European Journal of Nuclear Medicine

, Volume 16, Issue 8–10, pp 747–753 | Cite as

Association between false negative hepatobiliary scans and initial gallbladder visualization after 30 min

  • Rodney J. Hicks
  • Michael J. Kelly
  • Victor Kalff
Case Report


We have reviewed the experience of our institution and the literature concerning the use of hepatobiliary scintigraphy for the diagnosis of acute cholecystitis. The aim of this study was to assess whether the hepatobiliary scintigraphic finding of initial gallbladder visualization within 30 min is a more reliable criterion for excluding acute cholecystitis than gallbladder visualization within 1 h after tracer injection. In our institution's consecutive series, 113 of 211 hepatobiliary studies had gallbladder visualization within 1 h. Gallbladder visualization time in this group had a log normal distribution, with gallbladder visualization occurring within 30 min in 107 of 113 (95%). Gallbladder visualization occurred between 31 and 60 min in only 6 (5%); nevertheless, our one false negative study came from this small subgroup of patient studies (P = 0.05). Review of the literature (1645 patients with iminodiacetic acid [99mTc-IDA] derivative studies) revealed 6 further timed false negative results with gallbladder visualization within 1 h. Of these studies, in 4 (67%) the gallbladder was visualized between 31 and 60 min and in only 2 before 30 min. One of these latter 2 patients had a rare anatomy. Analysis of the pooled institutional and literature data gave an estimated false negative rate of 21 % if the gallbladder was visualized between 31 and 60 min. This was significantly higher (P < 0.001) than the 0.5% false negative rate when the gallbladder was seen prior to 30 min, but similar to the false negative rate of 16% reported by Weissmann et al. for studies with initial visualization after 1 h. Therefore, gallbladder visualization is strong evidence against acute cholecystitis only if it occurs within 30 min after tracer injection.

