Refinement of the positive predictive value of gallbladder non-visualization after morphine administration for acute cholecystitis based on the temporal pattern of common bile duct activity

Abstract

Methods Thirty-six patients who had morphine-augmented cholescintigraphy were divided into two groups: 19 with BD↑ after morphine administration and 17 with BD↓. Results Of the 36 patients, 22 had acute cholecystitis. The positive predictive value (PPV) of gallbladder nonvisualization was 61%. All of the remaining 14 had chronic cholecystitis. Of 19 patients with BD↑, 15 had acute cholecystitis (PPV = 79%), whereas only 7 of 17 patients with BD↑ (PPV = 41%) had acute cholecystitis (P = 0.023 by the one-tailed and 0.038 by the two-tailed Fisher exact tests). Conclusions Gallbladder nonvisualization after morphine administration with the pattern of BD↓ is not as reliable (intermediate probability in this series) for the diagnosis of acute cholecystitis as is nonvisualization of the gallbladder in patients with a pattern of BD↑ (high probability).