What is the role of technetium-99m (99m Tc) hepatoiminodiacetic acid (HIDA) scintigraphy in the diagnosis of gallstones (cholelithiasis)?

Updated: Apr 01, 2019
  • Author: Douglas M Heuman, MD, FACP, FACG, AGAF; Chief Editor: BS Anand, MD  more...
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Technetium-99m (99m Tc) hepatoiminodiacetic acid (HIDA) scintigraphy is occasionally useful in the differential diagnosis of acute abdominal pain. Scintigraphy gives little information about nonobstructing cholelithiasis and cannot detect other pathologic states, but it is highly accurate for the diagnosis of cystic duct obstruction.

HIDA is normally taken up by the liver and excreted into bile, where it fills the gallbladder and can be detected with a gamma camera. Failure of HIDA to fill the gallbladder, while flowing freely into the duodenum, is indicative of cystic duct obstruction. A nonvisualizing gallbladder on a HIDA scan in a patient with abdominal pain supports the diagnosis of acute cholecystitis.

A meta-analysis by Mahid et al found that patients without gallstones who have right upper quadrant pain and a positive HIDA scan result are more likely to experience symptom relief if they undergo cholecystectomy than if they are treated medically. [18]

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