Oates E, Selland D L, Chin C T, Achong D M
Department of Radiology, New England Medical Center, Boston, MA 02111, USA.
J Nucl Med. 1996 Feb;37(2):267-9.
This study investigated the value of morphine-augmentation in patients who demonstrated gallbladder nonvisualization with a pericholecystic rim sign at 1 hr, a cholescintigraphic pattern considered highly predictive of acute cholecystitis.
Retrospectively, 170 consecutive morphine-augmented cholescintigrams were analyzed for the presence of a pericholecystic rim sign, marked or mild, associated with gallbladder nonvisualization at 1 hr (before morphine); those with a pericholecystic rim sign were further evaluated for persistent gallbladder nonvisualization versus gallbladder visualization after morphine. Scintigraphic interpretations were correlated with surgical pathology or clinical diagnosis.
Before morphine, 43/170 (25%) patients demonstrated gallbladder nonvisualization with a pericholecystic rim sign. Since only 31 had acute cholecystitis, a diagnosis based solely on that scintigraphic pattern would have resulted in 12 false-positives. After morphine, gallbladder visualization correctly excluded acute cholecystitis in seven; a single false-negative was encountered; five false-positives remained. Morphine-augmentation improved the positive predictive value from 72% (gallbladder nonvisualization with pericholecystic rim sign before morphine) to 86% (gallbladder nonvisualization after morphine). Of 24 patients with marked pericholecystic rim signs, 21 had acute cholecystitis. Of 31 with acute cholecystitis, however, 10 (32%) had a mild pericholecystic rim sign.
Morphine-augmented cholescintigraphy optimizes the diagnosis of acute cholecystitis in patients with the suggestive, but not pathognomonic, cholescintigraphic pattern at 1 hr of gallbladder nonvisualization with a pericholecystic rim sign, regardless of its intensity.
本研究调查了在1小时胆囊不显影且胆囊周围有边缘征（一种被认为高度预测急性胆囊炎的胆闪烁造影模式）的患者中吗啡增强的价值。
回顾性分析170例连续进行吗啡增强胆闪烁造影的病例，以确定在1小时（吗啡注射前）是否存在与胆囊不显影相关的明显或轻微胆囊周围边缘征；对有胆囊周围边缘征的患者进一步评估吗啡注射后胆囊持续不显影与显影的情况。闪烁造影的解读与手术病理或临床诊断相关。
在注射吗啡前，170例患者中有43例（25%）胆囊不显影且有胆囊周围边缘征。由于只有31例患有急性胆囊炎，仅基于该闪烁造影模式进行诊断会导致12例假阳性。注射吗啡后，胆囊显影正确排除了7例急性胆囊炎；出现1例假阴性；仍有5例假阳性。吗啡增强使阳性预测值从72%（注射吗啡前胆囊不显影且有胆囊周围边缘征）提高到86%（注射吗啡后胆囊不显影）。在24例有明显胆囊周围边缘征的患者中，21例患有急性胆囊炎。然而，在31例急性胆囊炎患者中，10例（32%）有轻微胆囊周围边缘征。
对于在1小时胆囊不显影且有胆囊周围边缘征（无论其强度如何）这种提示性但非特异性胆闪烁造影模式的患者，吗啡增强胆闪烁造影可优化急性胆囊炎的诊断。
