What is the difference between a Hida (Hepatobiliary Iminodiacetic Acid) scan and a Hida CCK (Cholecystokinin) scan in assessing gallbladder function?

From the Guidelines

The primary distinction between a HIDA scan and a HIDA CCK scan is the addition of cholecystokinin (CCK) in the latter, which stimulates gallbladder contraction and allows for the measurement of gallbladder ejection fraction, providing a more comprehensive assessment of gallbladder function. A standard HIDA scan involves injecting a radioactive tracer to visualize the hepatobiliary system and assess bile flow, primarily evaluating for bile duct obstruction, bile leaks, or gallbladder filling. In contrast, the HIDA CCK scan includes the administration of CCK to stimulate gallbladder contraction, enabling the measurement of the gallbladder ejection fraction, which is crucial for diagnosing functional gallbladder disorders like biliary dyskinesia, as noted in studies such as 1 and 1.

Key Differences and Uses

• The HIDA scan is used for assessing bile flow and detecting issues like obstruction or leaks.
• The HIDA CCK scan is particularly useful for diagnosing functional gallbladder disorders by assessing gallbladder contractility.
• Both tests require a fasting period and involve minimal radiation exposure, but the HIDA CCK scan may cause temporary abdominal discomfort due to the induced gallbladder contraction.
• The use of a standardized CCK-CS protocol, as recommended by an interdisciplinary panel 1, involves the infusion of 0.02 g/kg of sincalide over 60 minutes, with a normal gallbladder ejection fraction defined as ≥38%.

Clinical Recommendations

Based on the most recent and highest quality evidence, the HIDA CCK scan is recommended for patients with suspected functional gallbladder disorders, particularly those meeting the Rome III criteria for functional biliary pain 1. However, it's crucial to note that the clinical utility of CCK-CS is still under debate, and further studies are needed to establish its role in diagnosing and managing functional gallbladder disease, as emphasized in 1 and 1.

Procedure and Considerations

• Patients should fast for 4-6 hours before both tests.
• The tests take approximately 60-90 minutes to complete.
• The HIDA CCK scan provides more detailed information about gallbladder function but may cause temporary discomfort.
• The choice between a HIDA scan and a HIDA CCK scan should be based on the specific clinical question and the patient's symptoms, with the HIDA CCK scan being more appropriate for evaluating gallbladder contractility and function.

From the FDA Drug Label

Sincalide, a synthetically prepared C-terminal octapeptide of the natural hormone cholecystokinin, induces contraction of the gallbladder muscle, resulting in reduction of gallbladder size and evacuation of bile. Sincalide may be used: to stimulate gallbladder contraction, as may be assessed by various methods of diagnostic imaging,

The main difference between a Hida scan and a Hida CCK scan is the use of Cholecystokinin (CCK) in the latter. A Hida scan assesses gallbladder function by visualizing the uptake and excretion of the radiotracer, while a Hida CCK scan uses sincalide, a synthetic CCK, to stimulate gallbladder contraction and evaluate its function 2. The addition of CCK in a Hida CCK scan helps to assess the gallbladder's ability to contract and empty in response to a stimulus, providing more information about its functional status 2.

• Key differences:
  • Hida scan: assesses gallbladder function through radiotracer uptake and excretion
  • Hida CCK scan: uses sincalide to stimulate gallbladder contraction and evaluate its function
• Clinical use: Hida CCK scan is used to assess gallbladder function, especially when there are symptoms of gallbladder disease, such as biliary colic or cholecystitis 2

From the Research

Hida vs Hida CCK Scan

• A Hida scan, also known as a Hepatobiliary Iminodiacetic Acid scan, is used to assess gallbladder function and diagnose certain liver and gallbladder disorders 3, 4, 5, 6, 7.
• A Hida CCK scan, on the other hand, is a specific type of Hida scan that uses Cholecystokinin (CCK) to stimulate the gallbladder and evaluate its function 3, 4, 5, 6, 7.

Key Differences

• The main difference between a Hida scan and a Hida CCK scan is the use of CCK in the latter to stimulate the gallbladder and assess its ejection fraction (EF) 3, 5, 7.
• The EF is a measure of the gallbladder's ability to contract and empty its contents, and a low EF (<35%) is often indicative of gallbladder dysfunction or biliary dyskinesia 3, 5, 7.
• The Hida CCK scan is considered more sensitive and specific than the standard Hida scan in diagnosing biliary dyskinesia and predicting outcomes after cholecystectomy 3, 5, 7.

Clinical Applications

• The Hida CCK scan is commonly used to evaluate patients with suspected biliary dyskinesia or acalculous gallbladder disease, particularly those with normal ultrasound findings 3, 4, 5, 6, 7.
• The scan can help identify patients who may benefit from cholecystectomy, and studies have shown that patients with a low EF on Hida CCK scan have a high likelihood of symptom resolution after surgery 3, 5, 7.
• Additionally, the Hida CCK scan can be used to evaluate patients with biliary hyperkinesia, a condition characterized by an elevated EF, and may be an indication for cholecystectomy in certain cases 6.