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Single-Photon Emission Computed Tomography/Computed Tomography as a Problem-Solving Tool in Patients With Suspected Acute Cholecystitis

Arabi, Mohammad MD*; Brown, Richard K.J. MD*; Dwamena, Ben A. MB, ChB; Jakubowski, Eric MD*; Kim, Kyu MD*; Alvarez, Rolando MD*; Piert, Morand MD*; Frey, Kirk MD, PhD*

Journal of Computer Assisted Tomography: November/December 2013 - Volume 37 - Issue 6 - p 844–848
doi: 10.1097/RCT.0b013e3182a604ae
Gastrointestinal Imaging

Aim: The aim of this study was to evaluate our institutional experience with single-photon emission computed tomography/computed tomography (SPECT/CT) hepatobiliary imaging as a problem-solving tool in the workup of suspected acute cholecystitis.

Methods: We queried our radiology information system database for cases in which SPECT/CT had been performed as part of the routine hepatobiliary technetium Tc 99m iminodiacetic acid studies done for the evaluation of acute cholecystitis. Fifty-three consecutive patients who had SPECT/CT after planar imaging were included. This cohort represents cases that were considered problematic by the initial interpreting physician on the basis of planar images. The planar and SPECT/CT images were retrospectively reviewed independently and separately by 2 experienced nuclear medicine specialists who evaluated the planar images for visualization of the gallbladder on a binary scale (yes or no) and rated their level of confidence on an ordinal scale(unsure, somewhat sure, and sure).

Results: Single-photon emission CT/CT would have led to change in the management for interpreter 1 in a total of 23 cases (41%), with change from normal to abnormal scan findings (28%) and from abnormal to normal scan findings (13%). Similarly, SPECT/CT would have led to change in the management for interpreter 2 in a total of 23 cases (43%), with change from normal to abnormal scan findings (13%) and from abnormal to normal scan findings (30%).

Conclusions: Although planar hepatobiliary scanning is usually sensitive and specific, there are occasionally problematic cases. In our experience, we found that the addition of SPECT/CT improved the interobserver agreement and may change management in patients with superimposed bowel activity and/or unusual gallbladder anatomy that can confound the planar interpretation.

From the*Department of Radiology, Division of Nuclear Medicine, University of Michigan Health Systems, Ann Arbor; and Division of Nuclear Medicine, Veterans Affairs Health System, Ann Arbor, MI.

Received for publication March 18, 2013; accepted July 8, 2013.

Reprints: Richard K.J. Brown, MD, Department of Radiology, Division of Nuclear Medicine, University of Michigan Health Systems, B1 G505 University Hospital, 1500 E. Medical Center Dr, Ann Arbor, MI 48109-0028 (e-mail: rkjbrown@med.umich.edu).

The authors declare no conflict of interest.

© 2013 by Lippincott Williams & Wilkins