MRC and fMRC images together (combined-MRC). Performance was determined by comparing findings with each mode to findings of invasive cholangiography (IC) and surgery.Results: Among 75 biliary segments (correlated with IC), the sensitivity/specificity for diagnosing dilation (N ϭ 41) with MRC was 95%/97%; with fMRC, 90%/100%; with combined-MRC, 100%/97%. For stricture (N ϭ 7), the sensitivity/specificity of MRC was 86%/98%; of fMRC, 43%/100%; of combined-MRC, 86%/100%. For filling defects (N ϭ 9), the sensitivity/specificity of MRC was 91%/98%; of fMRC, 82%/ 100%; of combined-MRC, 91%/100%. For diagnosing obstruction (N ϭ 9), the sensitivity/specificity of MRC, fMRC, and combined-MRC were 89%/100%, 100%/100%, and 100%/100%, respectively. For surgically proven cholecystitis (N ϭ 13), positive predictive values for diagnosing acute/ chronic cholecystitis for MRC were 33%/40%; for fMRC, 100%/50%; for combined-MRC, 100%/50%. Conclusion:Although single-shot fast spin echo (SSFSE)-MRC is valuable, the addition of fMRC increased diagnostic performance for functional biliary disorders.

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Section: Discussionmentioning

confidence: 95%

Functional magnetic resonance cholangiography (fMRC) of the gallbladder and biliary tree with contrast‐enhanced magnetic resonance cholangiography

Fayad

Holland

Bergin

et al. 2003

Magnetic Resonance Imaging

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“…Delayed gallbladder filling is caused by a functional resistance to flow through the cystic duct, often due to viscous concentrated bile within the gallbladder, gallstones, chronic mucosal thickening, and fibrosis. Visualization of the gallbladder by the end of the first hour after these patients are pretreated with cholecystokinin is considered evidence for a functional mechanism (17). Other scintigraphic findings suggestive of chronic cholecystitis include delayed biliary-to-bowel transit with normal gallbladder filling (18).…”

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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“…It was introduced as a means of reducing potential false-positive results for acute cholecystitis and of shortening the total imaging time [ 91 ]. The rationale of this approach is that gallbladder emptying before initiating the study is generally followed by more reliable gallbladder fi lling during the cholescintigraphy.…”

Section: Basis Of Scintigraphic Interventionsmentioning

confidence: 99%

Digestive System

Elgazzar¹

2014

Synopsis of Pathophysiology in Nuclear Medicine

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Role of cholecystokinetic agents in 99mTc-IDA cholescintigraphy

Cited by 25 publications

References 19 publications

Functional magnetic resonance cholangiography (fMRC) of the gallbladder and biliary tree with contrast‐enhanced magnetic resonance cholangiography

Functional magnetic resonance cholangiography (fMRC) of the gallbladder and biliary tree with contrast‐enhanced magnetic resonance cholangiography

Hepatobiliary Scintigraphy in 2014

Digestive System

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