Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 16, 2023; 11(11): 2423-2434
Published online Apr 16, 2023. doi: 10.12998/wjcc.v11.i11.2423
Classification of hepatobiliary scintigraphy patterns in segmented gallbladder according to anatomical discordance
Yun-Chae Lee, Won-Sik Jung, Chang-Hun Lee, Seong-Hun Kim, Seung-Ok Lee
Yun-Chae Lee, Won-Sik Jung, Chang-Hun Lee, Seong-Hun Kim, Seung-Ok Lee, Division of Gastroenterology, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju 54907, Jeonbuk, South Korea
Yun-Chae Lee, Won-Sik Jung, Chang-Hun Lee, Seong-Hun Kim, Seung-Ok Lee, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Jeonbuk, South Korea
Author contributions: Lee SO designed the study; Lee YC and Jung WS collected and analyzed the data; Lee YC, Lee CH, and Kim SH drafted the manuscript; Lee YC and Lee SO revised the manuscript; All authors reviewed the manuscript.
Institutional review board statement: The study was reviewed and approved by the Jeonbuk National University Hospital Institutional Review Board, No.2021-07-005.
Informed consent statement: This study was a retrospective mandatory records review study in patients who did not have additional in-hospital plans and could not obtain consent at this time; Even if consent is waived, the risk to the study subjects is extremely low. After review by the ethics committee, this study can exempt the respondent's consent.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Data sharing statement: Consent was not obtained but the presented data are anonymized, and risk of identification is low. No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Seung-Ok Lee, MD, PhD, Professor, Division of Gastroenterology, Department of Internal Medicine, Jeonbuk National University Medical School, 20 Geonjiro, Dukjingu, Jeonju 54907, Jeonbuk, South Korea. solee@jbnu.ac.kr
Received: December 21, 2022
Peer-review started: December 21, 2022
First decision: January 11, 2023
Revised: January 25, 2023
Accepted: March 17, 2023
Article in press: March 17, 2023
Published online: April 16, 2023
Processing time: 106 Days and 8.7 Hours
Abstract
BACKGROUND

Hepatobiliary scintigraphy (HBS) is a useful diagnostic imaging technique that uses radiotracers to evaluate the function of the gallbladder (GB) and biliary system. In segmented GB, some HBS images reveal a discordant GB boundary as compared to anatomical images.

AIM

To evaluate the characteristics of HBS in segmented GB and determine the clinical relevance according to HBS characteristics.

METHODS

A total of 268 patients with chronic cholecystitis, gallstones, or biliary colic symptoms who underwent HBS between 2011 and 2020 were enrolled. Segmented GB was defined as segmental luminal narrowing of the GB body on computed tomography (CT) or magnetic resonance (MR) images, and HBS was examined 1 mo before or after CT or MR. Segmented GB was classified into 3 types based on the filling and emptying patterns of the proximal and distal segments according to the characteristics of HBS images, and GB ejection fraction (GBEF) was identified: Type 1 was defined as a normal filling and emptying pattern; Type 2 was defined as an emptying defect on the distal segment; and Type 3 was defined as a filling defect in the distal segment.

RESULTS

Segmented GB accounted for 63 cases (23.5%), including 36 patients (57.1%) with Type 1, 18 patients (28.6%) with Type 2, and 9 patients (14.3%) with Type 3 emptying pattern. Thus, approximately 43% of HBS images showed a discordant pattern as compared to anatomical imaging of segmented GB. Although there were no significant differences in clinical symptoms, rate of cholecystectomy, or pathological findings based on the type, most gallstones occurred in the distal segment. Reported GBEF was 62.50% ± 24.79% for Type 1, 75.89% ± 17.21% for Type 2, and 88.56% ± 7.20% for Type 3. Type 1 showed no difference in reported GBEF compared to the non-segmented GB group (62.50% ± 24.79% vs 67.40% ± 21.78%). In contrast, the reported GBEF was higher in Types 2 and 3 with defective emptying and filling when compared to Type 1 (80.11% ± 15.70% vs 62.57% ± 24.79%; P = 0.001).

CONCLUSION

In segmented GB, discordance in the filling patterns detected by HBS and anatomical imaging could lead to misinterpretation of GBEF. For this reason, clinicians should be cautious when interpreting HBS results in patients with segmented GB.

Keywords: Gallbladder; Segmented; Gallbladder emptying; Radionuclide imaging; Misdiagnosis; Cholecystitis

Core Tip: This retrospective study aimed to evaluate the clinical relevance of discrepancies between anatomical and hepatobiliary scintigraphy (HBS) images in patients with segmented gallbladder (GB). HBS images of segmented GB were classified according to filling and emptying patterns: Type 1 was a normal pattern; Type 2 was an emptying defect on the distal segment; and Type 3 was a filling defect in the distal segment. Types 2 and 3 had higher GB ejection fraction measurements than Type 1. Therefore, clinicians should be cautious when interpreting the results of HBS in patients with segmented GB.