Cholescintigraphy

Last revised by Dr Ammar Ashraf on 29 Oct 2022

Cholescintigraphy is the use of radiotracers to assess the anatomy and function of the biliary system (and the liver indirectly). Currently, this is most commonly performed with Tc-99m-IDA analogs, and "hepatic "IDA" imaging gave rise to the more common term "HIDA scan."

Indications

Cholescintigraphy can be used for the evaluation of ref:

  • acute cholecystitis
    • the most common use is to confirm acute cholecystitis after an equivocal ultrasound study
    • if the tracer does not enter the gallbladder after a sufficient length of time, then this is compatible with obstruction of the cystic duct
  • chronic cholecystitis: diagnosed if an adequate % of bile mixed with radiotracer does not exit the gallbladder after administration of CCK
  • biliary atresia in neonates: good hepatic uptake of the tracer with no evidence of excretion into the bowel at 24 hours
  • bile leak: if tracer spreads outside the biliary system, it provides direct evidence of a biliary leak
  • biliary obstruction: tracer dose is held up before it can progress into the duodenum
  • confirmation of biliary dilatation: may be useful in imaging choledochal cysts
  • sphincter of Oddi dysfunction

With the exception of biliary atresia (and possibly chronic cholecystitis), cholescintigraphy is rarely a first-line imaging modality but is often used as a problem-solving tool.

Tracer dose and route of administration

After intravenous injection, IDA radiotracers are taken up by hepatocytes and then excreted into the biliary system ref

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Cases and figures

  • Case 1: normal HIDA scan
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  • Case 3: cystic duct obstruction
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  • Case 2: cystic duct obstruction
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  • Case 4: gallbladder dysfunction
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  • Case 5: normal ejection fraction of the gallbladder
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