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PubMed1982

Results of combined biliary drainage and cholecystokinin cholecystography in 81 patients with normal oral cholecystograms.

Combined biliary drainage-cholecystokinin cholecystography (BD-CC) was evaluated in 81 patients with pain indistinguishable from biliary colic, but normal conventional diagnostic tests. The test was performed using a new technique of intubation and aspiration, with a steerable catheter and sump duodenal tube. Both positive and negative groups were followed. One third of patients had positive tests, and almost all had pathologic gallbladders, and a symptomatic outcome equal to that obtained by cholecystectomy for cholelithiasis diagnosed by conventional means. Some patients with severe pain had cholecystectomy despite a negative report. Pathologic findings were significantly fewer, and symptomatic outcome less satisfactory but sufficiently good to suggest that painful functional gallbladder abnormalities, not amenable to diagnosis by BD-CC exist. Hypercontraction was found to be a reliable index of gallbladder pathology. A false bilirubin precipitate was identified in some patients; this precipitate may be recognized by microscopy and pH testing. This finding should reduce false-positives in BD-CC.

Adult↗

PubMedDate not supplied

Validation of a computer-assisted method for estimating the number and volume of gallstones visualized by cholecystography.

It is likely that in the near future there will be widespread use of medicinal therapy to dissolve gallstones. The efficacy of medicinal therapy can best be determined by attempting to relate the total surface area of a collection of gallstones to the composition of bile in patients undergoing therapy. Surface area, in turn, can be directly related to gallstone size and number. In this study, involving 48 cholecystectomized patients, we have shown that standard cholecystography, together with a computer-assisted method of metrology, can effectively monitor the above parameters. Determinations of the standard deviation of 1) replicate readings (35.8%) and 2) averaged metrology estimates compared with actual stone volumes (42.9%), as well as correlation of actual stone volumes with averaged metrology estimates (r = 0.961), indicated the magnitude of assessed change in stone volume that would be necessary to accept a roentgenographic decrease or increase in stone size with 95% confidence. Even with the increased precision found in the computer-assisted method as described, to attain a 98% certainty of some volume change it was necessary to have metrology volume change of 50% or more. Actual stone counts were without significant error in 87.5% of the determinations.

Chenodeoxycholic Acid↗

PubMed1991

Comparison of ultrasonography and oral cholecystography in lithotripsy. II. Determining retreatment.

Both ultrasonography (US) and oral cholecystography (OCG) are being used to evaluate patients after extracorporeal shock wave lithotripsy (ESWL) for gallstones. Criteria for retreatment after the initial ESWL are usually related to the size of the residual fragments. This study examines the efficacy of ultrasound and OCG for determining both the size and number of stone fragments in the gallbladder in an in vitro model and in patients. Ultrasonography and OCG examinations using an in vitro ESWL phantom with ten groups of stones, and on 39 patients, were reviewed independently by three radiologists to determine both the size and number of stone fragments. For the in vitro study, the three readers estimated the correct number of fragments, or the next closest range, in 87% of observations by OCG and in 43% by US. The size of the largest fragment was measured within 1 mm of its actual size in 87% of observations by OCG and 20% by US. Correlation coefficients for the mean measurements of the three readers versus the actual fragment size and number were greater for OCG than for US. For the in vivo study, the three readers agreed in 47% of the OCG versus 32% of US examinations with respect to the number of fragments, and in 65% of OCG compared to 40% of US studies with respect to size of the largest fragment. Multiple statistical analyses demonstrate that these differences are statistically significant. A discrepancy among the readers concerning whether a patient was eligible for retreatment occurred in 15% of OCG as compared to 45% of US studies. Both the in vivo and in vitro studies indicate that there is more interobserver reproducibility for OCG than for US, and that OCG is more reliable in making the decision concerning patient eligibility for retreatment following lithotripsy.

Adult↗

PubMed1993

Comparison of oral cholecystography and ultrasonography for evaluating chronic cholecystitis using patient outcome as the reference standard.

RATIONALE AND OBJECTIVES: The authors compared oral cholecystography (OCG) with ultrasound (US) in the detection of chronic gallbladder disease using clinical outcome, rather than pathology results, as the reference standard. METHODS: The authors interviewed 269 patients who underwent either OCG, US, or both, for evaluation of chronic right upper quadrant abdominal pain. The authors considered patients who underwent cholecystectomy with improved symptoms 1 to 4 years after surgery to be reference-standard positive for gallbladder disease, and patients with objective evidence of an alternative diagnosis (eg, peptic ulcer disease), which improved with therapy as reference-standard negative. RESULTS: The sensitivity and specificity of OCG were 83% and 97%, respectively, and for US, 86% and 90%, respectively. CONCLUSIONS: OCG is comparable with US in evaluating of chronic gallbladder disease. In institutions where OCG is used for diagnosing chronic cholecystitis, it may be reasonable to continue using OCG.

