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Related Experiment Videos

Two false-negative results using morphine sulfate in hepatobiliary imaging.

J M Mack1, J D Slavin, R P Spencer

  • 1Department of Radiology, Saint Francis Hospital and Medical Center, Hartford, Connecticut.

Clinical Nuclear Medicine
|February 1, 1989
PubMed
Summary

Morphine sulfate in hepatobiliary imaging can cause false-negative gallbladder scans. Despite gallbladder filling, two patients with acute cholecystitis were incorrectly diagnosed, highlighting potential diagnostic limitations.

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Area of Science:

  • Nuclear Medicine
  • Gastroenterology
  • Diagnostic Imaging

Background:

  • Morphine sulfate stimulates sphincter of Oddi contraction, increasing biliary pressure to aid gallbladder visualization in hepatobiliary scintigraphy.
  • This technique relies on gallbladder filling via a patent cystic duct under elevated biliary pressure.

Observation:

  • Two cases of false-negative hepatobiliary imaging results were identified.
  • Patients received standard technetium 99m-DISIDA and morphine sulfate doses.
  • Gallbladder filling occurred within one hour in both cases.

Findings:

  • Both patients were surgically explored due to high clinical suspicion of acute cholecystitis.
  • Surgical findings confirmed acute cholecystitis in both patients, despite successful gallbladder visualization on imaging.

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  • This indicates a potential for false-negative results with this imaging protocol.

    • Implications:

    • Clinicians should maintain a high index of suspicion for acute cholecystitis even with seemingly normal hepatobiliary imaging.
    • Morphine sulfate-augmented hepatobiliary scintigraphy may not be foolproof in ruling out gallbladder disease.
    • Further refinement of imaging protocols or consideration of adjunctive diagnostic methods may be warranted.