The significance of a positive test of morphine cholescintigraphy in hospitalized patients.

Morphine-augmented radionuclide cholescintigraphy (MC) is a useful adjunctive diagnostic tool for the identification of acute cholecystitis (AC) in patients who are hospitalized and critically ill with occult sepsis. The results of previous studies have demonstrated a reduction in false-positive rates, that is, nonvisualization, from 40 percent with standard radionuclide cholescintigraphy to 5 percent with MC in these high-risk patient groups, with an overall accuracy of 92 percent. This study was performed to determine the significance of a positive test result from MC in patients with occult sepsis. We reviewed the records of all 20 patients at high risk in whom MC was positive during the 35-month period ending 31 May 1992. AC was confirmed by laparotomy in all 16 patients who underwent surgical treatment. There were two patients who recovered with antibiotic therapy alone (considered false-positives) and two additional patients who died without operation or a confirmed diagnosis of AC (excluded from analysis). Thus, in this series, MC was associated with a positive predictive value of 0.89, confirming that it is a valuable adjunct in establishing the diagnosis of AC in patients who are seriously ill and hospitalized with occult sepsis.