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Morphine Augmentation Increases Gallbladder Visualization in Patients Pretreated with Cholecystokinin

Departments of Diagnostic Radiology and Pathology, Division of Nuclear Medicine, University of Maryland Medical System; Baltimore, Maryland, Philadelphia, Pennsylvania

Correspondence: For correspondence or reprints contact: Charles C. Chen, MD, Peoriaa Radiology, St. Francis Medical Center, 530 North East Glenn Oak Ave., Peoria, IL 61637.

ABSTRACT

The purpose of this study was to determine if a combination of Cholecystokinin (CCK) pretreatment followed by morphine augmentation improved the detection of cystic duct patency compared with CCK pretreatment only. Methods: One hundred fifty-five patients with suspected acute cholecystitis had scintigraphy performed with 185–481 MBq (5–13 mCi) ^99mTc-mebrofenin adjusted to the patients' total bilirubin levels. All patients were pretreated with 0.02 µg/kg sincalide injected intravenously over 3µ5 min. Sequential imaging was performed until gallbladder activity was identified or up to 90 min postinjection of mebrofenin. If no gallbladder was identified, a second dose of mebrofenin was given as necessary to have tracer in the biliary system. Then, 0.04 mg/kg intravenous morphine sulfate was administered, followed by imaging for up to 30 min or until gallbladder visualization. Results: Twenty-eight percent (43/155) of the patients pretreated with CCK had nonvisualization of the gallbladder at 90 min postinjection of radiotracer. After intravenous morphine, the gallbladder was identified in 42% (18/43) of these patients (p = 0.0001). Conclusion: Hepatobiliary imaging with CCK pretreatment and imaging for 90 min was insufficient to identify all patent cystic ducts. Morphine augmentation significantly increased the frequency of gallbladder visualization in patients pretreated with CCK.

Key Words: cholecystitis • Cholecystokinin • morphine-augmented cholescintigraphy

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