Prognostic value and pathophysiologic significance of the rim sign in cholescintigraphy

This study reviews 27 patients with nonvisualization of the galbladder on cholescintigraphy. The preoperative diagnosis of acute cholecystitis was confirmed pathologically in 23. A rim of increased hepatic activity (RIHA) adjacent to the galbladder fossa was seen throughout the study in 35% with acute cholecystitis and in no patients with chronic cholecystitis. Nine patients with 'complicated' cholecystitis (defined pathologically as a late stage of the spectrum of acute cholecystitis) had a positive RIHA in contrast to no patients with 'noncomplicated acute cholecystitis' (p<0.05). The sensitivity/specificity of the RIHA for 'complicated' acute cholecystitis was 45%/100% and the positive/negative predictive value was 100%/39%. Liver tissue that was attached to the galbladder by adhesions and removed at surgery was reviewed histogically and correlated with the presence or absence of a RIHA. The RIHA seems to be a useful indicator of patients presenting at a later stage of the pathologic spectrum of acute cholecystisis and perhaps at increased risk for complications.