[Diagnostic value of the reflux sign in cholescintigraphy after administration of a gallbladder contracting agent--a comparison with X-ray cholangiography].

This study reviewed 25 patients with the reflux sign in cholescintigraphy to assess its diagnostic value in evaluating biliary passage. After at least 4-hour fasting 5 mCi of 99mTcPMT or p-butyl IDA was injected intravenously and serial images were recorded before and after intramuscular injection of 10 micrograms of ceruletide diethylamine (caerulein). The reflux sign was determined positive when increased radioactivities in the left hepatic duct (minor reflux; MIR) or more peripheral intrahepatic ducts (major reflux; MAR) were recognized after injection of caerulein. The reflux sign was found in 28 of 237 (12%) studies. Direct and/or indirect X-ray cholangiograms were available in 25 (MIR; 15, MAR; 10). They included common bile duct (CBD) stone in 4, dilated CBD in 4, biliary dyskinesia (BD) in 4, chronic pancreatitis (CP) in 4, gallbladder (GB) stone in 3, duodenal ulcer (DU) in 2, CBD adenoma, pancreatic pseudocyst (PP), duodenal diverticle (DD), and acute cholangitis (AC) in 1 each. Their serum bilirubin levels were within normal limit in all but 2 at the time of cholescintigraphy. Transit time of radionuclides to the duodenum was found prolonged more than 60 min in 17 (68%) patients and persistent pooling in the CBD was found in 8 (28%) patients on scintigrams. The diameter of the CBD on X-ray cholangiogram was ranged 4 to 17 mm. Dilated CBD of more than 10 mm was found in 13 (52%) patients and apparent stenosis of the CBD in 6 (24%) patients. MAR seemed to correspond to increased diameter of the common hepatic more than 2 mm after caerulein injection in DIC. No abnormal findings in X-ray cholangiography was found in 10 (40%) patients including 3 with BD, 2 with GB stone, 2 with DU, 1 each with CP, PP, and AC. All those patients demonstrated MIR. We concluded that major reflux (MAR) sign was helpful in detecting an incomplete obstruction of the CBD, especially in patients with slightly to mildly dilated CBD.