Ponto James A
Department of Radiology, University of Iowa Hospitals and Clinics, and University of Iowa College of Pharmacy, Iowa City, Iowa
J Nucl Med Technol. 2015 Jun;43(2):117-21. doi: 10.2967/jnmt.115.153866. Epub 2015 Apr 9.
During times of sincalide shortage, a fatty meal can be used to stimulate gallbladder contraction during hepatobiliary scintigraphy. However, if a patient has an abnormal gallbladder ejection fraction (GBEF), is the cause chronic cholecystitis or is it inadequate cholecystokinin stimulation due to poor gastric emptying? Hence, during the 2014 sincalide shortage, simultaneous liquid gastric emptying using (99m)Tc-sulfur colloid along with corn oil emulsion was initiated as routine practice in patients evaluated for GBEF. The objective of this study was to retrospectively assess the time course of gastric emptying in these patients, especially with regard to whether delayed gastric emptying may be a factor in some patients with a poor GBEF.
My institution's clinical imaging procedure during the 2014 sincalide shortage consisted of routine (99m)Tc-mebrofenin hepatobiliary scintigraphy followed by corn oil emulsion and (99m)Tc-sulfur colloid orally. Dynamic imaging with regions of interest encompassing the gallbladder and the stomach allowed determination of GBEF and gastric emptying. For this study, the imaging records for 53 consecutive patients undergoing this clinical procedure were reviewed. The time for half gastric emptying, along with percentage gastric emptying at the end of imaging, was evaluated in relationship to GBEF.
Seventeen patients had a normal GBEF (74% ± 14%) and satisfactory gastric emptying (31 ± 21 min for half emptying, 75% ± 14% emptying at end of imaging); 17 patients had a normal GBEF (77% ± 17%) despite unsatisfactory gastric emptying (only 30% ± 14% emptying at end of imaging); 5 patients had an abnormal GBEF (19% ± 9%) and satisfactory gastric emptying (26 ± 19 min for half emptying, 82% ± 14% emptying at end of imaging), supporting a diagnosis of chronic cholecystitis; 11 patients had an abnormal GBEF (26% ± 9%) but also unsatisfactory gastric emptying (only 26% ± 13% emptying at end of imaging), which did offer additional support for a diagnosis of chronic cholecystitis; and 3 patients had a borderline GBEF (40% ± 2%) with satisfactory gastric emptying (59% ± 6% emptying at end of imaging).
Simultaneous liquid gastric emptying can provide additional information in the interpretation of GBEF when a fatty meal is used as an oral cholecystagogue, especially to help differentiate chronic cholecystitis from inadequate cholecystokinin stimulation due to poor gastric emptying.
在辛卡利特短缺期间，在肝胆闪烁显像时可使用脂肪餐刺激胆囊收缩。然而，如果患者胆囊射血分数（GBEF）异常，其原因是慢性胆囊炎还是由于胃排空不良导致胆囊收缩素刺激不足？因此，在2014年辛卡利特短缺期间，对于评估GBEF的患者，开始常规采用（99m）锝-硫胶体与玉米油乳剂同时进行液体胃排空检查。本研究的目的是回顾性评估这些患者的胃排空时间进程，特别是延迟胃排空是否可能是一些GBEF较差患者的一个因素。
在2014年辛卡利特短缺期间，我机构的临床成像程序包括常规的（99m）锝-美罗芬宁肝胆闪烁显像，随后口服玉米油乳剂和（99m）锝-硫胶体。通过包含胆囊和胃的感兴趣区域进行动态成像，可测定GBEF和胃排空情况。对于本研究，回顾了连续53例接受该临床程序患者的成像记录。评估了胃半排空时间以及成像结束时的胃排空百分比与GBEF的关系。
17例患者GBEF正常（74%±14%）且胃排空良好（半排空时间为31±21分钟，成像结束时排空75%±14%）；17例患者GBEF正常（77%±17%），尽管胃排空不佳（成像结束时仅排空30%±14%）；5例患者GBEF异常（19%±9%）且胃排空良好（半排空时间为26±19分钟，成像结束时排空82%±14%），支持慢性胆囊炎的诊断；11例患者GBEF异常（26%±9%）但胃排空也不佳（成像结束时仅排空26%±13%），这确实为慢性胆囊炎的诊断提供了额外支持；3例患者GBEF临界（40%±2%）且胃排空良好（成像结束时排空59%±6%）。
当使用脂肪餐作为口服胆囊造影剂时，同时进行液体胃排空在解释GBEF时可提供额外信息，特别是有助于区分慢性胆囊炎与因胃排空不良导致的胆囊收缩素刺激不足。
