Optimal hepatobiliary scintigraphy for gallbladder dyskinesia.

Area of Science:

• Gastroenterology
• Nuclear Medicine
• Diagnostic Imaging

Background:

• Hepatobiliary scintigraphy accuracy for gallbladder function is debated.
• Pharmaceutical-grade cholecystokinin shortages prompted fatty meal use for gallbladder stimulation.
• This study compares cholecystokinin and fatty meal efficacy in gallbladder contraction assessment.

Purpose of the Study:

• To compare the predictive indices of cholecystokinin (CCK) versus oral fatty meal (FM) for stimulating gallbladder contraction during hepatobiliary iminodiacetic acid (HIDA) scans.
• To evaluate the diagnostic performance of CCK and FM in patients with biliary dyskinesia.

Main Methods:

• Retrospective review of 359 patients undergoing HIDA scans from 2014-2017.
• Patients were grouped by stimulant: CCK (n=273) or FM (n=86).
• HIDA results correlated with surgical pathology and postoperative symptom resolution.

Main Results:

• Mean gallbladder ejection fraction was 38% (CCK) vs. 44% (FM), P=.073.
• No significant differences in predictive metrics for pathology, symptom improvement, or accuracy.
• Symptomatic resolution (78% CCK vs. 68% FM) and specificity (26% CCK vs. 44% FM) were comparable.

Conclusions:

• Fatty meal stimulation is a viable, affordable alternative to CCK for HIDA testing.
• FM demonstrates comparable diagnostic value for gallbladder dysmotility evaluation.
• This approach offers a reliable option amidst CCK supply issues.