Chronic cholecystitis other imaging findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Cholecystitis}} | {{Cholecystitis}} | ||
{{CMG}} ; {{AE}} {{ADI}} | {{CMG}} ; {{AE}} {{ADI}}, {{MMF}} | ||
==Overview== | ==Overview== | ||
[[HIDA scan|HIDA]] [[cholescintigraphy]] is the most sensitive and accurate modality for the diagnosis of chronic cholecystitis. HIDA cholescintigraphy findings for chronic cholecystitis include delayed gallbladder isotope accumulation, irregular [[gallbladder]] filling, or photopenic areas and septations. | |||
==Other Imaging Findings== | ==Other Imaging Findings== | ||
===Cholescintigraphy=== | |||
* | [[HIDA scan|HIDA]] [[cholescintigraphy]] findings for chronic cholecystitis include: | ||
* | * Delayed [[Gallbladder|gallbladde]]<nowiki/>r isotope accumulation | ||
* Irregular [[gallbladder]] filling or | |||
* Photopenic areas and septations | |||
A gallbladder ejection fraction of less than 35% after the administration of [[cholecystokinin]] indicates the presence of the chronic calculus or chronic acalculous cholecystitis. | |||
*Chronic cholecystitis may be diagnosed by hepatobiliary [[nuclear medicine|scintigraphy]] using [[technetium]]-99m. | |||
**The release capacity (ejection fraction) of the gall bladder may also be estimated using this technique. | |||
**A decreased in the capacity of the gallbladder to release bile is understood to be associated with chronic cholecystitis. | |||
**However, cholecystitis is not the most common cause of right upper quadrant pain, initial evaluation must focus on narrowing down the exact diagnosis.<ref name="Shea">Shea, JA, Berlin, JA, Escarce, JJ, et al. ''Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease''. Arch Intern Med 1994; 154:2573.</ref><ref name="Fink">Fink-Bennett, D, Freitas, JE, Ripley, SD, Bree, RL. ''The sensitivity of hepatobiliary imaging and real time ultrasonography in the detection of acute cholecystitis''. Arch Surg 1985; 120:904.</ref> | |||
*[[HIDA scan|HIDA]] [[cholescintigraphy]] in chronic cholecystitis may show: | |||
** A delay in the collection of isotope inside the gallbladder | |||
** Abnormal filling of the gallbladder and | |||
** Septations | |||
* A decrease in the ejection fraction of the gallbladder to 35% following [[cholecystokinin]] is helpful in the diagnosis of calculus or acalculous cholecystitis of chronic type.<ref name="Chamarthy-2010">{{Cite journal | last1 = Chamarthy | first1 = M. | last2 = Freeman | first2 = LM. | title = Hepatobiliary scan findings in chronic cholecystitis. | journal = Clin Nucl Med | volume = 35 | issue = 4 | pages = 244-51 | month = Apr | year = 2010 | doi = 10.1097/RLU.0b013e3181d18ef5 | PMID = 20305411 }}</ref> | |||
===Acalculous Cholecystitis=== | |||
The HIDA cholescintigraphy based diagnostic criteria from multiple studies for acalculous cholecystits is as follows.<ref name="Huffman-2010">{{Cite journal | last1 = Huffman | first1 = JL. | last2 = Schenker | first2 = S. | title = Acute acalculous cholecystitis: a review. | journal = Clin Gastroenterol Hepatol | volume = 8 | issue = 1 | pages = 15-22 | month = Jan | year = 2010 | doi = 10.1016/j.cgh.2009.08.034 | PMID = 19747982 }}</ref> | |||
{| class="wikitable" | |||
! Criteria!! Diagnosis | |||
|- | |||
| RC<BR>MC || Nonvisualization of the gallbladder 1 hour after injection of radiolabeled technetium ([this is radionuclide cholescintigraphy (RC)]<br>Nonvisualization of the gallbladder 30 minutes after injection of morphine (after initial radiolabeled technetium) [this is morphine cholescintigraphy (MC)] | |||
|- | |||
|} | |||
'''Diagnosis:''' RC alone or RC and MC. | |||
[[File:Chronic-acalculous-cholecystitis (1).jpg|400px|thumb|center| Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/chronic-cholecystitis |title=Chronic cholecystitis | Radiology Reference Article | Radiopaedia.org |format= |work= |accessdate=}}<nowiki></ref></nowiki>]] | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Gastroenterology]] | |||
[[Category:Hepatology]] | |||
[[Category:Surgery]] | |||
[[Category:Emergency medicine]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 18:40, 22 February 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2], Furqan M M. M.B.B.S[3]
Overview
HIDA cholescintigraphy is the most sensitive and accurate modality for the diagnosis of chronic cholecystitis. HIDA cholescintigraphy findings for chronic cholecystitis include delayed gallbladder isotope accumulation, irregular gallbladder filling, or photopenic areas and septations.
Other Imaging Findings
Cholescintigraphy
HIDA cholescintigraphy findings for chronic cholecystitis include:
- Delayed gallbladder isotope accumulation
- Irregular gallbladder filling or
- Photopenic areas and septations
A gallbladder ejection fraction of less than 35% after the administration of cholecystokinin indicates the presence of the chronic calculus or chronic acalculous cholecystitis.
- Chronic cholecystitis may be diagnosed by hepatobiliary scintigraphy using technetium-99m.
- The release capacity (ejection fraction) of the gall bladder may also be estimated using this technique.
- A decreased in the capacity of the gallbladder to release bile is understood to be associated with chronic cholecystitis.
- However, cholecystitis is not the most common cause of right upper quadrant pain, initial evaluation must focus on narrowing down the exact diagnosis.[1][2]
- HIDA cholescintigraphy in chronic cholecystitis may show:
- A delay in the collection of isotope inside the gallbladder
- Abnormal filling of the gallbladder and
- Septations
- A decrease in the ejection fraction of the gallbladder to 35% following cholecystokinin is helpful in the diagnosis of calculus or acalculous cholecystitis of chronic type.[3]
Acalculous Cholecystitis
The HIDA cholescintigraphy based diagnostic criteria from multiple studies for acalculous cholecystits is as follows.[4]
| Criteria | Diagnosis |
|---|---|
| RC MC |
Nonvisualization of the gallbladder 1 hour after injection of radiolabeled technetium ([this is radionuclide cholescintigraphy (RC)] Nonvisualization of the gallbladder 30 minutes after injection of morphine (after initial radiolabeled technetium) [this is morphine cholescintigraphy (MC)] |
Diagnosis: RC alone or RC and MC.
.jpg)
References
- ↑ Shea, JA, Berlin, JA, Escarce, JJ, et al. Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Intern Med 1994; 154:2573.
- ↑ Fink-Bennett, D, Freitas, JE, Ripley, SD, Bree, RL. The sensitivity of hepatobiliary imaging and real time ultrasonography in the detection of acute cholecystitis. Arch Surg 1985; 120:904.
- ↑ Chamarthy, M.; Freeman, LM. (2010). "Hepatobiliary scan findings in chronic cholecystitis". Clin Nucl Med. 35 (4): 244–51. doi:10.1097/RLU.0b013e3181d18ef5. PMID 20305411. Unknown parameter
|month=ignored (help) - ↑ Huffman, JL.; Schenker, S. (2010). "Acute acalculous cholecystitis: a review". Clin Gastroenterol Hepatol. 8 (1): 15–22. doi:10.1016/j.cgh.2009.08.034. PMID 19747982. Unknown parameter
|month=ignored (help)