Krishnamurthy S, Krishnamurthy G T
Nuclear Medicine Department, Tuality Community Hospital, Hillsboro, OR, USA.
Semin Nucl Med. 1996 Jan;26(1):16-24. doi: 10.1016/s0001-2998(96)80013-4.
Pharmacological intervention with either cholecystokinin-8 (CCK-8) or morphine during 99mTc- hepatoiminodiacetic acid (HIDA) cholescintigraphy is required primarily for the assessment of the diseases affecting the gallbladder, the common bile duct, or the sphincter of Oddi. For imaging, the patient should be prepared by an overnight fast, or with 4 hours of minimum fast. Pre-emptying with CCK-8 is probably undesirable and should either be avoided or one should wait for at least 4 hours after CCK-8 to begin the 99mTc-HIDA study to achieve higher specificity of the test for acute cholecystitis. When he gallbladder is not observed by 60 mins in a clinical setting of acute cholecystitis, a dose of 0.04 mg/kg of morphine is administered intravenously and imaging continued for an additional 30 mins. Nonvisualization of the gallbladder by 90 mins with morphine in an appropriate clinical setting is diagnostic for acute cholecystitis. When the gallbladder is not observed by 60 min but is seen with morphine administered after 60 mins, a positive diagnosis of abnormal gallbladder function can be made. When the gallbladder is observed in a clinical setting of biliary pain or chronic calculous or acalculous cholecystitis, CCK-8 at a dose rate of 3.3 ng/kg/min is infused intravenously for 3 mins (10 ng/kg/3 min) for the measurement of the ejection fraction. An ejection fraction value of less than 35% is indicative of calculous or acalculous chronic cholecystitis. The gallbladder emptying is directly related to the total number of cholecystokinin receptors in the smooth muscle. The ejection fraction can be controlled to any desired level simply by controlling the dose rate or the duration of infusion of CCK-8. Morphine and other opiate metabolites circulate for many hours in blood and act on the sphincter of Oddi and decrease the gallbladder ejection fraction. Careful drug history, especially that of opiates, is very critical in all subjects with a low ejection fraction before assigning an abnormality to the gallbladder motor function.
在99mTc-肝亚氨基二乙酸（HIDA）胆囊闪烁显像期间，使用胆囊收缩素-8（CCK-8）或吗啡进行药物干预主要用于评估影响胆囊、胆总管或Oddi括约肌的疾病。为了成像，患者应禁食过夜或至少禁食4小时。预先使用CCK-8排空胆囊可能不可取，应避免这种做法，或者在使用CCK-8后至少等待4小时再开始99mTc-HIDA研究，以提高该检查对急性胆囊炎的特异性。在急性胆囊炎的临床情况下，如果60分钟内未观察到胆囊，静脉注射0.04mg/kg的吗啡，并继续成像30分钟。在适当的临床情况下，90分钟时胆囊未显影且使用了吗啡，则可诊断为急性胆囊炎。如果60分钟时未观察到胆囊，但在60分钟后使用吗啡时观察到胆囊，则可做出胆囊功能异常的阳性诊断。在胆绞痛或慢性结石性或无结石性胆囊炎的临床情况下，如果观察到胆囊，以3.3ng/kg/min的剂量率静脉输注CCK-8 3分钟（10ng/kg/3分钟）以测量射血分数。射血分数值低于35%表明存在结石性或无结石性慢性胆囊炎。胆囊排空与平滑肌中胆囊收缩素受体的总数直接相关。只需控制CCK-8的剂量率或输注持续时间，就可以将射血分数控制在任何所需水平。吗啡和其他阿片类代谢产物在血液中循环数小时，作用于Oddi括约肌并降低胆囊射血分数。在将胆囊运动功能异常归因于所有射血分数低的受试者之前，仔细询问用药史，尤其是阿片类药物史非常关键。