Algorithms↗

PubMed1981

Tyropanoate cholecystography early in the course of acute pancreatitis.

Oral cholecystography (OCG) has traditionally been delayed until several weeks after hospitalization for pancreatitis because of the putative frequent poor visualization during the acute episode. Recently, OCG with iopanoic acid was reported successful in most patients with acute pancreatitis soon after resumption of a solid diet. We evaluated OCG with sodium tyropanoate, a pharmacokinetically different contrast material, in 30 hospitalized patients with pancreatitis before resumption of solid food. It accurately evaluated the gallbladder in 24 cases (80%). Abnormal liver function tests, including mild hyperbilirubinemia, did not interfere with the examination. Consequently, 1) tyropanoate OCG adequately opacifies the gallbladder in most patients with acute pancreatitis who are fasting or taking liquids only; 2) allows gallbladder evaluation earlier than with iopanoic acid OCG; 3) is less affected by hepatic dysfunction; and 4) provides an alternative to ultrasonography.

Acute Disease↗

PubMed1977

Accuracy of physicans' predictions of cholecystography results.

In the decision theory model of medical diagnosis and treatment, optimal choice of diagnostic tests requires accurate estimation of the probability that a given test will be positive. We assessed the ability of physicians to estimate the probability that a specific test (cholecystography) would be positive. For 102 patients, the predicted number of gallstone cases, 35.8, was significantly greater than the observed number, 15 (p less than 0.001), even though 13 of the 15 observed cases were patients with previous radiographic evidence of gallstones. The overestimation of probability of positive tests casts doubt on the correctness of decisions regarding selection of diagnostic tests when these decisions are derived from probability estimates based on intuition or expert opinion.

Adult↗

PubMed1978

The effect of fasting on gallbladder opacification during oral cholecystography: a controlled study in normal volunteers.

The effect of fasting on gallbladder opacification during oral cholecystography was studied in 10 normal volunteers using 2 oral cholecystographic agents, iopanoic acid and sodium tryopanoate. Radiographs made 15 hours after ingestion of the contrast agents revealed good opacification of the gallbladder in all subjects when iopanoic acid was administered with a meal and when sodium tyropanoate was administered in the fasting state; in only 2 subjects when iopanoic acid was given in the fasting state; in 3 when given in the fasting state with ox bile; and in 3 when sodium tyropanoate was given with a meal.

Administration, Oral↗

PubMed1978

Application of radiographic magnification technique with an ultra-high-speed rare-earth screen/film system to oral cholecystography.

2X magnification employing a 200-mu focal spot and an Alpha 8-XM screen/film system was applied to oral cholecystography and the results compared with those for the conventional contact technique with the Par-RP system. The basic imaging properties of the system, as well as phantom studies, indicated that the image quality obtained with magnification is comparable to or better than that for the conventional technique. In clinical studies on the detection of gallstones, the conventional technique revealed 5 true-positive and 17 true-negative cases and 1 false-positive and 2 false-negative cases, while the magnification technique provided 7 true-positive and 18 true-negative cases but no false cases. With the magnification technique the skin dose was reduced to approximately half that for the conventional contact technique.

Cholecystography↗

PubMed1981

The oblique bending view in oral cholecystography.

The oblique bending projection, when incorporated into routine radiographs during oral cholecystography, was found to be at least as effective as fluoroscopic spot radiographs in obtaining information about the gallbladder.

Cholecystography↗

PubMed1981

Grid selection for oral cholecystography.

A radiographic and fluoroscopic unit was modified to image without a grid, with one 6:1 grid, and with two crossed 6:1 grids, placed with the strips at right angles (equivalent to a 12:1 grid). Fifty patients were studied in all three modes in both horizontal and upright positions. The crossed 6:1 grids were superior in 80% of cases. In those cases where no grid or one grid was superior, there was a shorter exposure time or no movement by the patient. High-ratio grids should be used for routine cholecystography combined with shorter exposure times for the initial procedure.

Cholecystography↗

PubMed1982

A clinical trial of oral cholecystography using combinations of contrast agents and two consecutive doses.

Fifteen healthy volunteers underwent a randomized trial of oral cholecystography (OCG) using 5 different combinations of contrast agents given as 2 consecutive doses: Telepaque (iopanoic acid) given with food (TF) or without food (T), Bilopaque (sodium tyropanoate) given without food, and a combination of both agents (TF-B). The density of gallbladder opacification was judged visually on a scale of 1+ to 4+ and quantitatively by a densitometric method. Comparison of gallbladder opacification on the first and second days of the study revealed 52 of 75 (70%) combinations (TF-T, TF-TF,T-T, TF-B, B-B) resulted in improved opacification, 17% in equal opacification, and 13% in worse opacification on day 2. The TF-B combination showed the highest number (9) of excellent (grade 4+) results and the lowest number (2) of poor (grade 1+ and 2+) results, gave the best opacification in 8 volunteers, and had the highest average density difference (0.32) between first- and second-day opacifications. The TF-TF combination was the next most effective, and the T-T combination was the least effective. The results indicate that OCG in 2 consecutive doses is superior to single-dose OCG, and that a combination of TF-B or TF-TF will provide the greatest gallbladder opacification. The TF-B combination is recommended because of better patient tolerance.

