HIDA Scan Protocol for Acute Cholecystitis and Functional Gallbladder Disorder

Patient Preparation and Protocol

Patients must fast for a minimum of 4-6 hours to ensure adequate gallbladder filling and avoid false-positive results, according to the Clinical Gastroenterology and Hepatology guidelines 1
Opiates and anticholinergics must be withheld for at least 48 hours before testing, as recommended by the Clinical Gastroenterology and Hepatology guidelines 1
CCK-cholescintigraphy should be performed on an outpatient basis only, not during acute illness or hospitalization, to avoid confounding factors that can spuriously decrease gallbladder ejection fraction, as stated in the Clinical Gastroenterology and Hepatology guidelines 1

Dynamic imaging is performed continuously for up to 60 minutes after radiotracer injection to assess gallbladder filling, as recommended by the Clinical Gastroenterology and Hepatology guidelines 1
If the gallbladder has not filled by 60 minutes in a properly prepared patient, this is reported as abnormal and consistent with either acute or chronic cholecystitis depending on clinical presentation, according to the Clinical Gastroenterology and Hepatology guidelines 1

The HIDA scan has the highest sensitivity (84.2%) for acute cholecystitis compared to ultrasound (67.3%) and CT (59.8%), as reported in the World Journal of Emergency Surgery 2
HIDA should be reserved for selected patients when ultrasound is equivocal and clinical suspicion remains high, as recommended by the World Journal of Emergency Surgery 3

Sincalide is contraindicated in pregnancy as it may stimulate preterm labor, according to the Clinical Gastroenterology and Hepatology guidelines 1
Known allergic reaction to sincalide, intestinal obstruction, and pregnancy (for sincalide administration) are absolute contraindications for HIDA scan, as stated in the Clinical Gastroenterology and Hepatology guidelines 1

A technetium-99m (Tc-99m) labeled hepatobiliary iminodiacetic acid (HIDA) radiopharmaceutical is injected intravenously during a HIDA scan, with Tc-99m mebrofenin being the preferred agent, typically administered at 5 mCi intravenously 4, 5
The American College of Radiology recommends using Tc-99m labeled HIDA agents, such as Tc-99m mebrofenin or Tc-99m disofenin, for HIDA scans 5

For functional gallbladder disorder evaluation (CCK-cholescintigraphy), sincalide (synthetic cholecystokinin) is administered after gallbladder filling, with a dose of 0.02 μg/kg (or 1.4 μg/kg based on patient weight) and infused intravenously over 60 minutes 4, 5
The purpose of sincalide administration is to stimulate gallbladder contraction and calculate gallbladder ejection fraction (GBEF), with a normal GBEF being ≥38% 4, 5, 6

The American College of Radiology recommends that CCK/sincalide is NOT used for acute cholecystitis evaluation, but rather for functional gallbladder disorder and chronic acalculous cholecystitis where gallbladder contractility assessment is needed 6, 7, 8, 9