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Harvey A Ziessman - One of the best experts on this subject based on the ideXlab platform.

  • Cholecystokinin Cholescintigraphy: Methodology and Normal Values Using a Lactose-Free Fatty-Meal Food Supplement
    2015
    Co-Authors: Harvey A Ziessman, Md Douglas, A. Jones, Md Larry, R. Muenz, Anup K. Agarval
    Abstract:

    The purpose of this investigation was to evaluate the use of a commercially available lactose-free fatty-meal food supple-ment, as an alternative to sincalide Cholescintigraphy, to de-velop a standard methodology, and to determine normal gall-bladder ejection fractions (GBEFs) for this supplement. Methods: Twenty healthy volunteers all had negative medical histories for hepatobiliary and gallbladder disease, had no per-sonal or family history of hepatobiliary disease, and were not taking any medication known to affect gallbladder emptying. All were prescreened with a complete blood cell count, compre-hensive metabolic profile, gallbladder and liver ultrasonography, and conventional Cholescintigraphy. Three of the 20 subjects were eliminated from the final analysis because of an abnormal-ity in one of the above studies. Results: After gallbladder filling on conventional Cholescintigraphy, the subjects ingested the supplement and an additional 60-min study was acquired. GBEFs were calculated and ranged from 33 % to 95 % (mean SD, 62.6 % 21.3%). Statistical analysis determined the lower range of normal to be 32.6%. Maximal gallbladder emptying occurred between 55 and 60 min. Conclusion: A standard methodology and normal GBEFs (33%) were established for supplement-stimulated Cholescintigraphy

  • hepatobiliary scintigraphy in 2014
    The Journal of Nuclear Medicine, 2014
    Co-Authors: Harvey A Ziessman
    Abstract:

    Cholescintigraphy with (99m)Tc-hepatobiliary radiopharmaceuticals has been an important, clinically useful diagnostic imaging study for almost 4 decades. It continues to be in much clinical demand; however, the indications, methodology, and interpretative criteria have evolved over the years. This review will emphasize state-of-the-art methodology and diagnostic criteria for various clinical indications, including acute cholecystitis, chronic acalculous gallbladder disease, high-grade and partial biliary obstruction, and the postcholecystectomy pain syndrome, including sphincter-of-Oddi dysfunction and biliary atresia. The review will also emphasize the use of diagnostic pharmacologic interventions, particularly sincalide.

  • utilization of cholecystokinin Cholescintigraphy in clinical practice
    Journal of The American College of Surgeons, 2013
    Co-Authors: Bryan K Richmond, John D Dibaise, Harvey A Ziessman
    Abstract:

    Cholecystokinin-Cholescintigraphy (CCK-HIDA) is commonly performed to evaluate patients with upper abdominal pain thought to be biliary in origin and with a normal gallbladder on abdominal ultrasonography. The nomenclature of this disease entity, based on the finding of an abnormally low gallbladder ejection fraction (GBEF) on the CCK-HIDA examination, varies in the literature and has been known as biliary dyskinesia, gallbladder dyskinesia, functional gallbladder disorder, chronic acalculous cholecystitis, and chronic acalculous biliary dysfunction, just to name a few. For the purposes of this review, we will use the term gallbladder dyskinesia because this is the term most referenced in the surgical literature. Cholecystectomy is commonly recommended as the treatment of choice in these patients. 1 Although used commonly in today’s clinical surgical practice, the CCK-HIDA testing methodology, test interpretation, patient selection, and controversies surrounding long-term treatment outcomes pertaining to surgical intervention for gallbladder dyskinesia are controversial and poorly understood by many practicing clinicians. This review details the controversies surrounding the testing methodology, the method of determining normal vs abnormal CCK-HIDA values, and the data both supporting and questioning its clinical use to select patients for cholecystectomy based on the current available literature. In addition, evidence-based recommendations for the use of CCK-HIDA in clinical practice are presented.

  • sincalide Cholescintigraphy 32 years later evidence based data on its clinical utility and infusion methodology
    Seminars in Nuclear Medicine, 2012
    Co-Authors: Harvey A Ziessman
    Abstract:

    Sincalide Cholescintigraphy was first reported to have clinical utility in 1980. Since then, many publications have found that a reduced gallbladder ejection fraction (GBEF) can confirm the clinical diagnosis of acalculous chronic gallbladder disease and predict symptomatic relief with cholecystectomy. However, some publications had not found the test clinically predictive. Many different sincalide infusion methods and normal values have been used. It had been suspected that the different infusion methods and normal values might account for the variability in reported utility. Furthermore, clinical review articles have raised questions about the evidence-based quality of the published data on the diagnostic utility of sincalide Cholescintigraphy. A recently published multicenter trial has established the optimal methodology for sincalide infusion and normal values. A subsequent multispecialty consensus publication has recommended that this method be the standard method for sincalide infusion, specifically, a 60-minute infusion of 0.02 μg/kg (abnormal GBEF,

  • functional hepatobiliary disease chronic acalculous gallbladder and chronic acalculous biliary disease
    Seminars in Nuclear Medicine, 2006
    Co-Authors: Harvey A Ziessman
    Abstract:

