Diagnosis of hepatobiliary disease by 99mTc-HIDA cholescintigraphy

99mTc-HIDA is concentrated by the hepatocytes and excreted into the biliary system; the gallbladder, common bile duct, and early accumulation in the duodenum are visualized within 30 minutes of intravenous administration. The authors studied the utility of 99mTc-HIDA imaging in both acute and chronic cholecystitis and hepatobiliary disease in the presence of jaundice: (a) all normal gallbladders exhibited filling, (b) absence of visualization indicated gallbladder disease and/or cystic duct obstruction, (c) visualization of the gallbladder after cholecystokinin-induced emptying excluded an obstructed cystic duct and acute cholecystitis, and (d) a definitive diagnosis of hepatocellular disease, partial and complete obstruction, is possible in jaundiced patients with hyperbilirubinemias up to 5 mg%. Beyond that level, 99mT-HIDA imaging was of qualified value. The technique is useful in assessing biliary drainage in jaundiced patients with surgically altered biliary tract anatomy.