Cholecystokinin-Stimulated mebrofenin (99mTc-Choletec) hepatobiliary scintigraphy in asymptomatic postcholecystectomy individuals: assessment of specificity, interobserver reliability, and reproducibility

Am J Gastroenterol. 2001 Nov;96(11):3106-9. doi: 10.1111/j.1572-0241.2001.05266.x.


Objectives: Cholecystokinin-stimulated hepatobiliary scintigraphy (CCK-HBS) is a noninvasive method reported to be highly accurate in the diagnosis of sphincter of Oddi dysfunction. Our primary aim was to assess the specificity of CCK-HBS by evaluating its ability to exclude disease in 20 asymptomatic postcholecystectomy individuals. Secondary aims were to assess the interobserver reliability in scoring the CCK-HBS examinations between three blinded observers and to assess reproducibility of CCK-HBS repeated in the same individuals.

Methods: Twenty asymptomatic postcholecystectomy individuals with normal liver serum chemistries underwent CCK-HBS on two separate occasions. Three nuclear medicine specialists read each CCK-HBS study in a blinded fashion.

Results: There was good agreement between the three observers reading the same scans for both the first scan (kappa = 0.554) and the second scan (kappa = 0.507). There was poor agreement between the first and second scans on the same patient, read by the same nuclear medicine specialist (kappa = 0.062-0.385). The overall specificity of the CCK-HBS score was 77.5%; however, the specificity was only 60% when a true negative was defined as two negative CCK-HBS examinations.

Conclusions: Quantitative CCK-HBS is of poor specificity in asymptomatic postcholecystectomy individuals. Hence, it is of questionable value in excluding sphincter of Oddi dysfunction in patients suspected to suffer from this disorder.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aniline Compounds
  • Cholecystectomy
  • Common Bile Duct / diagnostic imaging*
  • Female
  • Gastrointestinal Agents*
  • Glycine
  • Humans
  • Imino Acids*
  • Liver / diagnostic imaging*
  • Middle Aged
  • Observer Variation
  • Organotechnetium Compounds*
  • Postoperative Care*
  • Radionuclide Imaging
  • Radiopharmaceuticals*
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Sincalide*
  • Sphincter of Oddi / diagnostic imaging


  • Aniline Compounds
  • Gastrointestinal Agents
  • Imino Acids
  • Organotechnetium Compounds
  • Radiopharmaceuticals
  • technetium Tc 99m mebrofenin
  • Sincalide
  • Glycine