From the Guidelines
A HIDA scan is the most useful diagnostic tool for acute cholecystitis, with the highest sensitivity and specificity compared to other imaging modalities, as stated in the 2020 world society of emergency surgery updated guidelines 1.
Key Points
- HIDA scans are particularly valuable when ultrasound results are inconclusive or when functional information about the biliary system is needed.
- The test can determine if the gallbladder is contracting properly by measuring its ejection fraction after administration of a medication called cholecystokinin (CCK).
- HIDA scans are relatively safe with minimal radiation exposure, though patients may experience brief discomfort from the IV insertion and occasionally from the CCK, which can cause temporary abdominal pain or nausea.
- According to the 2024 clinical practice guideline update by the infectious diseases society of america, HIDA is considered the gold standard for diagnosing acute cholecystitis and is far less costly than MRI/MRCP 1.
Clinical Considerations
- The test typically takes 1-4 hours to complete, and patients usually need to fast for 4-12 hours beforehand to ensure optimal gallbladder visualization.
- In clinical practice, HIDA scan utilization is limited due to the required resources and time, as noted in the 2020 world society of emergency surgery updated guidelines 1.
- A study comparing the sensitivity of CT, US, and HIDA scan found that HIDA had the highest sensitivity, with a value of 84.2% 1.
From the Research
Uses of Hepatobiliary Iminodiacetic Acid (HIDA) Scan
- A HIDA scan is useful for evaluating gallbladder function and diagnosing various hepatobiliary diseases, including acute and chronic cholecystitis, biliary obstruction, and hepatocellular disease 2, 3, 4, 5.
- It can help diagnose acute cholecystitis by showing nonfilling of the gallbladder due to cystic duct obstruction 3, 4, 5.
- HIDA scan can detect high-grade biliary obstruction prior to ductal dilatation and aid in the diagnosis of partial biliary obstruction due to stones, biliary stricture, and sphincter of Oddi obstruction 5.
- It can confirm biliary leakage postcholecystectomy and hepatic transplantation, and calculate a gallbladder ejection fraction after cholecystokinin infusion to diagnose chronic acalculous gallbladder disease 5.
- HIDA imaging is also useful for evaluating congenital gallbladder and biliary duct anomalies, and can provide functional imaging information when evaluating biliary tract anomalies 6.
- In patients with atypical symptoms of biliary colic, a HIDA scan can be helpful in predicting symptom improvement 2.
- However, a HIDA scan with ejection fraction may not be useful in patients with typical symptoms of biliary colic and negative ultrasounds, and should not be used to make a decision for cholecystectomy 2.