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Cholescintigraphy or hepatobiliary scintigraphy is scintigraphy of the hepatobiliary tract, including the gallbladder and bile ducts. The image produced by this type of medical imaging, called a cholescintigram, is also known by other names depending on which radiotracer is used, such as HIDA scan, PIPIDA scan, DISIDA scan, or BrIDA scan. Cholescintigraphic scanning is a nuclear medicine procedure to evaluate the health and function of the gallbladder and biliary system. A radioactive tracer is injected through any accessible vein and then allowed to circulate to the liver, where it is excreted into the bile ducts and stored by the gallbladder^[1] until released into the duodenum.

In the absence of gallbladder disease, the gallbladder is visualized within 1 hour of the injection of the radioactive tracer. If the gallbladder is not visualized within 4 hours after the injection, this indicates either cholecystitis or cystic duct obstruction, such as by cholelithiasis (gallstone formation).^[2] This investigation is usually conducted after an ultrasonographic examination of the abdominal right upper quadrant for a patient presenting with abdominal pain. If the noninvasive ultrasound examination fails to demonstrate gallstones, or other obstruction to the gallbladder or biliary tree, in an attempt to establish a cause of right upper quadrant pain, a cholescintigraphic scan can be performed as a more sensitive and specific test. Cholescintigraphic scans are not generally a first-line form of imaging owing to their increased cost and invasiveness.^[3]

Cholescintigraphy for acute cholecystitis has sensitivity of 97%, specificity of 94%.^[4] Several investigators have found the sensitivity being consistently higher than 90% though specificity has varied from 73–99%, yet compared to ultrasonography, cholescintigraphy has proven to be superior.^[5] The scan is also important to differentiate between neonatal hepatitis and biliary atresia, because an early surgical intervention in form of Kasai portoenterostomy or hepatoportoenterostomy can save the life of the baby as the chance of a successful operation after 3 months seriously decreases.^[6]

Radiotracers

Most radiotracers for cholescintigraphy are metal complexes of iminodiacetic acid (IDA) with a radionuclide, usually technetium-99m. This metastable isotope has a half-life of 6 hours, so batches of radiotracer must be prepared as needed using a moly cow. A widely recognized trade name for the preparation kits is TechneScan. These radiopharmaceuticals include the following:^[7]^[8]

Nonproprietary drug name (USP format)	Common chemical name	Acronym	Comments
Technetium Tc 99m lidofenin	hepatobiliary iminodiacetic acid;^[9] dimethyl-iminodiacetic acid^[7]	HIDA	An early and widely used tracer; not used as much anymore, as others have progressively replaced it,^[10]^[11] but the term "HIDA scan" is sometimes used even when another tracer was involved, being treated as a catch-all synonym.
Technetium Tc 99m iprofenin	paraisopropyl-iminodiacetic acid^[7]	PIPIDA
Technetium Tc 99m disofenin	diisopropyl-iminodiacetic acid^[7]	DISIDA
Technetium Tc 99m mebrofenin	trimethylbromo-iminodiaceticacid^[9]	BrIDA
	diethyl-iminodiacetic acid^[7]	EIDA	Seems to have been a laboratory tracer but never widely used clinically
	parabutyl-iminodiacetic acid^[7]	PBIDA	Seems to have been a laboratory tracer but never widely used clinically
		BIDA^[12]	Seems to have been a laboratory tracer but never widely used clinically
		DIDA^[12]	Seems to have been a laboratory tracer but never widely used clinically

Etymology and pronunciation

The word cholescintigraphy (/ˌkoʊliˌsɪnˈtɪɡrəfi/) uses combining forms of chole- + scinti(llation) + -graphy, most literally "bile + flash + recording".

