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PubMed1981

Role of cholecystokinetic agents in 99mTc-IDA cholescintigraphy.

Cholecystokinin (CCK) and its C-terminal octapeptide analog, Sincalide, have been utilized in two separate roles for the evaluation of gallbladder disease. These are: (1) prior to cholescintigraphy to evacuate the gallbladder and optimized subsequent filling with radiotracers, and (2) to study contractile function of visualizing gallbladders on cholecystography and cholescintigraphy. As a preparation for 99mTc-IDA studies, it clearly facilitates earlier gallbladder filling in patients with chronic cholecystitis, thereby ruling out complete cystic duct obstruction. The problem lies in the fact that the use of CCK as a premedication markedly decreases the sensitivity of the study to detect chronic cholecystitis, since the findings become indistinguishable from patients with normal gallbladders. For this reason, the authors prefer to obtain delayed images, since chronic cholecystitis is frequently associated with gallbladder filling beyond the first hour. The role of CCK in detecting abnormal gallbladder function in the normally visualizing gallbladder also is controversial. Other studies as well as the author's experience suggests that as much as one-forth of positive cases may be associated with normal gallbladders at surgery and often even on microscopic examination. However, most importantly, the great majority of these patients are relieved of their symptoms following surgery. It appears reasonable that CCK or Sincalide cholecystography or cholescintigraphy may be detecting functional abnormalities before anatomic changes occur and can, therefore, serve as a useful examination in selecting symptomatic patients who may benefit from cholecystectomy.

Acute Disease↗

PubMed1992

The value of sonography in determining cystic duct patency.

A prospective blinded comparison of ultrasonography (US) and oral cholecystography (OCG) was performed in 100 patients with symptomatic gall-stones to determine whether US would enable an accurate assessment of cystic duct patency to be made. Patency of the cystic duct was defined as gall-bladder opacification on OCG or a greater than 20% decrease in gall-bladder volume by US post-fatty meal. The ellipsoid method of volume measurement was used. Any patient who had a non-opacified gall-bladder on OCG but a greater than 20% volume decrease on US had cholescintigraphy performed (DISIDA). Oral cholecystography demonstrated cystic duct patency in 88 patients (88%), and fatty-meal gall-bladder US met the specified study criteria for patency in 86 patients (86%). False negative results were identified in four of the OCG and in six of the US examinations. The results of this study indicate that gall-bladder sonography with a post-fatty meal contraction of greater than 20% is a very accurate predictor of cystic duct patency. A contraction of less than 20%, however, cannot be considered a reliable predictor of cystic duct occlusion.

Adult↗

PubMed1977

The significance of conjugated phenobutiodil (biliodyl) in the intestine in the absence of gallbladder opacification a preliminary assessment.

Conjugated phenobutiodil (Biliodyl) in the small and large bowel can be recognised by its fine, homogeneous appearance. The findings in 41 patients undergoing oral cholecystography with subsequent clinical follow-up are reported. When the gallbladder fails to opacify on oral cholecystography, the presence of conjugated contrast medium in the intestine appears to provide reasonable evidence that the gallbladder is diseased.

Butyrates↗

PubMed1984

The fatty meal and acalculous gall-bladder disease.

The practice of routinely obtaining after fatty meal films during oral cholecystography has been questioned. A retrospective analysis of 45 cases of adenomyomatosis or polyps revealed that, in 28% of patients with adenomyomatosis, the gall-bladder appeared entirely normal before fat. It is concluded that, for the detection of acalculous gall-bladder disease, the fatty meal should be a routine part of oral cholecystography.

Cholecystography↗

PubMedDate not supplied

Bilobed gallbladder diagnosed by oral cholecysto-CT.

Morphological anomalies of the gallbladder are rare and are characterized by a large variety of configurations depending on the size and degree of fusion of the lobes, and on the number and position of the cystic ducts. We presented a case of bilobed gallbladder incidentally detected during abdominal ultrasonography. Oral cholecystography and computed tomographic examination after oral cholecystography (Oral Cholecysto-CT) were performed to confirm this abnormality. This is a quite rare anomaly consisted of complete duplication of the fundus and partially duplication of the corpus and separated lobes both of which entered a single infundibulum and cystic duct.

Cholecystography↗

PubMed1994

Percutaneous endoscopic polypectomy of gallbladder polyps.

We report here our preliminary experience with percutaneous endoscopic polypectomy of gallbladder polyps. Five patients with a total of 17 cholesterol polyps (size: 4-6 mm) and one patient with two gallbladder adenomas (size: 5 mm), four of whom were symptomatic and all of whom refused cholecystectomy, underwent a single-stage procedure under epidural anesthesia. All patients had functioning gallbladders, as assessed by oral cholecystography after stimulation. Following a small incision, the gallbladder was pulled out of the abdominal wall, incised, and a cholecystoscope introduced. The polyps were coagulated at their stalk using microwave irradiation (70-80 mA, 9 sec) and removed for histopathological evaluation thereafter. A catheter was left in situ for ten days. Follow-up for a mean of 11.6 months (8-16 months) showed all patients to be symptom-free and without recurrence of polyps on ultrasonography. Gallbladder function was assessed in five cases by meal-stimulated oral cholecystography, and in one by hepato-iminodiacetate acid (HIDA) scan and was found to be well preserved. The preliminary results warrant further evaluation of this method of removing indeterminate gallbladder polyps.

