ABSTRACT
OBJECTIVE: Visualization of enterogastric reflux (EGR) may be present during hepatobiliary imaging. Reflux of bile may damage the gastric mucosa, altering its function, and cause such symptoms as epigastric pain, heartburn, nausea, intermittent vomiting and abdominal fullness. These symptoms also are associated with gallbladder disease. The aim of this study was to quantitate the EGR index (EGRI) and to determine if a difference exists in normal and abnormal responses using standard cholecystokinin (CCK)-augmented hepatobiliary imaging. METHODS: This study used 129 patients. LAO dynamic data on a 128 x 128 matrix at a rate of 1 frame/min were obtained. After the gallbladder ejection fraction (GBEF) was determined, the EGRI (%) was calculated by relating the counts in the gastric ROI to the counts in the hepatobiliary ROI at a specified time. The results were compared with the patient's final clinical diagnosis. RESULTS: Normal responders (GBEF > or = 35%) had a higher EGRI than abnormal responders with a P = 0.001 EGR observed in 75 patients (58.1%). Significant reflux (EGRI > or = 14.2% at 15 min) was observed in 29 additional patients (22.5%). Patients with EGRI > or = 24.5% showed a strong association with the pathophysiologic syndrome of gastritis, alkaline reflux, gastric ulcer and gastro esophageal reflux disease. There was no EGR observed in the remaining 25 patients (19.4%). CONCLUSION: This simple addition to the CCK-augmented hepatobiliary imaging may both detect and quantitate abnormal EGR as the cause of the patient's symptoms in the presence of a normal GBEF result, and/or those patients with risk factors for gastritis.
Subject(s)
Bile Reflux/diagnostic imaging , Duodenogastric Reflux/diagnostic imaging , Gallbladder Diseases/diagnostic imaging , Aniline Compounds , Biliary Tract/diagnostic imaging , Diagnosis, Differential , Female , Gastrointestinal Agents , Glycine , Humans , Imino Acids , Liver/diagnostic imaging , Male , Middle Aged , Organotechnetium Compounds , Predictive Value of Tests , Radionuclide Imaging , Radiopharmaceuticals , Sensitivity and Specificity , SincalideABSTRACT
OBJECTIVE: Two routine lung SPECT studies showed what appeared to be uptake within the gallbladder. This finding was confirmed on coronal views and three-dimensional reconstruction. There was no contamination or problem with the radiopharmaceutical quality control. The patients had not had any prior nuclear procedures. Gallbladder visualization on routine lung imaging has not been previously observed. The purpose of this study was to ascertain the incidence of gallbladder uptake and to determine a possible mechanism. METHODS: Fifty-four patients referred for routine lung perfusion imaging were examined. At the end of the lung imaging, an anterior and/or right lateral 3-5 minute view of the abdomen was obtained. Patients too ill for additional imaging or those with prior cholecystectomies were excluded. RESULTS: Nineteen of the 54 patients showed activity within the gallbladder. Activity within the gut, kidneys, and urinary bladder also were observed. CONCLUSION: Gallbladder activity after Tc-99m macroaggregated albumin injection for lung perfusion studies, is a fairly common finding.
