Assessment of the reproducibility of quantitative hepatobiliary scintigraphy (QHBS) in patients with sphincter of Oddi dysfunction (SOD)--inappropriate method or intermittent disease?

ABSTRACT

BACKGROUND/AIMS: Although quantitative hepatobiliary scintigraphy (QHBS) was originally suggested as a promising method in the diagnosis of sphincter of Oddi dysfunction (SOD), it was recently claimed that QHBS displays poor reproducibility and specificity in cholecystectomized patients. The aim of the present study was to assess the reproducibility of QHBS in cholecystectomized patients. METHODOLOGY: 28 cholecystectomized patients with suspected SOD underwent QHBS evaluation on two separate occasions. On the basis of the clinical and endoscopic retrograde cholangiopancreatography (ERCP) data, patients with suspected SOD were categorized by applying the Geenen and Hogan classification 10 were identified as having SOD of biliary type I (SO stenosis group), and the remaining 18 patients as having SOD of biliary type II or III (SO dyskinesia group). During the same period, 12 asymptomatic cholecystectomized individuals (control group) were recruited to undergo QHBS evaluation on two separate occasions. QHBS was performed with our standard method in all subjects. After an overnight fast, 140MBq 99mTc-EHIDA was injected intravenously. Digital images were recorded continuously on a 128 x 128 matrix, at one frame/min for 90 min. For the final analysis, the liver-choledochus T. difference (LCTD), half-time of excretion of the common bile duct (CBD T1/2), and the duodenum appearance time (DAT) were applied. RESULTS: In the 12 asymptomatic controls, the QHBS parameters were highly reproducible, all but 6 of the 72 separate parameters obtained from two repeated studies were within our normal limits. In all 10 patients belonging in the SO stenosis group, the QHBS parameters were markedly abnormal and again highly reproducible. All of the 60 separate quantitative parameters obtained in this group from the two repeated studies were high above our normal range. In contrast, in the 18 patients with SO dyskinesia, the QHBS parameters were distinctly variable and poorly reproducible. Of the 108 separate quantitative parameters obtained in this group the two separate studies, 55 were normal and 53 were above our normal range. Of the 18 SO dyskinesia patients, only 9 had at least one quantitative parameter abnormal in both QHBS examinations. CONCLUSIONS: QHBS is a highly reproducible technique in cholecystectomized controls and in patients with SO stenosis. In contrast, the reproducibility of QHBS is poor in patients with SO dyskinesia, which is probably a consequence of the disease characteristics rather than methodological insufficiency of QHBS.