Radiology, Vol 151, 763-769, Copyright © 1984 by Radiological Society of North America
The need for routine delayed radionuclide hepatobiliary imaging in patients with intercurrent disease
WE Drane, WB Nelp and TG Rudd
A retrospective review was made of all radionuclide hepatobiliary studies
performed in a major trauma center over a 27-month period and correlated
with the patients' clinical course. In a population of 42 patients (27 of
whom were on total parenteral nutrition [TPN]) who had severe intercurrent
illness (primarily trauma), and an additional 18 patients who had
hepatocellular dysfunction, hepatobiliary imaging confirmed a patent cystic
duct in 43 of 60 patients (72%). Fourteen of these 43 patients (33%) had
gallbladder visualization at later than one hour after radiotracer
administration, and seven of these 14 required imaging from four to 24
hours. Of 17 patients who had nonvisualization of the gallbladder, four had
surgically proved acute cholecystitis. Images of nine of the remaining 13
patients with gallbladder nonvisualization were not obtained for 24 hours.
The presence of gallstones, wall thickening, or sludge on sonograms did not
correlate with cystic duct patency, and was not specific for acute
cholecystitis. Though gallbladder function is compromised in the population
with severe intercurrent disease, radionuclide hepatobiliary imaging is
still valuable; it can confirm a patent cystic duct in at least 72% of
patients if routine imaging is continued for up to 24 hours.