Administration, Oral↗

PubMed1982

Subjective vs. objective evaluation of gallbladder opacification during oral cholecystography in comparative clinical trials: implications for studies involving visual assessment.

Radiographs and CT images taken during oral cholecystography in dogs were interpreted in an independent, blind fashion by three radiologists on two occasions and visual assessment of gallbladder density compared to the actual CT values. While there was significant intra- and inter-observer variation, the mean scores for the observers' interpretations of both radiographs and prints correlated well with the actual CT values (p less than 0.05). In five out of six comparisons between first and second readings, the observers gave a lower score on the second reading. The considerable variation reflects the problems inherent in subjective evaluation of agents that produce small but measurable differences in radiographic density. Studies involving such subjective data have to be carefully designed in order to obtain meaningful results.

Administration, Oral↗

PubMed1984

Upright tomographic oral cholecystography.

Linear tomography performed with the patient in the upright position is a horizontal beam examination useful for further evaluation of the gallbladder during oral cholecystography in cases of superimposed densities and for confirmation of lesions attached to the wall of the gallbladder.

Cholecystitis↗

PubMed1987

Percutaneous cholecystography in children.

Percutaneous cholecystography was performed on 13 children who had biliary system abnormalities: two had biliary hypoplasia, five had sclerosing cholangitis, three had cirrhosis, two had distal choledochal obstruction, and one had an obstructed portoenterostomy. In 12 patients transcholecystic cholangiography showed, without significant complications, the intra-and extrahepatic bile ducts. In one patient with primary sclerosing cholangitis, the intrahepatic bile ducts were not opacified satisfactorily; dilatation of the gallbladder required surgical drainage. The transcholecystic technique is indicated when the intrahepatic bile ducts are either mildly dilated or not dilated.

Adolescent↗

PubMed1991

Oral cholecystography in contemporary gallstone imaging: a review.

The introduction of nonoperative alternatives to elective cholecystectomy in the management of gallstones has resurrected use of oral cholecystography (OCG). This article reviews basic principles involved in the proper performance of OCG and interpretation of the resulting images. The role of OCG in the current management of gallstones is discussed.

Bile↗

PubMed1978

Lecithine as an adjuvant in resorption of contrast medium in oral cholecystography.

No or poor filling of the gallbladder was obtained in 21 patients at cholecystography. They were re-examined after 10 days of later with the addition of lecithine to the contrast medium. The filling of the gallbladder, which was without abnormality, was improved in all cases. The mechanism of this effect is discussed.

Adjuvants, Pharmaceutic↗

PubMed1981

Gallbladder emptying with ceruletide in oral cholecystography.

In a consecutive series of 148 patients the gallbladder emptying in oral cholecystography was investigated after administration of ceruletide given in doses of 0.3 microgram/kg body weight intramuscularly and 0.03 and 0.05 microgram/kg intravenously. No essential side effects occurred. The effect of ceruletide seems to be on a par with that of cholecystokinin. A dose of 0.3 microgram/kg was found to be sufficient to assess the gallbladder emptying, but then in a few instances the emptying is delayed--up to one hour. The bile ducts are best demonstrated after intravenous administration of 0.05 microgram/kg.

Adolescent↗

PubMed1983

Gall-bladder contraction and bile duct opacification in oral cholecystography--a comparison of different methods.

The effect of injection of a cholecystokinetic agent, Ceruletide, was compared with that of the fatty meal following a single dose of Biloptin, and Biloptin with Solubiloptin, in regard to efficiency of gall-bladder contraction, cystic and common bile duct visualisation and side effects. In terms of gall-bladder contraction and ductal delineation no advantage was found from giving Ceruletide or Solubiloptin. Gall-bladder contraction occurred more quickly after Ceruletide than after a fatty meal, with corresponding earlier duct delineation, although the gall bladder was completely emptied of contrast medium in a significant proportion of Ceruletide cases. The incidence of abdominal pain was significantly greater after Ceruletide than after a fatty meal. Because Ceruletide requires an intramuscular injection and has no significant advantage over the fatty meal in regard to gall-bladder contraction and ductal delineation, its use in cholecystography is unjustified. A morning dose of Solubiloptin following Biloptin the previous evening offers no advantage over the Biloptin and fatty meal regimen.

Ceruletide↗