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Nuclear medicine hepatobiliary imaging.

Harvey A Ziessman1

  • 1Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. hziessm1@jhmi.edu

Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
|November 3, 2009
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Hepatobiliary iminodiacetic acid (HIDA) scans diagnose gallbladder and biliary system issues by tracking radiopharmaceuticals. This nuclear medicine technique is crucial for identifying conditions like acute cholecystitis and biliary obstruction.

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Area of Science:

  • Nuclear Medicine
  • Diagnostic Imaging
  • Hepatobiliary System Physiology

Background:

  • Hepatobiliary iminodiacetic acid (HIDA) imaging is an established nuclear medicine technique.
  • It utilizes radiopharmaceuticals processed by hepatocytes and cleared via the biliary system, mirroring bilirubin's pathway.
  • This method provides physiological insights into liver and biliary function.

Purpose of the Study:

  • To elucidate the diagnostic capabilities of HIDA imaging in various hepatobiliary conditions.
  • To highlight HIDA's role in diagnosing acute cholecystitis, biliary obstruction, and gallbladder dysfunction.
  • To underscore the value of HIDA in post-surgical and transplant evaluations.

Main Methods:

  • Administration of HIDA radiopharmaceuticals that are taken up by liver cells (hepatocytes).
  • Utilizing specialized cameras to visualize the uptake, clearance, and flow through the biliary system.
  • Assessing gallbladder filling, emptying (ejection fraction), and detecting biliary leakage.

Main Results:

  • HIDA imaging is highly effective for diagnosing acute cholecystitis by identifying non-filling of the gallbladder due to cystic duct obstruction.
  • It can detect high-grade biliary obstruction before ductal dilation, evidenced by persistent hepatogram and lack of biliary clearance.
  • The technique aids in diagnosing partial obstructions, biliary leakage post-surgery, and chronic acalculous gallbladder disease via ejection fraction calculation.

Conclusions:

  • HIDA imaging is a versatile and time-proven diagnostic tool for a wide range of hepatobiliary disorders.
  • Its physiological basis allows for early detection of obstruction and assessment of gallbladder function.
  • HIDA scans are invaluable for confirming biliary leakage and evaluating gallbladder ejection fraction, aiding in chronic disease diagnosis.