Normal Values for Sincalide Cholescintigraphy: Comparison of Two Methods

PURPOSE: To establish normal gallbladder ejection fraction (GBEF) values for two sincalide (cholecystokinin [CCK]) infusion dose rates, 0.01 μg per kilogram of body weight infused for 3 minutes and 0.01 μg/kg infused for 60 minutes.

MATERIALS AND METHODS: Twenty healthy subjects were examined. GBEFs were calculated for the 3-minute infusion and for each 15-minute interval for the 60-minute infusion. Normal values were determined by using the mean ± 2 SDs and a more rigorous statistical analysis.

RESULTS: With the 3-minute infusion, GBEFs were significantly more variable than with the 45- and 60-minute values for the 60-minute infusion (P < .01, .002). With intervals including 95% of the population, the GBEF lower normal range was 16.8% for the 3-minute infusion but 31% and 41% for the 45- and 60-minute values, respectively. GBEFs of less than 35% were noted in six (30%) of 20 healthy subjects with the 3-minute infusion but in only one with the 60-minute infusion. Hepatobiliary ultrasonography was performed in six of seven subjects with GBEF of 36% or less, and US findings in all six were normal.

CONCLUSION: A 3-minute infusion of sincalide, 0.01 μg/kg, produces too variable a GBEF response to establish a clinically useful normal range. With 0.01 μg/kg infused for 60 minutes, clinically useful normal values were established at 45 and 60 minutes.

