HIDA scanning in gall-bladder disease

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Abstract
HIDA [dimethylphenylcarbamoylmethyl iminodiacetic acid] labeled with 99mTc is a new hepatobiliary imaging radiopharmaceutical, which is selectively taken up by the liver and excreted into the biliary tree; it was shown to demonstrate the gallbladder in normal subjects. Using a gamma-camera computer system, dynamic liver scans were performed during the 1st h on 97 patients who, on the basis of standard investigations and on the findings at surgery, were divided into 6 groups: normal; hepatocellular disease; biliary obstruction; chronic gallbladder disease; acute gallbladder disease and acute abdomen (not due to gallbladder disease). Pictures were taken and activity-time curves of regions of interest were generated from the computer data. From these the presence or absence of a gallbladder image was easily determined. The gallbladder was visualized in all normals but in none of the patients with acute gallbladder disease. In the group with an acute abdomen suggestive of acute gallbladder disease, but subsequently shown to be otherwise, the gallbladder was visualized in all cases. The gallbladder was not visualized in 42% of hepatocellular disease patients, nor in any of those with biliary obstruction, due to poor uptake or poor excretion of the HIDA. In cases of chronic gallbladder disease, visualization of the gallbladder corresponded with gallbladder opacification on the oral cholecystogram; in these cases the HIDA scan offers no advantage over the oral cholecystogram. In cases of acute abdomen an absent gallbladder image with a normal hepatogram will probably strongly support the diagnosis of acute gallbladder disease. Visualization of the gallbladder probably excludes such a diagnosis, making the HIDA scan a useful 1st-line investigation in these patients.