Adult↗

PubMed1983

[Sonographic studies of gallbladder kinetics in childhood--a comparison between healthy and mucoviscidosis patients].

In mucoviscidosis, the gallbladder can show signs of disease even in childhood. In 10 of 35 mucoviscidosis patients the authors found thickening of the walls, gallstones and micro-gallbladders on sonographic examination. Compared with healthy children (N = 70), the mucoviscidosis patients showed impairment of the kinetics of the gallbladder to an increasing extent in step with progressing age. X-ray films of the gallbladder were preferably taken while using a preparation containing bile acids for better absorption of the contrast medium. When using this preparation, the gallbladder was found to yield good contrast more frequently than with double-dose cholecystography recommended in literature. However, oral cholecystography yielded additional information in one case only where sonography had failed to produce a clear sonographic image of the gallbladder.

Adolescent↗

PubMed1990

[The sonographic image of gallbladder adenomyomatosis].

Compared with oral or intravenous cholecystography, a diagnosis of adenomyomatosis of the gall bladder is only rarely made by ultrasound. In nine patients this diagnosis was made by sonography and confirmed at operation or by cholecystography. In four patients it was an incidental finding during ERCP. The main feature is localised or generalised thickening of the wall of the gall bladder with a smooth outer contour. In seven cases there were small cysts in the wall and in two echogenic areas in the wall. An important criterion for distinguishing between inflammatory and neoplastic mural thickening is the contractility of the gall bladder.

Cholangiopancreatography, Endoscopic Retrograde↗

PubMed1982

[Importance of cholegraphy for indicating litholysis].

Today patients with gallstones are treated surgically, by means of drugs, or by endoscopy. However, only cholesterol stones can be dissolved with bile acids. Besides the cholesterol stones in the gallbladder, insoluble pigment stones or insoluble stones with a high inorganic calcium content will be found. In every patient, the solubility of the gallbladder stones must be established by mineralogical analysis. Sonography is very helpful in detecting gallbladder stones, but it is impossible to perform a mineralogical analysis with this method. Plain radiography is likewise insufficient. The only way to obtain a relatively accurate selection of patients with soluble gallstones is the performance of roentgenography after cholecystography. Cholecystography for mineralogical analysis must always follow detection of gallstones by sonography.

Chenodeoxycholic Acid↗

PubMed1979

Identification of gallstone disease.

Oral cholecystography is the most widely used and accurate method for evaluating the gallbladder. Nonvisualization of the gallbladder on a two-day study is virtually diagnostic of cystic duct obstruction or gallbladder membrane dysfunction. Intravenous cholangiography may be used to confirm cystic duct obstruction but more commonly is used to demonstrate common-duct pathology. Percutaneous transhepatic cholangiography and endoscopic retrograde cholangiography are the best studies to demonstrate the intrahepatic and extrahepatic biliary tree. Tomography may be helpful in oral cholecystography and is invaluable in intravenous cholangiography. Ultrasonography appears promising for gallbladder evaluation, but reliability is greatly influenced by the equipment available and personnel employed. Biliary drainage and bile analysis are of value in patients with negative radiographic studies and clinical symptoms suggestive of biliary tract disease.

Cholangiography↗

PubMed1988

A primer on gallstones.

Gallstones may now be diagnosed by means of duodenal bile analysis, ultrasonography, oral cholecystography, cholescintigraphy, and cholecystography during endoscopic retrograde cholangiopancreatography. Dissolution or removal of stones can be achieved with oral pharmacotherapy with bile acid derivatives, extracorporeal shock wave lithotripsy, infusion of either methyl tertbutyl ether or monooctanoin (Moctanin), percutaneous transhepatic removal, endoscopic sphincterotomy, or the traditional surgical procedure, cholecystectomy.

Cholecystography↗

PubMedDate not supplied

Nephrotoxicity of sodium iopanoate in hydrated and dehydrated dogs.

The nephrotoxic effect of sodium iopanoate, infused intravenously in dosages of 1.5, 3 and 6 g over a 2-hour period in eight dogs (22--27 kg) in both the hydrated and dehydrated stages, were investigated. On biochemical, hemodynamic and morphological studies, the nephrotoxic effect was found to be clearly dose-dependent and greater in the dehydrated stage. Previously suggested mechanisms for acute renal failure, such as a direct tubular toxicity, tubular obstruction and hypotension, could not be supported as main factors in the development of acute renal failure post-cholecystography, although they might well have a contributory effect. The primary cause of renal failure post-cholecystography cannot be determined unequivocally from this investigation. However, the observed findings would appear to be consistent with a toxic effect of iopanoate in the small vessels possibly resulting in ischemic tubular necrosis.

