From the Guidelines
A HIDA scan with CCK augmentation is a nuclear medicine imaging test used to evaluate gallbladder function and detect disorders of the biliary system, involving the infusion of 0.02 g/kg of sincalide over 60 minutes, with a normal gallbladder ejection fraction defined as ≥38%. The procedure involves injecting a radioactive tracer that is taken up by liver cells and excreted into the bile ducts, allowing visualization of the liver, bile ducts, gallbladder, and small intestine. The CCK augmentation component involves administering synthetic CCK (sincalide) during the test, which causes the gallbladder to contract and empty its contents, allowing measurement of the gallbladder ejection fraction (GBEF) [ 1, 2 ].
Key Components of the Test
- The test is particularly useful for diagnosing functional gallbladder disorders like biliary dyskinesia when patients have gallbladder symptoms but ultrasound shows no gallstones.
- Patients should fast for 4-6 hours before the test and avoid opioid medications for 24 hours prior.
- The entire procedure takes approximately 90-120 minutes.
- The radiation exposure is minimal and considered safe for most patients, though it's typically avoided in pregnancy.
Clinical Utility and Recommendations
The use of CCK-CS is recommended in patients meeting the Rome III criteria for functional biliary pain and who are not having pain and who are not hospitalized at the time of the study [ 2 ]. However, more data are required before CCK-CS can be unconditionally recommended as a diagnostic test in patients with suspected functional gallbladder disease (FGBD). A large, prospective controlled study with patients meeting a standardized definition of functional biliary pain and a normal gallbladder ultrasound, randomized to either surgery or no surgery using the standardized CCK-CS methodology, is necessary to assess the clinical utility of CCK-CS in selecting patients with FGBD for cholecystectomy [ 2 ].
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,
A Hepatobiliary Iminodiacetic Acid (HIDA) scan with Cholecystokinin (CCK) augmentation is a diagnostic imaging procedure that uses a radiopharmaceutical, such as Technetium-99m lidofenin or mebrofenin, to visualize the gallbladder and biliary system. Cholecystokinin (CCK) augmentation, in this context, refers to the use of a medication like sincalide 3 to stimulate gallbladder contraction, which can help assess gallbladder function and emptying. The CCK augmentation is used to enhance the diagnostic accuracy of the HIDA scan by evaluating the gallbladder's ability to contract and empty in response to the hormone.
From the Research
Definition of HIDA Scan with CCK Augmentation
- A Hepatobiliary Iminodiacetic Acid (HIDA) scan with Cholecystokinin (CCK) augmentation is a medical imaging test used to evaluate the function of the gallbladder and biliary system 4, 5, 6.
- The test involves injecting a small amount of radioactive material, called a radiopharmaceutical, into the bloodstream, which is then taken up by the liver and excreted into the bile 5.
- The CCK augmentation part of the test involves administering a hormone called cholecystokinin, which stimulates the gallbladder to contract and release bile into the small intestine 4, 6.
Purpose of the Test
- The purpose of the HIDA scan with CCK augmentation is to diagnose and evaluate various conditions affecting the gallbladder and biliary system, such as biliary dyskinesia, chronic acalculous gallbladder disease, and sphincter of Oddi dysfunction 4, 5, 6.
- The test can help determine if the gallbladder is functioning properly and if there are any blockages or obstructions in the biliary system 5.
Interpretation of Results
- The results of the HIDA scan with CCK augmentation are interpreted based on the ejection fraction (EF) of the gallbladder, which is the percentage of bile that is released from the gallbladder in response to CCK stimulation 4, 6.
- A low EF (<35%) may indicate biliary dyskinesia or other conditions affecting the gallbladder, while a normal EF does not necessarily rule out a biliary etiology of symptoms 4, 7.
- Recreation of symptoms following CCK provocation may be a more reliable indicator of underlying chronic cholecystitis than EF alone 7.