References

^ Michael, Picco, M.D. "HIDA scan (cholescintigraphy): Why is it performed?". Mayo Clinic. Retrieved 2007-12-11.
^ Tulchinsky, M.; Ciak, B. W.; Delbeke, D.; Hilson, A.; Holes-Lewis, K. A.; Stabin, M. G.; Ziessman, H. A. (15 November 2010). "SNM Practice Guideline for Hepatobiliary Scintigraphy 4.0". Journal of Nuclear Medicine Technology. 38 (4): 210–218. PMID 21078782. doi:10.2967/jnmt.110.082289 .
^ Schirmer, Bruce D.; Winters, Kathryne L.; Edlich, Richard F. (2005). "Cholelithiasis and Cholecystitis". Journal of Long-Term Effects of Medical Implants. 15 (3): 329–338. PMID 16022643. doi:10.1615/JLongTermEffMedImplants.v15.i3.90.
^ Shea JA, Berlin JA, Escarce JJ, Clarke JR, Kinosian BP, Cabana MD, et al. (1994). "Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease.". Arch Intern Med. 154 (22): 2573–81. PMID 7979854. doi:10.1001/archinte.154.22.2573.
^ L. Santiago Medina; C. Craig Blackmore; Kimberly Applegate (29 April 2011). Evidence-Based Imaging: Improving the Quality of Imaging in Patient Care. Springer. p. 530. ISBN 978-1-4419-7776-2. Retrieved 23 August 2012.
^ Jorge A. Soto; Brian C. Lucey (27 April 2009). Emergency Radiology: The Requisites. Elsevier Health Sciences. p. 380. ISBN 978-0-323-05407-2. Retrieved 23 August 2012.
^ ^a ^b ^c ^d ^e ^f Bobba, VV; et al. (1983), "Comparison of biokinetics and biliary imaging parameters of four Tc-99m iminodiacetic acid derivatives in normal subjects", Clin Nucl Med, 8 (2): 70–75, PMID 6825355.
^ Brown, PH; et al. (1982), "Radiation-dose calculation for five Tc-99m IDA hepatobiliary agents", J Nucl Med, 23 (11): 1025–1030, PMID 6897074.
^ ^a ^b Elsevier, Dorland's Illustrated Medical Dictionary, Elsevier.
^ Krishnamurthy, Gerbail T.; Krishnamurthy, Shakuntala (31 July 2009). Nuclear Hepatology: A Textbook of Hepatobiliary Diseases. Springer. ISBN 978-3-642-00647-0.
^ Puthenedam, Manjula. "SNM issues guidelines for hepatobiliary scintigraphy". Retrieved 2012-12-02.
^ ^a ^b Ziessman, HA; et al. (2014), "Hepatobiliary scintigraphy in 2014", J Nucl Med, 55 (6): 967–975, PMID 24744445, doi:10.2967/jnumed.113.131490.

UpToDate Contents

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1. 急性胆石性胆のう炎：臨床的特徴および診断acute calculous cholecystitis clinical features and diagnosis [show details]
…failure of the gallbladder to fill during cholescintigraphy In most cases, the diagnosis can be established with an abdominal ultrasound. We perform cholescintigraphy if the diagnosis remains unclear despite …
2. 成人に生じる胆石症の概要overview of gallstone disease in adults [show details]
…for medical dissolution therapy for gallstones. Cholescintigraphy (HIDA scan) – Cholescintigraphy (99mTc-heapto-iminodiacetic acid [HIDA] scanning) is not used in the diagnosis of gallstones, but is…
3. 胆嚢摘出術以外の胆のう結石症治療の概要overview of nonsurgical management of gallbladder stones [show details]
…combined with oral cholecystography, or cholescintigraphy of the gallbladder. We do not assess gallbladder motor function with cholecystokinin-stimulated imaging (HIDA scan/oral cholecystogram/ultrasound) in …
4. 成人における胆嚢機能障害functional gallbladder disorder in adults [show details]
…of gallstones or other organic causes of biliary pain, we perform cholecystokinin (CCK)-stimulated cholescintigraphy to evaluate the gallbladder ejection fraction (GBEF). A low GBEF is supportive of the …
5. オッディ括約筋機能不全の臨床症状よび診断clinical manifestations and diagnosis of sphincter of oddi dysfunction [show details]
…percent, respectively. The sensitivity and specificity of hepatobiliary scintigraphy were 49 and 78 percent, respectively. Hepatobiliary scintigraphy and fatty meal ultrasonography (either one or both) were …

English Journal

Evaluation of the gallbladder and cystic duct patency with gadoxetate disodium enhanced MR cholangiography: prospective comparison of patients with normal gallbladder function and acute cholecystitis.

Yacoub JH1, Yousuf A2, Agrawal G3, Thomas S2, Appelbaum DE2, Oto A2.
Acta radiologica (Stockholm, Sweden : 1987).Acta Radiol.2015 Jul;56(7):782-9. doi: 10.1177/0284185114538955. Epub 2014 Jul 9.
BACKGROUND: Using hepatocyte-specific magnetic resonance imaging (MRI) contrast agents such as gadoxetate disodium, MRI can provide functional information regarding the patency of the cystic duct similar to hepatobiliary scintigraphy in addition to anatomic images.PURPOSE: To describe the gadoxetate
PMID 25009279

Hepatobiliary Scintigraphy of Evolving Spontaneous Biliary Leak.

Flynt L1, Grant P, Seitz JP, Qing F.
Clinical nuclear medicine.Clin Nucl Med.2015 Jul;40(7):592-5. doi: 10.1097/RLU.0000000000000784.
The patient is a 44-year-old woman with Crohn's disease, who presented to the ED with abdominal pain. Initial imaging by CT and US showed mild biliary tree dilatation, mild gallbladder distension, and pericholecystic fluid. The cystic and common bile ducts were patent without bile leak on cholescint
PMID 25899598

Ursodeoxycholic acid versus phenobarbital pretreatment prior to hepatobiliary scintigraphy in neonatal cholestasis: is it time for shifting gears towards a practice change?

