I had a Hida scan done today my EF@ 10 mins was 20% Ef @ 30 mins 39 % and at 60 mins 47 %. What does that mean?
How common is the 82% ejection fraction indicating a normal HIDA scan result with symptoms associated with gall bladder issues? I have upper center and right quadrant pain, headaches, right shoulder blade pain, bloating, excessive flatulence and burping. I am really uncomfortable, and getting equally as frustrated because I expected abnormal HIDA scan results. This pain comes and goes all day, all night, when I eat, it hurts. Although I am not to take her word for it, the lady who did my ultrasound said she did see some sludge.
I read this paper with great interest. I am a general surgeon with specific interests in biliary tract disease and have been in practice for 21 years. I have performed ove 3500 laparoscopic cholecystectomies. whereas I was taught that only 2% of GB disease is in the absence of stones roughly 20% of these procedures are now done for dysfunction. The HIDA w/ CCK has become the standard functional test and most surgeons have adopted the practice of recommending cholecystectomy when this test is abnormal. The problem is that what is abnormal is not generally agreed upon. There are technical variations in how it is performed and the most common involves the infusion of the hormone CCK over 2-3 minutes. This has been shown to produce abnormally low ejection fractions in 30% of normal asymptomatic individuals. The results from a slower infusion have been shown to be far superior in predicting symptomatic improvement after cholecystectomy but very few centers do it this way. I guess theyare in a hurry. When a test gives a quantitative result the numbers tend to bedistributed in a bell shaped curve. In most biological systems "normal" is defined as being within two standard deviations of the mean. The origins of the HIDA w/ CCK test was specifically designed to ferret out patients with low ejection fractions. Over the past 21 years, I have seen about three dozen patients who had extremely high ejection fractions - in the 85-98% range. These were typcally accompanied by reproduction of their upper abdominal pain following the CCK infusion. We decided to make a bold move and, after quite a lengthy discussion, went on to remove several of these gallbladders. Suprisingly, their symptoms disappeared. Over the years approximately 90% of my patients have had their symptoms resolve with cholecystectomy when they had high ejection fractions and reproduction of their symptoms after CCK injection. A couple of years ago, the group at the Cleveland Clinic published a series of patients that supported the notion that eproduction of symptoms is a better predictor of improvement after gallbladder removal that the ejection fraction. This is clearly a complex issue that we are only just beginning to develop a better understanding of.
Ladies,
There was a new study released recently called Normokinetic biliary dyskinesia.(http://www.ncbi.nlm.nih.gov/pubmed/22648109).
The authors contend there is a population of patients with symptomatic biliary pain who are negatively worked-up, including a “normal” CCK-HIDA scan with ejection fraction greater than 35% that never receive a diagnosis, and thus no definitive treatment. For some of these patients their symptomatic biliary pain is reproduced during their CCK-HIDA. It is believed these patients have a novel diagnosis, Normokinetic Biliary Dyskinesia (NBD). NBD consists of an ejection fraction greater than 35%, a complete negative work up, and reproducible biliary pain with CCK-HIDA scan. It is hypothesized these patients will have resolution of biliary pain when treated with cholecystectomy.
Reta
Methods:
I just had the same test done and mine is 39% and they said it was normal.I have lost all faith in doctors.I have a fullness fealing were my gallbladder is and severe pains that radiate into my shoulders and back. just a constent pressure
Hi. I had one a week ago. It was okay until they injected the cck. I felt horrible. i was nauseas and felt the pain in my gallbladder. I haven't had an attack in a few weeks so I thought it would be a wasted of time. It came back that my gallbladder was functioning at 39% and my pcp and gi are recommending removal. I meet with the surgeon okay. Don't worry, you will be fine. The bad effects I felt did not last that long.