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Hepatobiliary Scan (HIDA, Tc-99m Mebrofenin +/- CCK/Morphine)

NM+ ContrastAbdomen & Pelvis

Indications

Acute cholecystitis
Chronic cholecystitis / gallbladder dysfunction (ejection fraction)
Bile leak post-cholecystectomy or trauma
Biliary atresia (neonatal)
Assessment of biliary obstruction / patency

Patient prep

Fast 4-6 hours (essential)
Avoid prolonged fasting >24 h (give sincalide/CCK pretreatment if NPO >24 h or on TPN)
Hold opioids 6-12 hours before exam (interfere with sphincter of Oddi)
Recent meal causes false-positive nonvisualization

Contrast

AgentTc-99m mebrofenin (preferred in hyperbilirubinemia) or Tc-99m disofenin

RouteIV

Dose5 mCi (185 MBq); up to 10 mCi (range 3-5 mCi standard, higher if bilirubin elevated)

TimingDynamic imaging begins immediately; serial to 60 min; delayed to 4 h if GB not seen

Technique

LEHR collimator, 140 keV, supine with liver/RUQ in FOV
Dynamic acquisition 1 min/frame x 60 min
Delayed images at 2-4 h if gallbladder not visualized
Pharmacologic intervention: morphine 0.04 mg/kg IV at ~40-60 min if GB not seen; sincalide (CCK, Kinevac) 0.02 mcg/kg over 30-60 min for ejection fraction

Series / Sequences

#	Series / Sequence	Plane	Notes
1	Dynamic flow/uptake	Anterior	1 min/frame x 60 min; tracks hepatic uptake, ducts, GB, bowel
2	Post-morphine images	Anterior	If GB not seen by 40-60 min; image 20-30 min more
3	Gallbladder ejection fraction (CCK)	Anterior	Sincalide infusion; GBEF normal >38% (depends on infusion protocol)
4	Delayed images	Anterior	2-4 h if needed for delayed GB filling

Key points

Acute cholecystitis: nonvisualization of GB at 60 min and after morphine/4 h delay (cystic duct obstruction)
Morphine constricts sphincter of Oddi, promoting GB filling and shortening exam
Low GBEF after CCK suggests chronic acalculous cholecystitis / GB dyskinesia
Hold opioids; recent opioid use can cause false-positive nonfilling. Hyperbilirubinemia reduces hepatic extraction (use mebrofenin)

References

• SNM Practice Guideline for Hepatobiliary Scintigraphy 4.0 (J Nucl Med Technol 2010;38:210) link
• EANM/SNMMI/IHPBA Procedure Guideline for Tc-99m Mebrofenin HBS
• Radiopaedia: Cholescintigraphy (HIDA) link

Source: Researched — verify against your institution

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Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.