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10 - HIDA Scan

The hepatobiliary scan uses Tc99m-HIDA to evaluate the function of the biliary system. It involves imaging the filling and emptying of the gallbladder. A normal scan shows visualization of the liver, gallbladder, and small bowel. Abnormal findings include reduced gallbladder emptying in biliary dyskinesia and non-visualization of the bowel in biliary atresia. The scan can also detect biliary leaks following surgery.

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Louis Fortunato
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216 views

10 - HIDA Scan

The hepatobiliary scan uses Tc99m-HIDA to evaluate the function of the biliary system. It involves imaging the filling and emptying of the gallbladder. A normal scan shows visualization of the liver, gallbladder, and small bowel. Abnormal findings include reduced gallbladder emptying in biliary dyskinesia and non-visualization of the bowel in biliary atresia. The scan can also detect biliary leaks following surgery.

Uploaded by

Louis Fortunato
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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‫)‪Hepatobiliary Scan (HIDA‬‬

‫الدكتور قصي المقبل‬


‫أستاذ مشارك‪ -‬قسم األشعة والطب النووي‬
‫كلية الطب‪-‬جامعة العلوم والتكنولوجيا األردنية‬
Radiopharmaceutical

• Tc99m-HIDA shares the same


hepatocyte uptake, transport, and
excretion pathways as bilirubin.
• HIDA is excreted in its original
radiochemical form without being
conjugated or undergoing significant
metabolism.
Biliary System
Technique

• Filling dynamic images are obtained


for 60 minutes (1 image per
minute).
• Emptying dynamic images are
obtained for 30-60 minutes post
fatty meal.
• CCK can be injected instead of
fatty meal if available.
Filling Phase
Emptying phase
Normal HIDA Scan
Cystic
duct Liver

Hepatic
ducts

Small
GB bowel
Gallbladder Ejection
Fraction
• It is a numerical estimation of the
function of the gallbladder.
• Normally it should be greater than
50%.
• It is calculated as:
End filling volume - End emptying volume x 100%
End filling volume
Normal Parameters

• Gallbladder must be visualized


within the filling phase.
• Bowel must be visualized during
the test.
• Gallbladder EF should be normal
Indications for HIDA Scan
• Chronic cholecystitis.
• Evaluation of biliary atresia in
neonates.
• Detection of post cholecystectomy
biliary leak.
Biliary Dyskinesia

• It is also called chronic acalculus cholecystitis.


• The patients suffer from chronic abdominal
pain which is mostly biliary-like pain.
• The pain is not attributable to any known
organic abdominal disease.
• Routine work up is usually unremarkable (blood
chemistry, ultrasound, CT scan, upper/lower
endoscopy, … etc)
Biliary Dyskinesia

• No gallbladder stone disease by


ultrasound.
• Evaluation of gallbladder
contraction has proven most useful
in the diagnosis of this entity.
• Gallbladder ejection fraction is
usually reduced (< 50%).
Biliary Atresia
• HIDA scan is an accurate and non-
invasive test in the diagnosis of
biliary atresia and in
differentiating it from other
causes of neonatal jaundice.
• Non-visualization of the bowel
suggests biliary atresia (surgical
jaundice). Hepatisis and
hepatocellular dysfunction could
be other causes of this finding.
Biliary Atresia

• Negative scan (bowel visualization


= biliary-to-bowel-transit)
excludes biliary atresia.
• Positive scan (non-visualization of
the bowel) suggests the diagnosis
of biliary atresia. Hence, liver
biopsy is needed.
Biliary Atresia
Biliary Leak

• Postoperative biliary leak can be


evaluated with HIDA scan.
• Findings include visualization of
free bile in the abdomen.
Biliary Leak

a b

Abnormal accumulation of tracer extending superiorly and laterally


(a) and extending medially along the anteroinferior margin of the left
hepatic lobe (b). These findings are consistent with a biliary leak.

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