Pericholecystic hepatic activity in cholescintigraphy

Area of Science:

• Nuclear Medicine
• Diagnostic Imaging
• Hepatobiliary Imaging

Background:

• Gallbladder nonvisualization during cholescintigraphy is a recognized indicator of acute cholecystitis.
• A subtle finding of increased hepatic activity adjacent to the gallbladder (pericholecystic hepatic activity) has been observed in some nonvisualization scans.

Purpose of the Study:

• To determine the frequency and clinical significance of pericholecystic hepatic activity in patients with gallbladder nonvisualization on cholescintigraphy.
• To assess the association between this finding and the severity of gallbladder disease, including perforation.

Main Methods:

• Retrospective evaluation of 334 adult patients undergoing technetium-99m diisopropylphenylcarboamoyl iminodiacetic acid (HIDA) cholescintigraphy.
• Analysis of scan findings, specifically gallbladder nonvisualization and presence of pericholecystic hepatic activity.
• Correlation of imaging findings with surgical pathology and clinical outcomes.

Main Results:

• Pericholecystic hepatic activity was present in 21% of abnormal scans showing gallbladder nonvisualization.
• Of 13 surgically confirmed cases with this finding, 11 (85%) had acute cholecystitis and 2 (15%) had chronic cholecystitis.
• Four patients (31%) had gangrenous cholecystitis, and five (39%) had cholecystitis with gallbladder perforation.

Conclusions:

• Pericholecystic hepatic activity, in the context of gallbladder nonvisualization, is a reliable sign of inflammatory gallbladder disease.
• While not specific for gangrenous cholecystitis or perforation, this finding is associated with a higher incidence of complicated cholecystitis, including perforation.