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PubMed1980

Ultrasonography and oral cholecystography: a comparison of their use in the diagnosis of gallbladder disease.

The charts of all cholecystectomy patients at the White Memorial Medical Center, Los Angeles, from January 1977 to December 1979 were reviewed; of 374 patients, 76 had had both abdominal ultrasound scan and oral cholecystography performed preoperatively. Cholecystography accurately diagnosed gallbladder disease in 71 of these 76 patients, an accuracy rate of 93.4% with one false-positive and four false-negative results. Ultrasonography correctly predicted gallbladder disease in 66 of 76 patients, an accuracy rate of 86.8%, with one false-positive and nine false-negative results. On the basis of this study and others in the literature, ultrasound scanning is recommended as the initial screening diagnostic study for gallbladder disease. Oral cholecystography should follow in patients in whom ultrasonography fails to identify gallbladder calculi.

Cholecystography↗
PubMed1984

Infusion cholecystography in the early diagnosis of acute gallbladder disease.

The value of infusion cholecystography 99mTc HIDA cholescintigraphy and ultrasonography was compared in 51 patients presenting with a clinical diagnosis of acute cholecystitis. Of the 35 patients with proven gallbladder disease, the presence of gallstones was correctly predicted in 31 (88 per cent) by infusion cholecystography, 32 (90 per cent) by 99mTc HIDA cholescintigraphy and 27 (77 per cent) by ultrasonography. There were no false positive investigations. Infusion cholecystography may be of particular interest to surgeons with no ready access to isotope scanning techniques.

Acute Disease↗
PubMed1988

Studies on the mechanism of non-visualization of diseased human gallbladders during oral cholecystography.

Oral cholecystography is a well established method for studying the human gallbladder and radiological non-visualization of the gallbladder has been shown to correlate highly with the presence of disease. The exact mechanism by which diseased gallbladders fail to visualize is unclear, but may be due to a failure of the gallbladder to concentrate the luminal contents. Concentration of gallbladder contents is achieved by the reabsorption of water, the driving force for which is active sodium (Na+) absorption. Therefore Na+ transport was studied by measuring the flux of Na22 across isolated human gallbladder mucosa (obtained at cholecystectomy) and compared with the results of oral cholecystography and histological grading. In 27 gallbladders studied, 59% absorbed Na+, whilst the remainder secreted Na+. Comparison with histological grading showed that as gallbladders became more diseased they absorbed less Na+ and were more likely to secrete Na+. In addition, gallbladders that absorbed Na+ were significantly more likely to visualize on cholecystography than those that secreted Na+. These results indicate that some diseased human gallbladders secrete, rather than absorb, Na+ and suggest that the mechanism for radiological non-visualization is failure of fluid absorption and the development of active fluid secretion.

Cholecystography↗
PubMed1981

Conjugated sodium tyropanoate (Bilopaque) in the bowel: significance of its presence or absence after first-dose oral cholecystography.

Oral cholecystography following the ingestion of 4.5 g of sodium tyropanoate (Bilopaque) was performed in 1,053 patients. The radiographs of 89 patients in whom the gallbladder was either faintly visualized or nonvisualized were reviewed for the presence of conjugated contrast material in the bowel. All 89 of these patients underwent second-dose cholecystography. Oral cholecystography was found to be 100% accurate in the diagnosis of gallbladder disease when conjugated contrast media was found in the bowel in the presence of a faintly visualized or nonvisualized gallbladder. When this combination of findings is seen on the first-dose examination, a second-dose examination is unnecessary. When no conjugated contrast material is seen in the bowel after a first dose, a second dose is helpful only in those patients with normal biochemical liver function tests.

Adolescent↗
PubMed1986

Cholelithiasis in the morbidly obese: diagnosis by US and oral cholecystography.

