gallbladder nuclear scanning (Hepatobiliary scintigraphy, Cholescintigraphy, DISIDA scanning, HIDA scanning)
المؤلف:
Kathleen Deska Pagana, Timothy J. Pagana, Theresa Noel Pagana.
المصدر:
Mosbys diagnostic and laboratory test reference
الجزء والصفحة:
15th edition , p435-436
2025-12-16
53
Type of test Nuclear scan
Normal findings
Gallbladder, common bile duct, and duodenum are visualized within 60 minutes after radionuclide injection. (This confirms patency of the cystic and common bile ducts.)
Test explanation and related physiology
Through the use of iminodiacetic acid analogs (IDAs) labeled with technetium-99 m (99mTc), the biliary tract can be evaluated in a safe, accurate, and noninvasive manner.
Failure to visualize the gallbladder 60 to 120 minutes after injection of the radionuclide dye is virtually diagnostic of an obstruction of the cystic duct (acute cholecystitis). Delayed filling of the gallbladder is associated with chronic or acalculous cholecystitis. The identification of the radionuclide in the biliary tree, but not in the bowel, is diagnostic of common bile duct obstruction.
Gallbladder function can be numerically determined by calculating the capability of the gallbladder to eject its contents after the injection of a cholecystokinetic drug. It is believed that an ejection fraction lower than 35% indicates chronic cholecystitis or functional obstruction of the cystic duct. Ultrasound has largely replaced this test for the diagnosis of acute cholecystitis.
Occasionally, morphine sulfate is given intravenously during nuclear scanning. The morphine causes increased ampullary contraction. This reproduces the patient’s symptoms of biliary colic and forces the bile containing the radionuclide into the gallbladder, shortening the expected time of visualization of the gallbladder.
Contraindications
• Patients who are pregnant because of the risk of fetal damage Interfering factors
• If the patient has not eaten for more than 24 hours, the radio nuclide may not fill the gallbladder. This would produce a false-positive result.
* The administration of opiates can prolong the time for gall bladder identification.
Procedure and patient care
Before
* Explain the procedure to the patient. See p. xviii for radiation exposure and risks.
* Assure the patient that he or she will not be exposed to large amounts of radioactivity.
* Instruct the patient to fast for at least 2 to 4 hours before the test. This fasting is preferable but not mandatory.
During
• Note the following procedural steps:
1. After IV administration of a 99mTc-labeled IDA analog (e.g., mebrofenin, disofenin), the right upper quadrant of the abdomen is scanned.
2. Serial images are obtained over 1 hour.
3. Subsequent images can be obtained at 15- to 30-minute intervals.
4. If the gallbladder, common bile duct, or duodenum is not visualized within 60 minutes after injection, delayed images are obtained up to 4 hours later.
5. When an ejection fraction is to be determined, the patient is given a fatty meal or cholecystokinin to evaluate emp tying of the gallbladder. The gallbladder is continually scanned to measure the percentage of isotope ejected.
• Note that a radiologist performs this study in 1 to 4 hours in the nuclear medicine department. Tell the patient that the only discomfort associated with this procedure is the intravenous (IV) injection of radionuclide.
After
• Obtain a meal for the patient if indicated.
Abnormal findings
- Acute cholecystitis
- Chronic cholecystitis
- Acalculous cholecystitis
- Common bile duct obstruction secondary to gallstones, tumor, or stricture
- Cystic duct syndrome
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