Key words

Hepatobiliary scintigraphy Acute cholecystitis 


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  1. Al Sheikh W, Hourani M, Barkin JS, Clarke LP, Askar FS, Serafini A (1983) A sign of symptomatic chronic cholecystitis. Am J Roentgenol 140:283–285Google Scholar
  2. Bednarz GM, Kalff V, Kelly MJ (1986) Hepatobiliary scintigraphy. Increasing the accuracy of the preoperative diagnosis of acute cholecystitis. Med J Aust 145:316–318Google Scholar
  3. Bennett MT, Sheldon MI, dos Remedios LV, Weber PM (1981) Diagnosis of acute cholecystitis using hepatobiliary scan with technetium-99m PIPIDA. Am J Surg 142:338–342Google Scholar
  4. Brachman M, Levy R, Tanasecu D, Ramanna L, Waxman A (1981) Letter to the Editor. Re: False-negative gallbladder scintigram in acute cholecystitis. J Nucl Med 22:291–292Google Scholar
  5. Cabellon S, Brown JM, Cavanaugh DG (1984) Accuracy of the hepatobiliary scan in acute cholecystitis. Am J Surg 148:607–608Google Scholar
  6. Choy D, Shi EC, McLean RG, Hoschl R, Murray IPC, Ham JM (1984) Cholescintigraphy in acute cholecystitis: use of intravenous morphine. Radiology 151:203–207Google Scholar
  7. Dudczak R, Kletter K, Angelberger P, Frischauf H (1979) Comparison of two different biliary agents in healthy subjects and in patients with liver disease. Eur J Nucl Med 4:365–368Google Scholar
  8. Echevarria RA, Gleason JL (1980) False-negative gallbladder scintigram in acute cholecystitis. J Nucl Med 21:841–843Google Scholar
  9. Fonseca C, Greenberg D, Rosenthall L, Arzoumanian A (1978) Assessment of the utility of gallbladder imaging with 99m-TcIDA. Clin Nucl Med 3:437–441Google Scholar
  10. Freitas JE (1982) Cholescintigraphy in acute and chronic cholecystitis. Semin Nucl Med 12:18–26Google Scholar
  11. Freitas JE, Fink-Bennett DM, Thrall JH, Resinger WW, Calderon HC, Mirkes SH, Shah PK (1980) Efficacy of hepatobiliary imaging in acute abdominal pain: concise communication. J Nucl Med 21:919–924Google Scholar
  12. Gliedman ML, Wilk PJ (1982) A surgeon's view of hepatobiliary scintigraphy. Semin Nucl Med 12 (vol 1):2–4Google Scholar
  13. Klingensmith WC, Spitzer VM, Friztberg AR, Kuni CC (1981) The normal fasting and postprandial diisopropyl-IDA Tc 99m hepatobiliary study. Radiology 141:771–776Google Scholar
  14. Mack JM, Slavin JD, Spencer RP (1989) Two false-negative results using morphine sulphate in hepatobiliary imaging. Clin Nucl Med 14:87–88Google Scholar
  15. Nicholson RW, Hastings DL, Testa HJ, Torrance B (1980) HIDA scanning in gall-bladder disease. Br J Radiol 53:878–882Google Scholar
  16. O'Callaghan JD, Verow PW, Hopton D, Craven JL (1980) The diagnosis of acute gallbladder disease by technetium-99m-labelled HIDA hepatobiliary scanning. Br J Surg 67:805–808Google Scholar
  17. Pare P, Shaffer EA, Rosenthall L (1978) Nonvisualization of the gallbladder by 99m-Tc-HIDA cholescintigraphy as evidence of acute cholecystitis. Can Med Assoc J 118:384–386Google Scholar
  18. Pauwels S, Steels M, Piret L, Beckers C (1978) Clinical evaluation of Tc-99m-diethyl-IDA in hepatobiliary disorders. J Nucl Med 19:783–788Google Scholar
  19. Reimer DE, Donald JW (1981) Technetium-99m-HIDA visualization of an obstructed gallbladder via an accessory hepatic duct. AJR 137:610–611Google Scholar
  20. Rosen PR, Rusing TW, Nusynowitz ML, Lecklitner ML (1982) 99mTc-PIPIDA cholescintigraphy in the diagnosis of gallbladder disease. Am J Med Sci 284:23–31Google Scholar
  21. Rosenthall L (1978) Clinical experience with the newer hepatobiliary radiopharmaceuticals. Can J Surg 21:297–300Google Scholar
  22. Samuels BI, Freitas JE, Bree RL, Schwab RE, Heller ST (1983) A comparison of radionuclide hepatobiliary imaging and realtime ultrasound for the detection of acute cholecystitis. Radiology 147:207–210Google Scholar
  23. Shuman WP, Mack LA, Rudd TG, Rogers JV, Gibbs P (1982) Evaluation of acute right upper quadrant pain: sonography and 99mTc-PIPIDA cholescintigraphy. AJR 139:61–64Google Scholar
  24. Suarez CA, Block F, Bernstein D, Serafini A, Rodman G, Zeppa R (1980) The role of H.I.D.A./P.I.P.I.D.A. scanning in diagnosing cystic duct obstruction. Ann Surg 191:391–396Google Scholar
  25. Szlabick RE, Catto JA, Fink-Bennett D, Ventura V (1980) Hepatobiliary scanning in the diagnosis of acute cholecystitis. Arch Surg 115:540–544Google Scholar
  26. Weissmann HS, Frank MS, Bernstein LH, Freeman LM (1979) Rapid and accurate diagnosis of acute cholecystitis with 99mTcHIDA cholescintigraphy. AJR 132:523–528Google Scholar
  27. Weissmann HS, Badia J, Sugarman LA, Kluger L, Rosenblatt R, Freeman LM (1981) Spectrum of 99-Tc-IDA cholescintigraphic patterns in acute cholecystitis. Radiology 138:167–175Google Scholar
  28. Worthen NJ, Uszler JM, Funamura JL (1981) Cholecystitis: prospective evaluation of sonography and 99mTc-HIDA cholescintigraphy. AJR 137:973–978Google Scholar
  29. Zeman RK, Burrell MI, Cahow CE, Caride V (1981) Diagnostic utility of cholescintigraphy and ultrasonography in acute cholecystitis. Am J Surg 141:446–451Google Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • Rodney J. Hicks
    • 1
  • Michael J. Kelly
    • 1
  • Victor Kalff
    • 1
  1. 1.Department of Nuclear MedicineAlfred HospitalMelbourneAustralia

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