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Improving Hepatobiliary Imaging as a Physiologic Test with Superior Clinical Outcomes

1 Departments of Diagnostic and Interventional Imaging, Nuclear Medicine Section, University of Texas, Houston, Texas, USA
2 Department of Internal Medicine, UTHealth McGovern Medical School, University of Texas, Houston, Texas, USA
3 Department of Gastroenterology, UTHealth McGovern Medical School, University of Texas, Houston, Texas, USA
4 Department of Surgery, UTHealth McGovern Medical School, University of Texas, Houston, Texas, USA

Correspondence Address:
Isis W Gayed,
Department of Diagnostic and Interventional Imaging Nuclear Medicine Section, McGovern Medical School, University of Texas, Houston, Texas
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/wjnm.WJNM_21_20

This study aims at prospectively evaluating the difference in the effect of cholecystokinin (CCK) and half-and-half milk (HHM) administered in the same patient on gallbladder contractility and correlation with clinical outcomes. Upon gallbladder visualization during standard hepatobiliary imaging, 0.02 μg/kg of CCK was injected over 3 min, and additional 30 min of dynamic imaging was obtained. Patients with gallbladder ejection fraction (GBEF) <35% after CCK were administered 8 oz of HHM followed by 30 min of imaging. The GBEF was recalculated. The number of patients whom GBEF changed from below 35% (abnormal) after CCK to above 35% (normal) after HHM was recorded. Follow-up of the clinical outcome at 6 months was performed. Fifty patients with abnormal GBEF were prospectively included. The average GBEF after CCK was 14.7% ± 8.5% and after HHM was 30.7% ± 20.8%. The average increase in GBEF with HHM was 16.0% ± 22.2%. The GBEF changed from abnormal to normal in 17 patients (34%). The remaining 33 patients remained abnormal. Clinical outcomes at 6 months were available in 47 patients. Cholecystectomy was performed in 60% of patients with abnormal GBEF with CCK and HHM with resolution or improvement of pain. Two of 16 patients (12%) with abnormal GBEF after CCK but normal after HHM had cholecystectomies with pain improvement, while 8 out of these patients (50%) were diagnosed and treated with other disorders and improved. Hepatobiliary imaging with HHM stimulation is a superior physiologic test which can lower the number of unnecessary cholecystectomies and misdiagnoses as functional cholecystitis.

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