HEPATOBILIARY IMAGING

Posted by e-Medical PPT Sunday, October 28, 2012
Hepatobiliary Imaging
The function of the biliary tree and gall bladder
A "HIDA" scan or a "DISIDA" scan
Performed with a variety of compounds that share the common imminodiacetate moiety

Structures of DISIDA
HIDA - Little used today
DISIDA - Imaging the gall bladder better when liver function is poor

Pathways of DISIDA
The lipophilic component : binding to hepatocyte receptors for bilirubin
Transported through the same pathways as bilirubin, except for conjugation

Indications
Acute cholecystitis
Chronic cholecystitis
Bile leakage
Biliary atresia

Requirements for DISIDA Scan
Patient preparation: fasted for 4 hours
Radiotracer: Tc-99m IDA compounds i.v.
Imaging: serial anterior/lateral views for 60 minutes
 Every 5 minutes for 30 minutes
 Once at 45 minutes
 Once at 1 hour
 Delayed views of the gall bladder 2 hours, 4 hours, 6 hours or 24 hours after injection

Acute Cholecystitis
If hepatic scintigraphy reveals adequate filling of the gallbladder, acute cholecystitis is effectively excluded.
Within 30 minutes, the gallbladder fails to visualize
Wait for one whole hour
Differential diagnosis for non-visualization of the gallbladder
 Relaxation of the sphincter of Oddi
 Inject morphine (3-5 milligrams) and continue the study for another half an hour
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