Forty-two morbidly obese patients underwent cholecystectomy at the time of gastroplasty, primarily for prophylactic reasons. Preoperatively, 37 patients underwent ultrasonography (US) of the gallbladder and oral cholecystography, four US only, and one oral cholecystography only. There was one indeterminate US study (2.4%) and one indeterminate oral cholecystogram (2.7%). At US study, gallstones were detected in six of the eight patients with gallstones (sensitivity = 75%), and the gallbladders of all 32 patients without gallstones were categorized as normal (specificity = 100%). The gallstones not identified measured 1-2 mm in diameter. Oral cholecystographic study enabled detection of gallstones in three of the seven patients with gallstones (sensitivity = 43%) and categorized as normal all 30 gallbladders without gallstones (specificity = 100%). The gallstones not seen were small and included those not detected by US. The results suggest that US is equal or superior to oral cholecystography for detection of cholelithiasis in obese patients.

Adult↗
PubMed1991

Optimal technique for detection of gallstones at injection cholecystography: in vitro analysis.

Injection cholecystography is often employed during invasive gallbladder procedures to determine the number of gallstones that are present. The authors undertook this study to define the optimal radiographic technique for performance of injection cholecystography. Condoms filled with 100 mL of contrast medium at four different iodine concentrations (30%, 15%, 7.5%, and 3.8% [wt/vol]) and containing up to five 4-mm-thick gallstones or a single 10-mm-thick gallstone were radiographed in a 20-cm-deep water bath by using four kilovolt peak settings (70, 80, 90, and 100 kVp). Images were read by three radiologists who were blinded to the radiographic technique. significantly (P less than .05) improved Decreasing iodine concentration significantly (P less than .05) improved detection of 4-mm-thick gallstones at a constant kilovolt peak setting. However, increasing the kilovolt peak setting while using the same concentration of contrast medium had no statistically significant influence on gallstone detectability, although radiologists did indicate a preference for the high-kilovolt peak technique. Results of the authors' experiments showed that for detection of small gallstones at injection cholecystography, use of a low-concentration contrast medium and a high kilovolt peak setting is the recommended radiographic technique.

Cholecystography↗
PubMed1985

Oral cholecystography after liver transplantation in man.

Orthotopic liver transplantation has been performed in Cambridge since 1967. In order to prevent complications resulting from the biliary drainage techniques, the donor gall bladder was interposed between the donor and recipient common bile duct as a vascularised pedical graft. The procedure, first performed in 1976, has been employed where possible ever since. Six patients having had this technique performed, and who remained well six months to six years after liver graft, underwent oral cholecystography. Four patients opacified the interposed gall bladder and the gall bladder contracted in response to cholecystography or a fatty meal. This is the first time oral cholecystography has been used in these patients. The detail is such that it can be used to follow non-jaundiced liver-grafted patients.

Cholecystography↗
PubMed1978

Preliminary abdominal films in oral cholecystography: are they necessary?

A survey of 45 radiologists with a special interest in gastrointestinal radiology showed that only 8% used a preliminary abdominal film for oral cholecystography. Review of 467 cases of oral cholecystography with preliminary films over a 1 year period disclosed 88 confirmed cases of cholelithiasis. Of these 88 cases, 27% had opaque gallstones visible on the preliminary film. In one-third of the cases, the opaque gallstones had a classic diagnostic appearance, while the remainder required oral cholecystography for confirmation. Opaque calculi were obscured by oral contrast material in 2% of cases. Other significant pathology on the preliminary films was found in 5.5% of the 467 cases.

Administration, Oral↗
PubMed1982

Cholecystokinin cholecystography, sonography, and scintigraphy: detection of chronic acalculous cholecystitis.

Because the efficacy of cholecystokinin cholecystography in the detection of chronic acalculous cholecystitis remains in doubt, the procedure is rarely used in clinical practice. However, the ability to observe gallbladder contraction with sonography and 99mTc-para-isopropylacetanilido-iminodiacetic acid cholescintigraphy (PIPIDA) offers a possibility to improve the sensitivity of the test. To determine if the degree of gallbladder contraction after cholecystokinin is the same as measured by the three techniques and if it differs in symptomatic patients compared to the normal population, cholecystokinin cholecystography, cholecystokinin sonography, and cholecystokinin PIPIDA were performed in 10 symptomatic patients and 10 normal volunteers. The mean maximum contraction of the gallbladder during the three studies was 63%, 61%, and 68%, respectively, for the volunteers, and 72%, 63%, and 73%, respectively, for the patients. The mean maximum gallbladder contraction during all three procedures was 64% +/- 26% SD in the volunteers and 74% +/- 17% SD in the patients. The differences were not statistically significant. Although there was good correlation in the degree of maximum gallbladder contraction among cholecystokinin cholecystography, cholecystokinin sonography, and cholecystokinin PIPIDA, marked variation in both the volunteers and the patients makes it unlikely that the degree of contraction as observed by any of these techniques can be used to indicate the presence of chronic acalculous cholecystitis.

