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10 - HIDA scan - )‪Hepatobiliary Scan(HIDA‬‬...

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Unformatted text preview: ‫)‪Hepatobiliary Scan (HIDA‬‬ ‫الدكتور قصي المقبل‬ ‫أستاذ مشارك­ قسم الشعة والطب النووي‬ ‫كلية الطب­جامعة العلوم والتكنولوجيا الردنية‬ Radiopharmaceutical Radiopharmaceutical • Tc99m­HIDA shares the same hepatocyte uptake, transport, and excretion pathways as bilirubin. • HIDA is excreted in its original radiochemical form without being conjugated or undergoing significant metabolism. Biliary System Technique Technique • Filling dynamic images are obtained for 60 minutes (1 image per minute). • Emptying dynamic images are obtained for 30­ 60 minutes post fatty meal. • CCK can be injected instead of fatty meal if available. Filling Phase Emptying phase Normal HIDA Scan Cystic duct Liver Hepatic Hepatic ducts ducts GB Small bowel Gallbladder Ejection Fraction • It is a numerical estimation of the function of the gallbladder. • Normally it should be greater than 50%. • It is calculated as: End filling volume ­ End emptying volume x 100% End filling volume Normal Parameters • Gallbladder must be visualized within the filling phase. • Bowel must be visualized during the test. • Gallbladder EF should be normal Indications for HIDA Scan • Chronic cholecystitis. • Evaluation of biliary atresia in neonates. • Detection of post cholecystectomy biliary leak. Biliary Dyskinesia • It is also called chronic acalculus cholecystitis. • The patients suffer from chronic abdominal pain which is mostly biliary­like pain. • The pain is not attributable to any known organic abdominal disease. • Routine work up is usually unremarkable (blood chemistry, ultrasound, CT scan, upper/lower endoscopy, … etc) Biliary Dyskinesia • No gallbladder stone disease by ultrasound. • Evaluation of gallbladder contraction has proven most useful in the diagnosis of this entity. • Gallbladder ejection fraction is usually reduced (< 50%). Biliary Atresia • HIDA scan is an accurate and non­invasive test in the diagnosis of biliary atresia and in differentiating it from other causes of neonatal jaundice. • Non­visualization of the bowel suggests biliary atresia (surgical jaundice). Hepatisis and hepatocellular dysfunction could be other causes of this finding. Biliary Atresia • Negative scan (bowel visualization = biliary­ to­bowel­transit) excludes biliary atresia. • Positive scan (non­visualization of the bowel) suggests the diagnosis of biliary atresia. Hence, liver biopsy is needed. Biliary Atresia Biliary Leak • Postoperative biliary leak can be evaluated with HIDA scan. • Findings include visualization of free bile in the abdomen. Biliary Leak a b Abnormal accumulation of tracer extending superiorly and laterally Abnormal (a) and extending medially along the anteroinferior margin of the left hepatic lobe (b). These findings are consistent with a biliary leak. ...
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