Gastrointestinal · Case 04

Chronic Cholecystitis

Imaging Findings

The DISIDA scan images at 1, 15, 30 and 60 minutes show non-filling of the gall bladder. However, on the delayed view at 2 hours it can be seen that there is a small amount of tracer entering the gall bladder. This confirms that the function is poor, but the cystic duct is patent.

Essential Facts

What are some common causes of Chronic Cholecystitis?

Long-standing and untreated cholecystitis. Chronic inflammation of gallbladder wall may lead to calcium deposition in the gallbladder characteristic finding on X-ray/CT: Porcelain gallbladder (diagnostic if seen but not a frequent finding) and has been associated with increased risk of gallbladder carcinoma.

Patient Presentation:

Recurrent biliary colic-like pain
Poor gallbladder contraction
Symptom resolution with cholecystectomy

Scan Information

HIDA findings will show delayed gallbladder filling or reduced contractility post CCK administration
CCK  is  administered  slowly  intravenously with various recommended infusion times from 15  to  60  minutes. 
(The slower  the  infusion the less  likely  the  patient  is  to  experience  abdominal pain and the less variability in ejection values obtained in normal patients.)
If CCK is not available,  a  fatty  meal  can  be  used  to  induce gallbladder  emptying,  with a  mean  ejection fraction of ~50% (with a SD of  20%),  and  the  emptying  rate  is  slower ~2%/min
A reduced ejection fraction is suggestive, but not specific for chronic cholecystitis
10% of patients have an acalculous form
Abnormal ejection fraction < 35% with 30 minute protocol and < 38% with 60 minute protocol

References

Mettler, Fred A., and Milton J. Guiberteau. Essentials of Nuclear Medicine Imaging. Elsevier/Saunders, 2012.