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Efficacy of Hepatobiliary Imaging in Acute Abdominal Pain: Concise Communication

University of Michigan Medical Center, Ann Arbor, Michigan
William Beaumont Hospital, Royal Oak, Michigan

Correspondence: For reprints contact: John E. Freitas, MD, Nuclear Medicine Dept., William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI 48072.

ABSTRACT

To assess prospectively the usefulness of hepatobiliary imaging in acute abdominal pain (72 hr or less), 36 patients were scintigraphed after intravenous injection of 5 mCi of Tc-99m p-isopropyl-iminodiacetic acid (PIPIDA). Before the procedure, the referring physician completed Part I of a questionnaire indicating his differential diagnosis, diagnostic confidence (expressed as a percentage), and therapeutic plan. Immediately after the test, the same physician, with knowledge of the results, completed Part II of the questionnaire indicating again his differential diagnosis, diagnostic confidence, and therapeutic plan. The impact of the imaging on the physician's diagnostic confidence was expressed as a log-likelihood-ratio (LLR). The mean LLR for this series was 1.48 ± 0.93, with 33 of 36 (92%) patients demonstrating a LLR greater than 0.0. In 26 of 33 patients, a LLR greater than 1.0 was achieved; and in 11 of 36 patients, a change in the physician's therapeutic plan occurred, reflecting the considerable impact of hepatobiliary imaging on the decision-making process.