Berk R N, Leopold G R
Invest Radiol. 1978 Nov-Dec;13(6):477-89. doi: 10.1097/00004424-197811000-00002.
Oral cholecystography is still the basic modality for the diagnosis of gallbladder disease. Now, for the first time since the introduction of this procedure in 1924, this status is being challenged by another diagnostic technique, ultrasonography of the gall bladder. Ultrasound studies have major advantages over conventional cholecystography. These are sufficiently important that it can be safely predicted that ultrasonography will eventually become the primary diagnostic tool for evaluating the gallbladder. Just as the use of colonoscopy has provoked a new analysis of the barium enema examination in the evaluation of the colon, the introduction of ultrasound examination of the gallbladder has revealed the fact that false-negative oral cholecystograms are not rare. Before ultrasonography this information was unobtainable, because of the surgeon's proper reluctance to perform a cholecystectomy in patients with normal oral cholecystograms. Indeed, the availability of an accurate alternate diagnostic procedure has stimulated a reevaluation of other difficulties associated with oral cholecystography. These include problems involved with non-visualization and impaired visualization of the gallbladder after a single dose of contrast material, misunderstandings concerning the uses of oral cholecystography compared to those for intravenous cholangiography and uncertainty regarding the value of cholecystokinin cholecystography in the diagnosis of acalculous cholecystitis. Knowledge of the pharmacokinetics of the oral cholecystographic contrast agents has been long overdue, considering the extensive use of these compounds in clinical practice for more than 50 years. However, information on this subject has finally reached a stage where the data can be applied to ensure that cholecystography is done with maximun efficiency and safety and with the least radiation exposure. The purpose of this report is to review the problems involved with imaging of the gallbladder by oral cholecystography and to discuss the indications, interpretation and accuracy of gallbladder imaging with ultrasonography. Data concerning the use of computerized tomography for evaluation of the gallbladder are still preliminary but are discussed.
口服胆囊造影术仍然是诊断胆囊疾病的基本方法。自1924年引入该检查方法以来，其地位首次受到另一种诊断技术——胆囊超声检查的挑战。超声检查相对于传统胆囊造影术具有诸多主要优势。这些优势非常显著，以至于可以有把握地预测，超声检查最终将成为评估胆囊的主要诊断工具。正如结肠镜检查的应用引发了对钡剂灌肠检查在结肠评估中作用的重新分析一样，胆囊超声检查的引入揭示了口服胆囊造影假阴性结果并不罕见这一事实。在超声检查出现之前，由于外科医生通常不愿意对口服胆囊造影正常的患者进行胆囊切除术，所以无法获得这一信息。事实上，一种准确的替代诊断方法的出现促使人们重新审视与口服胆囊造影术相关的其他问题。这些问题包括单次服用造影剂后胆囊不显影和显影不良、与静脉胆管造影相比对口服胆囊造影术用途的误解以及胆囊收缩素胆囊造影术在无结石性胆囊炎诊断中的价值的不确定性。考虑到这些口服胆囊造影剂在临床实践中已广泛使用50多年，对其药代动力学的了解早就应该有了。然而，关于这一主题的信息终于达到了一个阶段，即这些数据可以应用于确保以最高效率、最安全且辐射暴露最少的方式进行胆囊造影。本报告的目的是回顾口服胆囊造影术在胆囊成像方面存在的问题，并讨论超声检查胆囊成像的适应证、解读及准确性。关于计算机断层扫描用于评估胆囊的数据仍属初步，但也会进行讨论。
