Gallbladder Nonvisualization with Pericholecystic Rim Sign: Morphine-Augmentation Optimizes Diagnosis of Acute Cholecystitis

• Published in: The Journal of nuclear medicine (1978) Vol. 37; no. 2; pp. 267 - 269
• Main Authors: Oates, Elizabeth, Selland, Donna-Lee G, Chin, Cynthia T, Achong, Dwight M
• Format: Journal Article
• Language: English
• Published: Reston, VA Soc Nuclear Med 01.02.1996; Society of Nuclear Medicine
• Subjects: Acute Disease; Biological and medical sciences; Case-Control Studies; Cholecystitis - diagnostic imaging; Chronic Disease; False Positive Reactions; Female; Gallbladder - diagnostic imaging; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Imino Acids; Liver - diagnostic imaging; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Morphine; Organotechnetium Compounds; Other diseases. Semiology; Predictive Value of Tests; Radionuclide Imaging; Retrospective Studies; Time Factors; Radionuclide study; Human; Chemotherapy; Morphine derivatives; Digestive diseases; Gallbladder; Diagnosis; Scintigraphy; Biliary tract disease; Cholecystitis; Optimization
• ISSN: 0161-5505; 1535-5667

This study investigated the value of morphine-augmentation in patients who demonstrated gallbladder nonvisualization with a pericholecystic rim sign at 1 hr, a cholescintigraphic pattern considered highly predictive of acute cholecystitis. Retrospectively, 170 consecutive morphine-augmented cholescintigrams were analyzed for the presence of a pericholecystic rim sign, marked or mild, associated with gallbladder nonvisualization at 1 hr (before morphine); those with a pericholecystic rim sign were further evaluated for persistent gallbladder nonvisualization versus gallbladder visualization after morphine. Scintigraphic interpretations were correlated with surgical pathology or clinical diagnosis. Before morphine, 43/170 (25%) patients demonstrated gallbladder nonvisualization with a pericholecystic rim sign. Since only 31 had acute cholecystitis, a diagnosis based solely on that scintigraphic pattern would have resulted in 12 false-positives. After morphine, gallbladder visualization correctly excluded acute cholecystitis in seven; a single false-negative was encountered; five false-positives remained. Morphine-augmentation improved the positive predictive value from 72% (gallbladder nonvisualization with pericholecystic rim sign before morphine) to 86% (gallbladder nonvisualization after morphine). Of 24 patients with marked pericholecystic rim signs, 21 had acute cholecystitis. Of 31 with acute cholecystitis, however, 10 (32%) had a mild pericholecystic rim sign. Morphine-augmented cholescintigraphy optimizes the diagnosis of acute cholecystitis in patients with the suggestive, but not pathognomonic, cholescintigraphic pattern at 1 hr of gallbladder nonvisualization with a pericholecystic rim sign, regardless of its intensity.