THE CLINICAL UTILITY OF QUANTITATIVE CHOLESCINTIGRAPHY - THE SIGNIFICANCE OF GALLBLADDER DYSFUNCTION

Purpose: Cholelithiasis is a common disorder occurring in over 20 mill ion people in the United States and resulting in approximately 600,000 cholecystectomies annually. Although over 95% of biliary tract diseas e is caused by gallstones, the vast majority (>80%) of cholelithiasis cases are asymptomatic. the purpose of this study is to evaluate the u tility of quantitative cholescintigraphy in detecting symptomatic bili ary tract disease and predicting clinical relief after cholecystectomy . Materials and Methods: Fifty-two patients with clinical symptoms of chronic cholecystitis were evaluated by cholescintigraphy with a gallb ladder ejection fraction calculated after the intravenous administrati on of cholecystokinin. A gallbladder ejection fraction of greater than or equal to 35% was considered a normal physiologic response. Forty-o ne of the patients subsequently underwent cholecystectomy, whereas the remaining 11 subjects were diagnosed and treated for non-biliary diso rders that did not require cholecystectomies. After clinical follow-up including histopathological gallbladder findings, all subjects' final diagnoses were established and correlated with their quantitative cho lescintigram study. Results: Twenty-six of twenty-eight patients who h ad an abnormal quantitative cholescintigram demonstrated evidence of c hronic cholecystitis by histopathologic criteria after cholecystectomy . Furthermore, 27 of these 28 patients (96%) experienced complete reli ef of their clinical symptoms after surgery. Conclusion: Functional ch olescintigraphy is a safe, accurate, and useful test for detecting sym ptomatic gallbladder disease, and appears reliable in predicting sympt omatic relief after cholecystectomy.