Acute Kidney Injury↗

PubMed1982

Alterations in thyroid function after cholecystographic contrast agents.

The radiographic contrast agents commonly used for oral cholecystography have diverse effects on thyroid hormones in man. They may: (i) decrease serum triiodothyronine (T3) and increase reverse T3 in both hyperthyroid and euthyroid subjects, an effect attributable to inhibition of phenolic (outer) ring deiodination of iodothyronines; (ii) acutely increase serum thyroxine (T4) by displacing it from the liver, so inviting an erroneous diagnosis of hyperthyroidism; (iii) precipitate hyperthyroidism in apparently euthyroid subjects who have autonomous thyroid tissue. In comparison with the cholecystographic agents which are taken up by the liver, the renally-excreted contrast agents used for angiography or intravenous urography are much less potent in producing these effects. The paradox of T4 excess with normal T3 may arise after cholecystography, either by an acute T4 increase in a euthyroid subject, or by normalization of T3 in hyperthyroidism, thus creating a diagnostic dilemma. The recent trend towards use of oral cholecystographic agents in the urgent management of hyperthyroidism, because of their effect on serum T3, needs to be regarded with caution in view of the risk that hyperthyroidism may eventually be worsened if synthesis of T4 is not effectively blocked. For this reason, contrast media should probably be used in the treatment of hyperthyroidism only in conjunction with conventional antithyroid drugs. A history of exposure to contrast media should be sought in any acute or unexpected exacerbation of hyperthyroidism, or when T4 excess is found without an increase in T3.

Cholecystography↗

PubMed1983

Studies of gallbladder contraction using intramuscular sincalide.

Intramuscular sincalide (the carboxy terminal octapeptide of cholecystokinin) was evaluated as an agent for producing gallbladder contraction. Following oral cholecystography 35 patients received intramuscular sincalide in one of two dosages, 18 patients received intravenous sincalide, and six patients were given intramuscular placebo. Generalized symptoms, often similar to those noted clinically, were more common following intravenous injection of sincalide; gallbladder contraction was greater following intramuscular injection. Both of these findings may be related to lower but more sustained blood levels of sincalide following intramuscular administration. Intramuscular sincalide may be useful for further studies of the value of cholecystokinin cholecystography.

Cholecystography↗

PubMed1975

Gall-bladder emptying measured by a radioisotopic method.

A method of oral radioisotope cholecystography is described using 131I sodium ipodate. Gall-bladder emptying was measured by this method and radiographically: (a) in a model, (b) in 34 patients having oral cholecystography. There was a good correlation between the two methods of measuring volume changes, both in vitro and in vivo. The isotope cholecystogram has the advantage of a lower radiation hazard, and is the only satisfactory method of studying the onset, rate and duration of gall-bladder emptying. These may be easily measurable markers of disorders of the upper small bowel.

Cholecystography↗

PubMed1976

Gray scale cholecystosonography: an evaluation of accuracy.

The accuracy of gray scale cholecystosonography is evaluated by comparing oral cholecystography and ultrasonography findings on 141 patients. Confirmation of findings by oral cholecystography or surgery was available in 123, and there was agreement by cholecystosonography in 111, for an accuracy of 90%. Of 39 patients with gallstones, 30 were correctly diagnosed by ultrasound. These results represent an improvement in the accuracy of gray scale ultrasonography for evaluation of the gallbladder compared to previous reports and demonstrate the potential usefulness of the procedure for evaluation of the nonvisualized gallbladder.

Cholecystography↗

PubMed1979

Nonvisualized gallbladder by cholecystosonography.

To further define the significance of gallbladder nonvisualization by cholecystosonography, we studied follow-up data on 25 consecutive patients in whom the gallbladder could not be identified despite adequate fasting. In one patient, intravenous cholangiography demonstrated a large gallbladder but no gallstones. In the 24 cases for which a pathoanatomic diagnosis was established, all but two had diseased gallbladders with obliteration of the lumen. This 88% accuracy for positive prediction confirms results of previous sonographic studies and matches the diagnostic significance of nonvisualization at oral cholecystography. We recommend oral cholecystography for all ultrasonic nonvisualized gallbladders for greater diagnostic accuracy when surgery is contemplated.

Cholangiography↗

PubMed1991

Imaging the gallbladder: a historical perspective.

After Wilhelm Conrad Roentgen's discovery of the X-ray in 1895, it was initially thought that gallstones could not be visualized. Surgeons relied solely on the clinical examination to detect biliary disease. Today, no evaluation of the gallbladder would be complete without the performance of an imaging study. Radiology has gone through several eras in the imaging of gallstones. The plain film era, 1895-1924, was characterized by techniques that improved soft-tissue detail, allowing better detection of radiopaque stones. The contrast media era, 1924-1960, was initiated by the invention of IV cholecystography. In 1925, oral cholecystography was developed. During the era of expanding technology, 1960-1979, percutaneous transhepatic cholangiography, scintigraphy, and sonography came into use. The therapeutic era began in the 1980s.

Cholecystography↗