Hepatobiliary scanning in the diagnosis of acute cholecystitis

Two hundred seventy-one consecutive hepatobiliary scans (HBS) using technetium Tc 99m iprofenin (Pipida [Sn]) were obtained to evaluate abdominal pain. The material (5 to 10 mCi) was injected and standard anterior and lateral scintographic images were obtained during a one-hour period. An abnormal scan was defined as one in which the gallbladder failed to be seen by one hour with adequate visualization of the biliary tree and proximal gastrointestinal tract. The accuracy of this method was evaluated on the basis of surgical pathology obtained in 117 patients. Of the 76 patients undergoing surgery with an abnormal HBS, 75 had acute cholecystitis, yielding a test accuracy of 98.7%. A normal scan reliably excluded the possibility of acute cholecystitis (100%). Hepatobiliary scanning is presently the most accurate and rapid modality in the diagnosis of acute cholecystitis.