Article Figures & Data
Figures
- FIGURE 1.
Normal and abnormal biliary transit. (A) Normal anatomy and physiology of hepatobiliary system, with hepatic production of bile, excretion via hepatic ducts, localization to gallbladder, and excretion, on stimulation, through common bile duct and ampulla of Vater to small bowel. Sphincter of Oddi acts as pressure valve for bile passing into small bowel near junction of biliary system and duodenum. (B) Reduced bile flow (which in case of chronic functional gallbladder disorder is due to gallbladder dysmotility), which results in increased pressure and inflammation within gallbladder (cholecystitis).
- FIGURE 2.
Ensure Plus hepatobiliary scintigraphy results for patient with chronic functional gallbladder disorder (gallbladder ejection fraction, 25%). Appropriate gallbladder ROI placement is shown. Ejection fraction was calculated from demonstrated time–activity curve. Low ejection fraction (<33%) is consistent with chronic functional gallbladder disorder. EF = ejection fraction; Fr:1 = frame 1; T max = time of maximum counts/s; T min = time of minimal counts/s.
- FIGURE 3.
In this patient with severe hepatic dysfunction, image at 60 min after 99mTc-mebrofenin injection demonstrates significant persistent uptake in cardiac blood pool (blue arrow) and liver (red arrow), with little passage into bowel and nonvisualization of gallbladder.
- FIGURE 4.
In this selected hepatobiliary scintigraphy image 40 min after injection of 99mTc-mebrofenin, there is moderate reflux (arrow) of radiopharmaceutical in retrograde fashion to stomach. Enterogastric reflux can be cause of abdominal symptoms in patients and should be reported if seen.
Tables
- TABLE 1.
Gallbladder/Biliary Pathologies, Common Symptoms, and Hepatobiliary Scintigraphy Findings
Pathology Symptom Finding Acute calculous cholecystitis Acute biliary colic with or without fever, nausea, vomiting Nonvisualization of gallbladder Acute acalculous cholecystitis Critical illness, sepsis, jaundice, pain in right upper quadrant Nonvisualization of gallbladder (variable false positive due to illness) Chronic calculous cholecystitis Variable: biliary colic, nausea, reflux, bloating Delayed gallbladder ejection fraction; stones on hepatobiliary scintigraphy or ancillary imaging Chronic functional gallbladder disorder Variable: biliary colic, nausea, reflux, bloating Delayed gallbladder ejection fraction (other reported signs not diagnostic) Sphincter-of-Oddi syndrome Biliary colic, nausea, vomiting Radiopharmaceutical concentration in biliary tree; delayed bowel excretion Enterogastric reflux Epigastric pain, vomiting, nausea, heartburn Reflux of radiopharmaceutical in bowel proximal to ampulla of Vater Hepatic dysfunction Pain in right upper quadrant; severe illness pending cause Delayed extraction by liver and delayed excretion from liver