References

  • 1 Topper TE, Tyerson TW, Nora PF. Quantitative gallbladder imaging following cholecyostokinin. J Nucl Med 1980; 2121:694-696. Google Scholar
  • 2 Pickelman J, Peiss R, Henkin R, et al. The role of sincalide cholescintigraphy in the evaluation of patients with acalculous gallbladder disease. Arch Surg 1985; 120:693-697. Crossref, MedlineGoogle Scholar
  • 3 Fink-Bennett D, DeRidder P, Kolozsi WZ, et al. Cholecystokinin cholescintigraphy: detection of abnormal gallbladder motor function in patients with chronic acalculous gallbladder disease. J Nucl Med 1991; 32:1695-1699. MedlineGoogle Scholar
  • 4 Yap L, Wycherley AG, Morphett AD, Toouli J. Acalculous biliary pain: cholecystectomy alleviates symptoms in patients with abnormal cholescintigraphy. Gastroenterology 1991; 101:786-793. Crossref, MedlineGoogle Scholar
  • 5 Halverson JD, Garner BA, Siegel BA, et al. The use of hepatobiliary scintigraphy in patients with acalculous biliary colic. Arch Intern Med 1992; 152:1305-1307. Crossref, MedlineGoogle Scholar
  • 6 Middleton GW, Williams JH. Is gall bladder ejection fraction a reliable predictor of acalculous gall bladder disease? Nucl Med Commun 1992; 13:894-896. Crossref, MedlineGoogle Scholar
  • 7 Sorenson MK, Fancer S, Lang N, et al. Abnormal gallbladder nuclear ejection fraction predicts success of cholecystectomy in patients with biliary dyskinesia. Am J Surg 1993; 166:672-674. Crossref, MedlineGoogle Scholar
  • 8 Misra DC, Blossom GB, Fink-Bennett D, Glover J. Results of surgical therapy for biliary dyskinesia. Arch Surg 1991; 126:957-960. CrossrefGoogle Scholar
  • 9 Ziessman HA, Fahey FH, Hixson DJ. Calculation of a gallbladder ejection fraction: advantage of continuous sincalide infusion over the three-minute method. J Nucl Med 1992; 33:537-541. MedlineGoogle Scholar
  • 10 Sarva RP, Shreiner DP, Van Thiel D, Yingvorapant N. Gallbladder function: methods for measuring filling and emptying. J Nucl Med 1985; 26:140-146. MedlineGoogle Scholar
  • 11 Krishnamurthy SK, Krishnamurthy GT. Biliary dyskinesia: role of the sphincter of Oddi gallbladder and cholecystokinin. J Nucl Med 1997; 38:1824-1830. MedlineGoogle Scholar
  • 12 Krishnamurthy SK, Krishnamurthy GT. Cholecystokinin and morphine pharmacological intervention during 99mTc-HIDA cholescintigraphy: a rational approach. Semin Nucl Med 1996; 26:16-24. Crossref, MedlineGoogle Scholar
  • 13 Izenman AJ. Recent developments in nonparametric density estimation. J Am Stat Assoc 1991; 86:205-224. Google Scholar
  • 14 Kotz S, Johnson NL. The Pitman-Morgan test In: Encyclopedia of statistical sciences. Vol 6. New York, NY: Wiley, 1985; 739-740. Google Scholar
  • 15 Wiener I, Inoue K, Fagan CJ, et al. Release of cholecystokinin in man: correlation of blood levels with gallbladder contraction. Ann Surg 1981; 194:321-327. Crossref, MedlineGoogle Scholar
  • 16 Thompson JC, Fender HR, Ramus NI, et al. Cholecystokinin metabolism in man and dogs. Ann Surg 1975; 496-503. MedlineGoogle Scholar
  • 17 Torsoli A, Ramorino ML, Calagrande C, et al. Experiments with cholecystokinin. Acta Radiol Scand 1961; 55:193-195. CrossrefGoogle Scholar
  • 18 Westlake PJ, Hershfield NB, Kelly JK, et al. Chronic right upper quadrant pain without gallstones: does HIDA scan predict outcome after cholecystectomy? Am J Gastroenterol 1990; 85:986-990. MedlineGoogle Scholar
  • 19 Fink-Bennett D. The role of cholescystogogues in the evaluation of biliary tract disorders. In: Freeman LM, Weissman HS, eds. Nuclear medicine annual 1985. New York, NY: Raven, 1985; 107-132. Google Scholar
  • 20 Fink-Bennett D. Augmented cholescintigraphy: its role in detecting acute and chronic disorders of the hepatobiliary tree. Semin Nucl Med 1991; 21:128-139. Crossref, MedlineGoogle Scholar
  • 21 Krishnamurthy GT, Bobba VR, McConnell D, et al. Quantitative biliary dynamics: introduction of a new noninvasive scintigraphic technique. J Nucl Med 1983; 24:217-223. MedlineGoogle Scholar
  • 22 Krishnamurthy GT, Bobba VR, Kingston E. Radionuclide ejection fraction: a technique for quantitative analysis of motor function of the human gallbladder. Gastroenterology 1981; 80:482-490. Crossref, MedlineGoogle Scholar
  • 23 Bobba VR, Krishnamurthy GT, Kingston E, et al. Gallbladder dynamics induced by a fatty meal in normal subjects and patients with gallstones: concise communication. J Nucl Med 1984; 25:21-24. MedlineGoogle Scholar
  • 24 Krishnamurthy GT, Bobba VR, Kingston E, Turner F. Measurement of gallbladder emptying sequentially using a single dose of 99mTc labeled hepatobiliary agent. Gastroenterology 1982; 83:773-776. Crossref, MedlineGoogle Scholar
  • 25 Mesgarzadeh M, Krishnamurthy GT, Bobba VR, Langrell K. Filling, postcholecysto-kinin emptying, and refilling of normal gallbladder: effects of two different doses of CCK on refilling: concise communication. J Nucl Med 1983; 24:666-671. MedlineGoogle Scholar
  • 26 Krishnamurthy GT, Bobba VR, Langrell K. The gallbladder emptying response to sequential exogenous and endogenous cholecystokinin. Nucl Med Commun 1984; 5:27-33. Crossref, MedlineGoogle Scholar
  • 27 Drane WE, Johnson DA. Sincalide-augmented quantitative hepatobiliary scintigraphy (QHBS): definition of normal parameters and preliminary relationship between QHBS and sphincter of Oddi SO manometry in patients suspected of having SO dysfunction. J Nucl Med 1990; 31:1662-1668. MedlineGoogle Scholar
  • 28 Krishnamurthy GT, Bobba VR, Kingston E. Optimization of octapeptide of cholecystokinin dose for gallbladder emptying. In: Raynaud C, eds. Proceedings of the Third World Congress of Nuclear Medicine and Biology. Paris, France: Pergamon, 1982; 2224-2247. Google Scholar
  • 29 Raymond F, Lepanto L, Rosenthall L, Fried GM. Tc-99-IDA gallbladder kinetics and response to CCK in chronic cholecysitis. Medicine 1988; 14:378-381. Google Scholar
  • 30 Everhart JE. Gallstones. In: Johanson JF, eds. Gastrointestinal diseases: risk factors and prevention. Philadelphia, Pa: Lippincott-Raven, 1997. Google Scholar
  • 31 Spellman SJ, Shaffer EA, Rosenthall L. Gallbladder emptying in response to cholecystokinin. Gastroenterology 1979; 77:115-120. Crossref, MedlineGoogle Scholar
  • 32 Hopman WPM, Jansen JBMJ, Rosenbusch G. Gallbladder contraction induced by cholecystokinin: bolus injection or infusion? Br Med J 1986; 292:375-376. CrossrefGoogle Scholar
  • 33 Courtney DF, Clanachan AS, Scott GW. Cholecystokinin constricts the canine cystic duct. Gastroenterology 1983; 85:1154-1159. Crossref, MedlineGoogle Scholar

Article History

Published in print: Nov 2001