Biliary Dyskinesia↗
PubMed1981

The value of 99mTc-cholescintigraphy as compared with infusion cholecystography for diagnosing acute cholecystitis.

A prospective comparative study was made of 99mTc-HIDA cholescintigraphy and 24-h infusion cholecystography for the diagnosis of acute cholecystitis. The material comprised 50 patients. Non-visualization of the gallbladder was regarded as a positive result and as indicative of acute cholecystitis. The final diagnoses were made at operation (36 patients), by additional examinations (9 patients), by a typical clinical course (3 patients), and at autopsy (2 patients). The predictive value of a positive and a negative cholescintigraphy was 92.6% and 95.7%, respectively. The predictive value of a positive and a negative infusion cholecystography was 78.6% and 81.8%, respectively. There was no statistically significant difference between the results of the two tests. The 99mTc-HIDA cholescintigraphy was easier and quicker to perform than the cholecystography, and likewise the scintigrams were easier to assess than the infusion cholecystograms. The diagnostic certainty of cholescintigraphy was found to be high, and the test is recommended in patients suspected of having acute cholecystitis.

Acute Disease↗
PubMed1978

Gray-scale ultrasonic cholecystography. A primary screeing procedure.

The accuracy of ultrasonic cholecystography is well established. However, oral cholecystography remains the primary screening examination. Ultrasonic and oral cholecystograms were performed in 100 consecutive patients to determine if ultrasound could be used as a primary screening procedure, particularly in patients with acute right-upper-quadrant pain, suggestive of acute cholecystitis. Ultrasound compared favorably with oral cholecystography in accuracy and specificity. It was also cost-effective, saving one to two days of hospitalization.

Acute Disease↗
PubMed1981

Intravenous cholecystography is a reliable method in the diagnosis of acute cholecystitis.

To evaluate the reliability of intravenous cholecystography in the diagnosis of acute cholecystitis, 186 consecutive patients with a clinical suspicion of acute cholecystitis were investigated. The contrast medium was administered as an intravenous infusion. The gall-bladder was not visualized in 110 patients (59%), suggesting acute cholecystitis. In 105 of these patients acute cholecystitis was confirmed at operation, or by a characteristic clinical course and/or oral cholecystography done later. There were 5 false positives; four of these patients were operated on, and proved to have other serious disease of the biliary tract. Filling of the gall-bladder was obtained in 76 cases (41%). One of these patients developed acute cholecystitis with perforation of the gall-bladder, diagnosed at laparotomy. In most other patients with filling of the gall-bladder diagnoses other than acute cholecystitis were verified. Intravenous cholecystography has proved highly reliable in the diagnosis of acute cholecystitis, and can contribute to reducing the incidence of misdiagnosis.

Acute Disease↗
PubMed1990

Cholescintigraphy versus infusion cholecystography in acute cholecystitis.

Patients with the clinical diagnosis of acute cholecystitis were studied with intravenous cholecystography and cholescintigraphy. The two examinations alternated in a random order. The final diagnosis was ascertained by surgery in most patients. Either cholecystography or cholescintigraphy could be used in the diagnostics of patients with suspected acute cholecystitis. The methods have about the same accuracy. However, cholescintigraphy is performed more easily and more rapidly than intravenous cholecystography.

Acute Disease↗
PubMed1980

Oral cholecystography in assessment of acute abdominal pain.