Basu S1, Bhattacharya A.
European journal of nuclear medicine and molecular imaging.Eur J Nucl Med Mol Imaging.2015 Jun;42(7):1160-1. doi: 10.1007/s00259-015-3011-z. Epub 2015 Feb 17.
PMID 25687536

Japanese Journal

小児外科における乳児黄疸の診断治療戦略

加藤久尚,文野誠久,古川泰三 [他]
京都府立医科大学雑誌 120(2), 89-95, 2011-02
NAID 40018737222

胆道シンチよりみた乳頭機能の評価 : 胃切後胆石症の解析

橋本直樹
胆膵の病態生理 27(1), 19-21, 2011
NAID 40019262884

肝細胞造影相を利用した肝機能情報の取得法に関する検討

森泰成,古家乾,秋元聰 [他],鯵岡リサ,江本貴
日本放射線技術學會雜誌 65(11), 1502-1511, 2009-11-20
… In this study, we examined the possibility of obtaining liver function in only one hepatobiliary phase 60 minutes after injection. … Secondly, we compared the difference between liver and spleen signal intensity with biochemical laboratory tests, Child-Pugh class, liver damage class, and the two indices(HH15 and LHL15)calculated by 99mTc-DTPA-galactosyl-human serum albumin hepatic scintigraphy in patients with chronic liver diseases. …
NAID 10025977773

★リンクテーブル★

リンク元	「肝胆道シンチグラム」
関連記事	「hepatobiliary」

「肝胆道シンチグラム」

Cholescintigraphy
	Normal hepatobiliary scan (HIDA scan). The nuclear medicine hepatobiliary scan is clinically useful in the detection of the gallbladder disease.
ICD-9-CM	92.02
OPS-301 code	3-707.6
	[edit on Wikidata]

　　[★]

英: hepatobiliary scintigram
同: (方法)肝胆道シンチグラフィ hepatobiliary scintigraphy、胆道シンチグラフィ cholescintigraphy biliary scintigraphy, 肝胆道スキャン hepatobiliary scan

N-ピリドキシル-5-メチルトリプトファンテクネチウム(99mTc) 99mTc-PMTを用いるシンチグラフィー
肝細胞から排泄され、胆管・胆道を経て腸管に排泄される。胆汁の排泄障害などを目的として実施される。

「hepatobiliary」

　　[★]

肝胆道の、肝胆嚢の

関: hepatocystic

[1] Michael, Picco, M.D. "HIDA scan (cholescintigraphy): Why is it performed?". Mayo Clinic. Retrieved 2007-12-11.

[2] Tulchinsky, M.; Ciak, B. W.; Delbeke, D.; Hilson, A.; Holes-Lewis, K. A.; Stabin, M. G.; Ziessman, H. A. (15 November 2010). "SNM Practice Guideline for Hepatobiliary Scintigraphy 4.0". Journal of Nuclear Medicine Technology. 38 (4): 210–218. PMID 21078782. doi:10.2967/jnmt.110.082289 .

[3] Schirmer, Bruce D.; Winters, Kathryne L.; Edlich, Richard F. (2005). "Cholelithiasis and Cholecystitis". Journal of Long-Term Effects of Medical Implants. 15 (3): 329–338. PMID 16022643. doi:10.1615/JLongTermEffMedImplants.v15.i3.90.

[pmid7979854-4] Shea JA, Berlin JA, Escarce JJ, Clarke JR, Kinosian BP, Cabana MD, et al. (1994). "Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease.". Arch Intern Med. 154 (22): 2573–81. PMID 7979854. doi:10.1001/archinte.154.22.2573.

[MedinaBlackmore2011-5] L. Santiago Medina; C. Craig Blackmore; Kimberly Applegate (29 April 2011). Evidence-Based Imaging: Improving the Quality of Imaging in Patient Care. Springer. p. 530. ISBN 978-1-4419-7776-2. Retrieved 23 August 2012.

[SotoLucey2009-6] Jorge A. Soto; Brian C. Lucey (27 April 2009). Emergency Radiology: The Requisites. Elsevier Health Sciences. p. 380. ISBN 978-0-323-05407-2. Retrieved 23 August 2012.

[pmid_6825355-7] ^ ^a ^b ^c ^d ^e ^f Bobba, VV; et al. (1983), "Comparison of biokinetics and biliary imaging parameters of four Tc-99m iminodiacetic acid derivatives in normal subjects", Clin Nucl Med, 8 (2): 70–75, PMID 6825355.

[pmid_6897074-8] Brown, PH; et al. (1982), "Radiation-dose calculation for five Tc-99m IDA hepatobiliary agents", J Nucl Med, 23 (11): 1025–1030, PMID 6897074.

[Dorlands-9] Elsevier, Dorland's Illustrated Medical Dictionary, Elsevier.

[10] Krishnamurthy, Gerbail T.; Krishnamurthy, Shakuntala (31 July 2009). Nuclear Hepatology: A Textbook of Hepatobiliary Diseases. Springer. ISBN 978-3-642-00647-0.

[11] Puthenedam, Manjula. "SNM issues guidelines for hepatobiliary scintigraphy". Retrieved 2012-12-02.

[pmid_24744445-12] Ziessman, HA; et al. (2014), "Hepatobiliary scintigraphy in 2014", J Nucl Med, 55 (6): 967–975, PMID 24744445, doi:10.2967/jnumed.113.131490.

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案内

hepatobiliary scintigraphy