Normal gallbladder ejection fraction by age

Q: What is an abnormal HIDA scan result?

If your scan was abnormal,” it likely means your images revealed one of the following: An infection. Gallstones. Bile duct blockage. A problem with how your gallbladder functions.

Background/aims: Hepatobiliary Iminodiacetic Acid (HIDA) scan provides a technique to quantify gallbladder ejection fraction (EF) in patients suffering acalculous biliary colic (ACBC). We wished to evaluate the accuracy of EF in the prediction of gallbladder pathology in patients undergoing cholecystectomy.

Table of Contents Show

The Current Standard for the Gall Bladder Ejection Fraction “GB EF” as an Indication for Cholecystectomy Is Way Too High
What is a normal EF for gallbladder?
What is an abnormal HIDA scan result?
What is a good HIDA scan score?
What is a high gallbladder ejection fraction?

Methods: Data were retrieved from a database of patients referred for HIDA scan for ACBC, including EF and the pathological outcome of those undergoing cholecystectomy, and compared to normal values obtained from a review of related studies. Significant associations were demonstrated by chi-square, Mann-Whitney test, and linear regression. The predictive accuracy of different cut-offs of EF was demonstrated by the ROC curve analysis.

Results: Of 83 patients referred for HIDA scan for ACBC, 41 underwent cholecystectomy. The median EF of this group (33%) was significantly lower than the composite normal median value from previous studies (56%). Thirty-two patients revealed evidence of gallbladder pathology. The EF declined with age (coefficient = -0.51, 95% CI = -0.99 to -0.33), but the median value did not differ between those with gallbladder pathology (34%) and those with normal gallbladders (29%).

Conclusion/discussion: Although an EF cut-off of 35% had the greatest accuracy in the prediction of pathology of those tested (0.56), the poor negative predictive value (23.5%) was a major contributor to its low accuracy. Although patients with ACBC have reduced gallbladder EF compared to the normal population, its quantitative assessment is of limited value in the prediction of gallbladder pathology.

Background and aims: Sincalide, in conjunction with cholescintigraphy, is necessary for the diagnosis of chronic acalculous cholecystitis. However sincalide is not widely available. This study investigates the use of a commercially available formula as an inexpensive alternative to sincalide, containing a sufficient and known amount of fat to cause gallbladder contraction, and to determine normal gallbladder ejection fraction (GBEF) values.

Methods: We studied 36 patients aged 51.7+/- 10.9 years with body mass index 26.7+/- 5.2 who were referred for 99mTc-sestamibi myocardial perfusion imaging. They did not have any abdominal symptoms, or history of abdominal disease and were not taking any medication known to affect the biliary tract. All were prescreened with a hepatobiliary ultrasonography to exclude any abnormality. After 6 hours fasting, 20 mCi of 99mTc-sestamibi was injected intravenously at rest and 90 minutes later the subjects ingested a test meal (10 g fat). GBEF was calculated at 30 and 60 minutes after fatty meal ingestion.

Results: GBEF at 30 minutes and at 60 minutes after fatty meal ingestion were 69.54+/- 21.04% and 84.26+/-11.41%, respectively. GBEF did not differ significantly between men and women. There was no statistically significant correlation between BMI and GBEF. No significant difference was noticed in GBEF between obese, overweight and normal weight patient groups.

Conclusion: Lower limit of normal GBEF values was 27.46% at 30 min and 61.44% at 60 min using a standard fatty meal. It is possible to report the results of a GBEF measurement after fatty meal in terms of the percentile rank, compared with subjects without biliary disease.

Abstracts: PANCREATIC/BILIARY

The Current Standard for the Gall Bladder Ejection Fraction “GB EF” as an Indication for Cholecystectomy Is Way Too High

156

Mon Digestive Diseases, Morgantown, WV.

doi: 10.1038/ajg.2012.269

Free

Purpose: Many studies have suggested multiple etiologies for the postcholecystectomy syndrome. However, the question was never raised whether we are removing way too many normal gall bladders based on an imperfect test (the GB Ejection Fraction (GB EF) on the Hepato-Biliary Scan). The Objective of this study was to revise the current standard of 35% as the cut-off for recommending a cholecystectomy.

Methods: Between 2008 and 2011, the electronic medical records of 337 patients who underwent cholecystectomy at a community hospital were reviewed, and the data was extracted. One hundred patients were excluded because they had stones on the GB path reports. Only patients with no stones were included in this study. Two hundred thirty patients were included, 145 females, and 85 males. Seven patients were excluded because they were younger than 18 years of age.

Results: The mean GB EF was 28% with a range from 0% to 86%. There were 145 females and 85 males, with an age range from 18 to 87 years of age. The ER visits for those patients were recorded for one year following their cholecystectomy. One hundred sixty-nine patients were still symptomatic following their cholecystectomy (73%). Patients with higher EF and no stones had more frequent ER visits for GI related complaints and abdominal pain (more than four visits in one year) than patients with lower EF (one or less ER visit in one year). Female patients tend to do worse following cholecystectomy than their male counterparts, particularly younger females.

Conclusion: In absence of symptomatic gall stones, the GB EF should not be used as a sole indication for cholecystectomy. If it is used, it should be documented to be less than 10% on two different occasions done in the outpatient setting, six weeks apart.

What is a normal EF for gallbladder?

Biliary dyskinesia, or hypokinesia of the gallbladder, is accepted as an ejection fraction less than 35%, while an accepted normal functioning gallbladder ejection fraction is greater than 35%.

What is an abnormal HIDA scan result?

If your scan was “abnormal,” it likely means your images revealed one of the following: An infection. Gallstones. Bile duct blockage. A problem with how your gallbladder functions.

What is a good HIDA scan score?

The gallbladder ejection fraction is considered normal when it's above 30% to 35%. An abnormally low number might indicate chronic cholecystitis.

What is a high gallbladder ejection fraction?

When the gallbladder empties poorly, the diagnosis of biliary dyskinesia, defined as a gallbladder ejection fraction less than 35%, is made, and cholecystectomy can be considered. There is a subset of symptomatic patients, however, who have an abnormally high ejection fraction, defined as greater than 65%.