Department of Nuclear Medicine, Tuality Community Hospital, Hillsboro, Oregon, USA
*Correspondence to: Gerbail T. Krishnamurthy, M.D., FACP, Nuclear Medicine Department, Tuality Community Hospital, 335 SE 8th Avenue, Hillsboro, OR, 97123 Telephone (503) 681-1745, Fax (503)681-1949, E-mail: GTKrishna@aol.com
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Sphincter of Oddi spasm (SOS) is a rare disorder whose diagnosis is a great clinical challenge. Biliary manometry is considered the gold standard, but it is invasive, expensive, and not available in most hospitals. Main objective of this project is to describe a non-invasive, quantitative, and less expensive test for diagnosis of SOS.
Seventeen patients with clinical suspicion of SOS were chosen retrospectively from list of 1179 patients who had undergone quantitative Tc-99m HIDA cholescintigraphy with cholecystokinin for various types of hepatobiliary diseases. All opioids were discontinued for 24-48 hours, and studies obtained 6-8 hours after fasting with 3-5mCi of Tc-99m mebrofenin. Hepatic phase images were obtained at one frame/ minute for 60 minutes, gallbladder phase images at one frame/minute for 30 minutes. Cholecystokinin (CCK-8) was infused intravenously for three minutes in nine patients and for 10 minutes in the remaining eight patients. CCK-8 induced paradoxical filling of the gallbladder (>30%) was considered as indicative of SOS. Following cholescintigraphic diagnosis, 15 patients were treated with anti-spasmodics and two underwent sphincterotomy. Data were compared with 10 control subjects.
Bile formation was normal in all of 17 patients with SOS, but relatively less (28%) amount entered the gallbladder (vs small intestine) when compared to control subjects (61%). Gallbladder emptied normally (EF=54%) in most patients, but refilled paradoxically with CCK-8 immediately after the ejection period in all patients with SOS, but in none of the control subjects. Smooth muscle relaxants relieved pain in most patients, and two required sphincterotomy.
Cholescintigraphy with cholecystokinin is a simple, non-invasive, quantitative, and relatively less expensive diagnostic test and may either supplement or provide an alternative to biliary manometry in the diagnosis of SOS.
