Various scintigraphic patterns indicative of chronic cholecystitis

Learning Objectives 1. To identify the various scintigraphic patterns that are indicative of chronic cholecystitis on hepatobiliary studies via illustrations. 2. To recognize unusual patterns that might explain patient’s symptoms and be suggestive of the need of surgical intervention through specific examples.

Summary: Chronic cholecystitis results from long standing inflammation resulting in loss of gallbladder (GB) function and can present as recurrent abdominal pain or dyspeptic symptoms requiring cholecystectomy. US and Hepatobiliary imaging are often used in conjunction and form the main stay of establishing a diagnosis of chronic cholecystitis. Hepatobiliary scintigraphy (HIDA scan) is the primary imaging procedure utilized for diagnosis of acute cholecystitis. However, there is no single definite pattern to indicate chronic cholecystitis. In the course of performing HIDA scan, several findings suggesting chronic rather than acute GB disease might be encountered. Recognition of these abnormal scintigraphic patterns should suggest chronic GB disease that can most often be confirmed with US. The various scintigraphic patterns that might represent chronic cholecystitis on a HIDA scan are: 1) delayed GB filling with normal biliary to bowel transit, 2) delayed biliary to bowel transit with normal GB filling (no prior analgesic or CCK administered), 3) slow filling of GB, 4) irregular or eccentric GB filling, 5) faint or very small contracted GB, 6) band or septa across GB, 7) photopenic defects in GB, 8) poor response to sincalide (CCK) with low EF. Examples of the above scintigraphic patterns with correlative radiological imaging and pathology would be included for illustration.