Pericholecystic hepatic activity in cholescintigraphy.

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Abstract
Gallbladder nonvisualization in cholescintigraphy has been shown to be a reliable finding in acute cholecystitis. In some cholescintigrams, faintly increased pericholecystic hepatic activity in conjunction with gallbladder nonvisualization has been observed. To determine the frequency and significance of the pericholecystic hepatic activity finding, 334 consecutive adult patients who had cholescintigrams were evaluated with 99mTc diisopropylphenylcarbamoyl iminodiacetic acid. Pericholecystic hepatic activity was seen in 21% of the abnormal scans demonstrating gallbladder nonvisualization but in none of the other scans. Thirteen of these patients underwent surgery; 11 (85%) were found to have acute cholecystitis, and 2 (15%) had chronic cholecystitis. Four patients (31%) had acute gangrenous cholecystitis, and 5 (39%) had cholecystitis complicated by gallbladder perforation. The pericholecystic hepatic activity sign is not specific for gangrenous cholecystitis or gallbladder perforation but does reliably indicate inflammatory gallbladder disease and is associated with a relatively high incidence of cholecystitis complicated by perforation.

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