During one year, 77 patients had oral cholecystography within five days of the onset of acute upper abdominal symptoms. These patients were not severely ill, as evidenced by the fact that only 18 were hospitalized. The patients were unselected and the results were reviewed in retrospect. Accordingly, the data cannot be critically analyzed. Nonetheless, diagnostically useful information was obtained in 57 of these cases. In 44 patients, a normal gallbladder was visualized, and in 13 patients gallstones were seen. Three conclusions are derived from this study. First, oral cholecystography can be performed within five days of the onset of acute upper abdominal symptoms with a reasonable expectation of obtaining diagnostically useful information. Second, the usually recommended delay of four to six weeks is unnecessary. Finally, this diagnostic study should be performed in the acute situation when it is not precluded by nausea, vomiting, or a severely ill patient.

Abdomen, Acute↗
PubMed1983

Severe thrombocytopenia following oral cholecystography with iocetamic acid.

We report the first case of severe thrombocytopenia occurring after ingestion of a widely used cholecystographic medium, iocetamic acid. The patient had not been given any treatment before he received the gallbladder contrast medium. Onset of symptoms was acute, and the clinical course was benign with complete recovery after one week. Bone marrow aspiration showed increased numbers of megakaryocytes, suggesting that platelets were rapidly removed from circulation. In vitro tests for antiplatelet antibodies were not performed because iocetamic acid is insoluble in aqueous solutions. Since only a few cases of thrombocytopenia following ingestion of iodine-compounds have been reported, it seems highly unlikely that purpura will be, in the future, a major hazard in cholecystography. However, it would be wise to question patients as to any prior sensitivity to iodine before proceeding with oral cholecystography.

Adult↗
PubMed1979

Infusion cholecystography in the diagnosis of acute cholecystitis.

The use of infusion cholecystography as an aid in the diagnosis of acute cholecystitis was investigated in 21 patients. Seventeen of 18 patients (94 per cent) with positive cholecyst-tomograms who underwent laparotomy had confirmation of acutely inflamed gallbladders both macroscopically and histologically. These findings suggest that infusion cholecystography can make a significant contribution in reducing the incidence of misdiagnosis in acute cholecystitis, and that the investigation should be part of the management of patients in whom early surgery is planned.

Acute Disease↗
PubMed1978

Oral cholecystography in chronic renal insufficiency.

Thirty-two patients with chronic renal insufficiency (CRI) had oral cholecystography. Eleven of 15 patients (73%) with moderately advanced renal impairment had diagnostically inadequate single-dose cholecystograms. In contrast, all 11 patients on chronic hemodialysis had diagnostically opacified gallbladders following a single dose of contrast. Six other patients had biliary disease, either calculi (5 patients) or neoplasia (1 patient). These data suggest that CRI diminishes the likelihood of diagnostic gallbladder opacification, even in the absence of gallbladder disease, and that if the metabolic consequences of CRI are controlled by dialysis, the chances of diagnostic opacification are significantly improved (P less than 0.005). As oral cholecystography may not only result in inadequate opacification, but also carry the potential of renal toxicity, abdominal ultrasound should prove a safer and possibly more effective alternative in such patients.

Biliary Tract Diseases↗
PubMed1980

Thyroid, renal, and hepatic function tests following cholecystography with high-dose contrast agents.

Serum biochemical tests were observed for about three weeks following oral cholecystography with fractionated high doses (6 g) of iopanoic acid (Telepaque) or sodium ipodate (Biloptin) in 24 and 29 patients, respectively. Both agents produced similar effects. No significant changes were seen in renal or hepatic function except for a mild increase in bilirubin on day 22. Serum urate decreased 10% on day 4, but the change was not significant. On days 4 and 11, there were significant increases in thyroid-stimulating hormone, thyroxine and free thyroxine index, and a moderate fall in triiodothyronine. Reverse triiodothyronine increased sharply on day 4. The pattern of changes observed suggests that these contrasts interfere with the extrathyroidal deiodination of iodothyronines. The temporary rise in thyroxine and free thyroxine index exceeded reference ranges in about half of all subjects, but they remained clinically euthyroid. Thyroid function tests should be interpreted with caution within three weeks of cholecystography.

Adult↗