‫)‪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.