Journal of Nuclear Medicine Technology, Vol 27, Issue 4 294-297, Copyright © 1999 by Society of Nuclear Medicine
The role of morphine-augmented cholescintigraphy and real-time ultrasound in detecting gallbladder disease
M Lorberhoym, J Simon and T Horne
Department of Nuclear Medicine and Radiology, Edith Wolfson Medical Center, Holon, Israel.
OBJECTIVE: Rapid diagnosis of acute cholecystitis is essential to minimize
morbidity and mortality. The purpose of this study was to assess the
diagnostic utility of cholescintigraphy using morphine augmentation
compared with ultrasound, in acute and chronic gallbladder disease.
METHODS: Cholescintigrams were performed on 103 patients suspected of
having acute cholecystitis. In 79 patients (Group A) morphine sulfate was
administered to reduce the scintigraphic imaging time if the gallbladder
was not visualized during the first hour. In 24 control patients (Group B)
no morphine was administered. All patients were evaluated clinically and 93
patients had concurrent ultrasound examination. RESULTS: The clinical
presentation was nonspecific. The ultrasound findings were sensitive in
detecting gallbladder disease (100%), but had low specificity (24%). Only
findings of sediments and pericholecystic fluid were specific for cystic
duct obstruction. Morphine augmentation reduced the imaging time by 126 min
in patients with chronic cholecystitis. CONCLUSION: Real-time ultrasound
has low specificity for gallbladder disease. In the presence of an abnormal
ultrasound, it is essential to perform a hepatobiliary scan, either to
exclude gallbladder disease or distinguish acute from chronic
cholecystitis. Low-dose morphine administration is a safe and useful
adjunct to standard cholescintigraphy by substantially reducing the time
required to obtain a diagnostic study.
