Department of Nuclear Medicine, Hanyang University College of Medicine, Hanyang University Seoul Hospital, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, DL203, Boston, MA, 02215, USA.
Ann Nucl Med. 2019 Oct;33(10):740-745. doi: 10.1007/s12149-019-01384-3. Epub 2019 Jul 11.
On hepatobiliary scintigraphy, "preferential gallbladder (GB) filling without tracer excretion into the small bowel (SB) [p-GB-no-SB]" is occasionally seen on images obtained up to an hour. In such cases, many practitioners administer cholecystokinin (CCK) (even when the measurement of GB ejection fraction is not indicated) or obtain delayed images (DI) to exclude common bile duct (CBD) obstruction. We aimed (1) to assess the prevalence of clinically relevant CBD obstruction found by CCK administration or DI in this circumstance and (2) to find imaging findings and/or parameters that can be used to triage patients who do or do not need such maneuvers.
Of 1244 scans reviewed, 1089 were excluded because of one or more of the following reasons: SB visualized within 60 min, GB not visualized within 60 min, severely decreased hepatic function, and less than 1 month of clinical follow-up after scanning. The remaining 155 showed p-GB-no-SB with clinical follow-up available for ≥ 1 month. For the 155 scans, clearance of liver parenchymal activity was assessed.
Of the 155 scans, 142 showed visually prompt clearance of liver parenchymal activity (group A), while 13 scans showed mild to moderately delayed clearance of liver parenchymal activity with or without initial decreased hepatic uptake (group B). 134 of 142 in group A had additional imaging (99 CCK or 35 DI); all 134 showed SB visualization. Eight remaining scans were terminated without additional imaging. None of the 142 had any event attributable to CBD obstruction on follow-up. All 13 in group B had additional imaging (9 CCK, 4 DI); SB visualized in 11, but not in two; clinical follow-up revealed no CBD obstruction in 11. ERCP revealed CBD obstruction in the latter two.
When a HIDA scan shows p-GB-no-SB, the probability of identifying clinically relevant CBD obstruction by additional imaging with CCK or DI is virtually zero in an acute clinical setting if clearance of liver parenchymal activity is prompt. Additional imaging with CCK or DI can be reserved for only those showing abnormal clearance of liver parenchymal activity.
在肝胆闪烁显像中，在 1 小时内获得的图像上偶尔会出现“胆囊（GB）优先充盈而示踪剂未排入小肠（SB）[p-GB-no-SB]”。在这种情况下，许多医生会给予胆囊收缩素（CCK）（即使不提示测量 GB 排出分数）或获取延迟图像（DI）以排除胆总管（CBD）梗阻。我们旨在：（1）评估在这种情况下，通过 CCK 给药或 DI 发现临床相关 CBD 梗阻的患病率；（2）找到可以用于分诊是否需要这些操作的患者的影像学表现和/或参数。
在回顾的 1244 次扫描中，有 1089 次因以下一个或多个原因被排除在外：SB 在 60 分钟内显影，GB 在 60 分钟内未显影，严重肝功能减退，以及扫描后临床随访时间少于 1 个月。其余 155 次扫描显示 p-GB-no-SB，且临床随访时间≥1 个月。对于这 155 次扫描，评估了肝实质活性的清除情况。
在 155 次扫描中，142 次扫描显示肝实质活性迅速清除（A 组），而 13 次扫描显示肝实质活性清除缓慢至中度延迟，伴有或不伴有初始肝摄取减少（B 组）。在 A 组的 142 例中，有 134 例进行了额外的影像学检查（99 例 CCK 或 35 例 DI）；134 例均显示 SB 显影。其余 8 例未进行额外影像学检查。在随访中，A 组 142 例中均无任何归因于 CBD 梗阻的事件。B 组的 13 例均进行了额外的影像学检查（9 例 CCK，4 例 DI）；11 例显示 SB 显影，但 2 例未显影；11 例临床随访均未发现 CBD 梗阻。在这 2 例中，ERCP 发现 CBD 梗阻。
在急性临床情况下，如果肝实质活性清除迅速，HIDA 扫描显示 p-GB-no-SB 时，通过 CCK 或 DI 进行额外影像学检查以识别临床相关 CBD 梗阻的概率几乎为零。只有那些显示肝实质活性清除异常的患者才需要进行 CCK 或 DI 的额外影像学检查。
