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IMAGE CURRENTLY UNAVALIABLE
CHOLECYSTITIS
Nuclear Medicine
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CCK EVALUATION OF
CHOLECYSTITIS
- Jennifer Fry, Student NMT
- Corey Jones, CNMT, RT(N)
- Athens Regional Medical Center
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- Mary Anne Owen, M.H.E., RT(N),
Program Director, NMT
- Medical College of Georgia
NM Technologists Concerns:
Detailed Discussion
Patient History:
A 42 year -old female entered the emergency
department suffering from severe right side abdominal pain, nausea,
vomiting and dehydration. The
patient was admitted into the hospital.
An ultrasound of the abdomen was performed.
No gallstones were found, however, prominent gallbladder wall
thickening was present. No
biliary ductal dilation or liver lesions were found.
Acute cholecystitis was of concern and a nuclear medicine HIDA scan
was ordered for further evaluation.
Radiopharmacy:
- 6.5 mCi Choletec (
mebrofenin), followed by subsequent reinjection
with 1.0 ug of Cholecystokinin (cck). These injections were
made by intravenous method.
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- T1/2 of Tc99m MEBROFENIN CHOLETEC = 6 hour
- Method of Localization : Active
Transport, binds to change pathways of bilirubin. It is taken up
by the hepatocytes
- Method of Excretion:
Primary route of excretion is through the hepatobiliary system
(80%-90%) and the secondary route is the urinary tract (10%-20%)
- Method of calculating CCK dose:
Patient weight converted to kg (lb/2.2) then multiply by.02. This equals the ug CCK dose to be put into a 250 ml bag of saline
for one hour infusion.
Procedure:
Patient Prep:
NPO 4-6 hours
Instrumentation:
- Low energy, all purpose collimator
- 128 x 128 matrix
- 140 kev energy window
- (Dynamic or static? Counts, Time per
frame?)
Positioning: Patient
supine, 10 degree LAO , anterior images obtained for approximately one
hour.
The patient was given 6.5 mCi Tc 99m CHOLETEC by intravenous
administration. A one hour delay was observed. The patient was
then given 1.0 ug of CCK in 250 ml of saline. This was infused
through the existing IV line (Is this done by
injection pump? If so, set at what rate?). Uptake of activity
by the gallbladder as well as the small bowel was observed. A
markedly abnormal negative ejection fraction was identified. It was
elected to proceed with another attempt at CCK administration due to
questionable infiltration and amount of CCK previously administered.
Repeat imaging was performed following administration of a second CCK
dose. The ejection fraction was then found to be an abnormal
1.87%. Normal is approximately 35%. The cystic duct and distal
common bile duct remained patent.
Followup:
The patient did have her gallbladder surgically removed.
References
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