    Chronic acalculous gallbladder and chronic acalculous biliary disease are considered functional hepatobiliary diseases. Cholescintigraphy provides physiologic imaging of biliary drainage, making it ideally suited for their noninvasive diagnosis. For chronic acalculous gallbladder disease, calculation of a gallbladder ejection fraction during sincalide Cholescintigraphy can confirm the clinical diagnosis and has become a common routine procedure in many nuclear medicine clinics. Published data generally confirm a high overall accuracy for predicting relief of symptoms with cholecystectomy. However, data also exist suggesting it is not useful. The discrepant results probably are caused by the various different methodologies that have been used for sincalide infusion. Proper methodology of sincalide infusion is critical for providing accurate reproducible results, minimizing false positive studies, and preventing adverse side effects. The most common causes for the postcholecystectomy pain syndrome are partial biliary obstruction secondary to stones or tumor and sphincter of Oddi dysfunction. The latter is a partial biliary obstruction at the level of the sphincter. This has long been considered a functional hepatobiliary disease because of the lack of anatomical abnormalities. Sphincterotomy is the present treatment; however, diagnosis requires invasive procedures, such as endoscopic retrograde cholangiopancreatography and sphincter of Oddi manometry, which has a high complication rate and is not widely available. The unique ability of Cholescintigraphy to image biliary drainage allows noninvasive diagnosis. Different methodologies have been reported, many with good overall accuracy. Various pharmacologic interventions and quantitative methodologies have been used in conjunction with Cholescintigraphy to enhance its diagnostic capability. Further investigations are needed determine the optimal methodology; however, cholescintigraphic methods have already a clinical role in the diagnosis of sphincter of Oddi dysfunction and will be used increasingly in the future.

Mustafa Kula - One of the best experts on this subject based on the ideXlab platform.

  • Cholescintigraphy in the Diagnosis of Rotor Syndrome
    Clinical nuclear medicine, 1997
    Co-Authors: Ahmet Tutus, Güler Silov, Mustafa Kula
    Abstract:

    A 2-year-old boy with Rotor syndrome was studied with Tc-99m N-(di-isopropylphenyl carbamoylmethyl) iminodiacetic acid (DIPA). In this patient, the liver was not visualized, and there was persistent visualization of the cardiac blood pool and along with prominent kidney excretion. It is concluded that Tc-99m DIPA Cholescintigraphy may be helpful in the diagnosis of Rotor syndrome.

Arun C Nachiappan - One of the best experts on this subject based on the ideXlab platform.

Anish Bansal - One of the best experts on this subject based on the ideXlab platform.

  • a diagnostic dilemma of atypical gallbladder appearance on tc 99m hida Cholescintigraphy resolved with spect ct
    Clinical Nuclear Medicine, 2011
    Co-Authors: Ravi F Sood, Jeff Murguia, Michael M Graham, David L Bushnell, Shayne Squires, Sandeep T Laroia, Anish Bansal
    Abstract:

    Abstract: Tc-99m HIDA Cholescintigraphy is the diagnostic procedure of choice for acute cholecystitis. Acute cholecystitis is associated in vast majority of the cases with cystic duct obstruction. The demonstration of presence (cystic duct patency) or absence (cystic duct obstruction) of visualization of the gallbladder on Cholescintigraphy is critical to the diagnosis of acute cholecystitis. The visualization of the gallbladder rules out acute cholecystitis in most of the cases. Although, in most cases, determination of visualization or nonvisualization of gallbladder is straight forward, occasionally it can be challenging. We describe a patient with suspected acute cholecystitis, in whom an unusual appearance of the gallbladder on hepatobiliary scintigraphy was clarified with SPECT/CT, an approach that is rarely used in Tc-99m HIDA Cholescintigraphy.

Corrado P Marini - One of the best experts on this subject based on the ideXlab platform.

  • diagnosis of acute cholecystitis sensitivity of sonography Cholescintigraphy and combined sonography Cholescintigraphy
    Journal of The American College of Surgeons, 2001
    Co-Authors: Robert Kalimi, Gary Gecelter, Drew M Caplin, Michael Brickman, Gene T Tronco, Charito Love, Jeffery Yao, Hank H Simms, Corrado P Marini
    Abstract:

    Abstract BACKGROUND: Radiographic diagnosis of acute cholecystitis can be established using ultrasonography (US), cholecystoscintigraphy (HIDA), or both. Although both modalities have been effective in diagnosing acute cholecystitis (AC), physicians from the emergency department and admitting surgeons continue to request both tests in an attempt to increase the diagnostic accuracy of AC. This article reports the institutional experience of a large tertiary care health care facility, with respect to the sensitivity of US, HIDA, and combined US and HIDA. STUDY DESIGN: We conducted a retrospective review of 132 patients diagnosed with AC who underwent laparoscopic cholecystectomy during the same hospitalization. Patients were stratified into three groups: Group 1 (Gp1, n=50) included patients who underwent US alone, group 2 (Gp2, n=28) included patients who underwent HIDA scan alone, and group 3 (Gp3, n=54) included patients who underwent both US and HIDA. RESULTS: The three groups did not differ with respect to age, liver chemistry, time to operation, and hospital length of stay. The sensitivity of US, HIDA, and combined US/HIDA as diagnostic modalities for acute cholecystitis was referenced to histopathologic confirmation. Sensitivity was 24 of 50 (48%), 24 of 28 (86%), and 49 of 54 (90%) for US, HIDA, and the combination of US/HIDA, respectively. CONCLUSIONS: HIDA scan is a more sensitive test than US in diagnosing patients with AC. Based on the results of this study, we recommend that HIDA scan should be used as the first diagnostic modality in patients with suspected acute cholecystitis; US should be used to confirm the presence of gallbladder stones rather than to diagnose AC.