Morphine augmentation increases gallbladder visualization in patients pretreated with cholecystokinin

Area of Science:

• Nuclear medicine
• Gastroenterology
• Diagnostic imaging

Background:

• Hepatobiliary scintigraphy is crucial for diagnosing acute cholecystitis.
• Detecting cystic duct patency is essential for accurate diagnosis.
• Cholecystokinin (CCK) is used to stimulate gallbladder contraction.

Purpose of the Study:

• To evaluate if combining cholecystokinin (CCK) pretreatment with morphine augmentation improves cystic duct patency detection compared to CCK alone.
• To assess the efficacy of morphine in enhancing gallbladder visualization during hepatobiliary scintigraphy.

Main Methods:

• 155 patients with suspected acute cholecystitis underwent 99mTc-mebrofenin hepatobiliary scintigraphy.
• All patients received intravenous sincalide (CCK) followed by sequential imaging up to 90 minutes.
• If gallbladder was not visualized, a second dose of mebrofenin was administered, followed by intravenous morphine sulfate and further imaging.

Main Results:

• 28% of patients pretreated with CCK alone did not show gallbladder visualization at 90 minutes.
• Following intravenous morphine administration, gallbladder visualization increased to 42% in this non-visualizing group (p = 0.0001).

Conclusions:

• Hepatobiliary imaging with CCK pretreatment alone for 90 minutes is insufficient to identify all patent cystic ducts.
• Morphine augmentation significantly increases the detection rate of gallbladder visualization in patients pretreated with CCK.