Noncontrast MRI with MRCP is very helpful in the follow-up of known hepatobiliary stone disease. Abdominal MRI with, and sometimes without, IV contrast in combination with MRCP provides comprehensive evaluation of the hepatobiliary system. In addition to evaluating for cholelithiasis and choledocholithiasis, additional pathologies may be identified. Sources of biliary ductal dilatation, such as masses and lymph nodes, may be identified. Nuclear Medicine Scan Gallbladder Low-grade, partial, or intermittent biliary obstruction may present with symptoms of recurrent right upper quadrant abdominal pain, mimicking chronic cholecystitis and numerous nonbiliary causes of abdominal pain. Nuclear medicine hepatobiliary imaging also aids in the diagnosis of partial biliary obstruction that is due to stones, biliary stricture, and sphincter of Oddi obstruction. Sphincter of Oddi evaluation with cholecystokinin cholescintigraphy does not carry the risk of pancreatitis, which may be seen with manometric evaluation. The use of cholecystokinin- augmented nuclear medicine hepatobiliary imaging in patients with pain of biliary origin is an acceptable practice under current Society of Gastrointestinal and Laparoendoscopic Surgeons clinical guidelines [45]. Nuclear medicine hepatobiliary imaging with calculation of the gallbladder ejection fraction after cholecystokinin infusion may be used to diagnose chronic gallbladder disease, partial biliary obstruction, and biliary dyskinesia as a cause of right upper quadrant pain. However, this test may be less useful in patients with atypical symptoms. Variant 4: Right upper quadrant pain. Fever, elevated WBC count. Suspected biliary disease. Negative or equivocal ultrasound. Next imaging study.
Right Upper Quadrant Pain. Noncontrast MRI with MRCP is very helpful in the follow-up of known hepatobiliary stone disease. Abdominal MRI with, and sometimes without, IV contrast in combination with MRCP provides comprehensive evaluation of the hepatobiliary system. In addition to evaluating for cholelithiasis and choledocholithiasis, additional pathologies may be identified. Sources of biliary ductal dilatation, such as masses and lymph nodes, may be identified. Nuclear Medicine Scan Gallbladder Low-grade, partial, or intermittent biliary obstruction may present with symptoms of recurrent right upper quadrant abdominal pain, mimicking chronic cholecystitis and numerous nonbiliary causes of abdominal pain. Nuclear medicine hepatobiliary imaging also aids in the diagnosis of partial biliary obstruction that is due to stones, biliary stricture, and sphincter of Oddi obstruction. Sphincter of Oddi evaluation with cholecystokinin cholescintigraphy does not carry the risk of pancreatitis, which may be seen with manometric evaluation. The use of cholecystokinin- augmented nuclear medicine hepatobiliary imaging in patients with pain of biliary origin is an acceptable practice under current Society of Gastrointestinal and Laparoendoscopic Surgeons clinical guidelines [45]. Nuclear medicine hepatobiliary imaging with calculation of the gallbladder ejection fraction after cholecystokinin infusion may be used to diagnose chronic gallbladder disease, partial biliary obstruction, and biliary dyskinesia as a cause of right upper quadrant pain. However, this test may be less useful in patients with atypical symptoms. Variant 4: Right upper quadrant pain. Fever, elevated WBC count. Suspected biliary disease. Negative or equivocal ultrasound. Next imaging study.