HIDA scan

Overview:

A hepatobiliary iminodiacetic acid scan abbreviated as HIDA scan is a procedure that involves imaging to detect any problems in the liver, gall bladder, and bile duct.

A chemical called radioactive tracer is injected into the arm of a person through the vein. The tracer gets carried via the bloodstream to the liver from where it is passed to the cells that produce the bile. The tracer is then transported along with the bile to the gallbladder and then to the small intestine. A camera called the gamma camera tracks the path of the tracer and generates computer images.

The scan is performed by the department of nuclear medicine in radiology.

How Does The Biliary System Work:

The liver produces bile which acts as a digestive fluid and breaks down the fat from the food consumed. The bile ducts transport the bile from the liver to the gallbladder which is a small sac-like organ that is situated under the right side of the liver and stores it. When a person eats food, the gall bladder contracts and squeezes out the bile through the ducts into the small intestine to help in the digestion of the fats.

If this process is disrupted at any stage it can lead to certain health conditions that the scan helps diagnose. The scan is also called cholescintigraphy and hepatobiliary scintigraphy.

The professionals involved in carrying out the scan include a physician in nuclear medicine or nuclear radiology, a nuclear technologist, and a medical physicist. The team is required to calibrate the equipment used for scanning, provide the tracer used in the procedure, and evaluate the test results.

What Does The HIDA Scan Help Diagnose:

• Inflammation in the gall bladder. The condition is called cholecystitis.
• The obstruction of the bile duct.
• Congenital issues in the bile ducts like biliary atresia.
• Problems that occur after surgery like leaking of the bile and fistulas.
• Evaluation of the liver after transplant.
• The doctor also conducts the test to check the rate at which the bile is released from the gall bladder. The process is called gall bladder ejection fraction.

Why is the HIDA Scan Recommended:

The doctor suggests the scan of the person has the following symptoms:

• Severe abdominal pain on the right side due to the inflammation of the gall bladder.
• Pain and fever after surgery.
• Severe jaundice in infants due to biliary atresia which can be a fatal condition.
• To check if the biliary stent is working properly. A stent is inserted in the duct to prevent blockage if the duct is constricted.

The Procedure Details Of HIDA Scan:

• The doctor and the scan provide detailed instructions to the person before the scan begins. They include:
• The person should notify the team if they are pregnant or even doubt if they are pregnant or breastfeeding. 
• The doctor should be informed about any medications or supplements the person is taking and if they have any health concerns or conditions. These may affect the accuracy of the results.
• The person should not wear any jewelry or metal accessories during the procedure.
• If the person is claustrophobic, they must inform the team in advance.
• The person is required to fast for four hours before the procedure is conducted. In case they are required to fast for a longer time the doctor will inform them.
• If the scan is performed on newborn babies they need a preparation of three to five days,
• The specific instructions for which are given by the doctor.
• The scan requires the person to remain still. If there is a problem with that or if the scan is conducted on infants, sedatives are administered to make the person calm and sleepy during the scan.
• The duration of the scan is around one to four hours. Some people may be required to do additional imaging 24 hours after the first scan.
• During the scan the person is asked to remove their clothing that covers the tummy and is given a gown to wear. They are asked to lie on their backs on a table.
• An IV catheter is put into the vein of the arm for injecting the radiotracer.
• The technologist positions the gamma camera on the stomach to take multiple images. The camera either moves or stays in one place and the person is required to stay still for the image quality to be good. The person may however be asked to change positions.
• After the images are taken the person is given medicines to empty the gall bladder for more images. This may cause cramps in the upper portion of the stomach.
• The entire process is not painful. The person may only feel a prick while the IV is inserted.
• If a person is suffering from inflammation of the gall bladder or any other condition they may be in pain as they are not allowed to take painkillers during the scan as they can influence the accuracy of the test.
• Depending on their health condition the person can go home or stay at the hospital after the procedure.
• The person is advised to drink many fluids to flush out the radiotracer from the body. Usually, the tracer is drained out in the urine or stools within 24 hours.
• If a woman is breastfeeding, she may be required to throw away the milk for the next 24 hours as it may contain radiation from the radiotracer which can affect the baby.

What Do The Results Indicate:

The report after the scan reveals how the tracer flows through a person’s biliary system.

The types of findings include:

• Normal or Typical -The tracer flowed freely from the liver to the gallbladder and the small intestine.
• Slow movement of the tracer- This finding indicates a blockage or improper functioning of the liver.
• No tracer seen in the gallbladder- This result means that there is severe inflammation in the gallbladder.
• Abnormal gallbladder ejection fraction- A normal ejection fraction is 30% to 35%. If the ejection is low it means that the person has chronic cholecystitis (inflammation).
• Radiotracer seen in other parts- The finding indicates that there is a leak in the bile duct.

Based on the findings, the doctor may suggest further investigations to come to a definitive diagnosis.

The Risks Involved In The Procedure:

• There may be a risk of bruising at the site where the radiotracer is injected.
• The person may face exposure to radiation due to the radiotracer used in the scan.
• There can be reactions to medicines that have radiotracers that are used while scanning.
• The scan cannot be performed on pregnant women as it can harm the fetus.

Conclusion:

The HIDA scan is very useful to diagnose any abnormalities in the liver, gallbladder, and bile ducts. Although the procedure is extensive and requires thorough preparation, it is relatively painless and offers valuable insights for the doctor to decide the treatment ahead. 

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