Last revised by Mostafa El-Feky on 2 Mar 2023

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."


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 2: normal HIDA scan
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  • Case 3: 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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  • Case 6: cystic duct obstruction
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