What is the role of HIDA/DISIDA scans in the evaluation of biliary colic and acute cholecystitis?

Updated: Jan 18, 2017
  • Author: Peter A D Steel, MBBS, MA; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Answer

Depending on the clinical setting, either ultrasonography or nuclear medicine testing is the test of choice for cholecystitis. Hepatic 2,6-dimethyliminodiacetic acid (HIDA) scans have sensitivity (94%) and specificity (65-85%) for acute cholecystitis, and they are sensitive (65%) and specific (6%) for chronic cholecystitis. Normal scans are characterized by normal visualization of gallbladder in 30 minutes. Oral cholecystography is not practical for in the emergency department setting.

HIDA and diisopropyl iminodiacetic acid (DISIDA) scans are functional studies of the gallbladder. Technetium-labeled analogues of iminodiacetic acid (IDA) or diisopropyl IDA-DISIDA are administered intravenously (IV) and secreted by hepatocytes into bile, enabling visualization of the liver and biliary tree.

With cystic duct obstruction (cholecystitis), the HIDA scan shows nonvisualization (ie, considered positive) of the gallbladder at 60 minutes and uptake in the intestine as the bile is excreted directly into the duodenum. This finding has a sensitivity of 80-90% for acute cholecystitis. Obstruction of the common bile duct causes nonvisualization of the small intestine.

The rim sign is a blush of increased pericholecystic radioactivity, tracer adjacent to the gallbladder, present in approximately 30% of patients with acute cholecystitis and in 60% with acute gangrenous cholecystitis.


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