SSAT - HIDA Scan for Gallbladder Dysfunction: Ensure That You Know How the Scan Was Done

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HIDA Scan for Gallbladder Dysfunction: Ensure That You Know How the Scan Was Done
Naeem Goussous^*¹, Hadia Maqsood¹, Guneet Kaur¹, Lisa Setiawan¹, Anita Pabani¹, Charlotte Horne¹, Ethan Spiegler², Gopal Kowdley¹, Steven C. Cunningham¹

¹Surgery, Saint Agnes Hospital, Ellicott City, MD; ²Nuclear Medicine, Saint Agnes Hospital, Baltimore, MD

Introduction: The management of patients with biliary pain, normal gallbladder ultrasound, and hepatobiliary iminodiacetic acid (HIDA) scan showing a normally patent cystic duct, but an abnormal ejection fraction (EF) is controversial. Because some literature suggests that pain reproduction upon cholecystokinin (CCK) injection predicts finding clinically significant pathology (chronic acalculous cholecystitis) after cholecystectomy, some surgeons use pain reproduction in the decision-making process to identify which of these challenging patients might benefit from cholecystectomy. Due to CCK unavailability, however, a fatty meal (FM) is often used as a replacement for CCK, but few data exist comparing them. We have compared outcomes of HIDA scan in patients stimulated with CCK and FM.
Methods: Retrospective review of all patients undergoing HIDA scans from August 2013 to May 2014 was done. All scans showing delayed visualization or nonvisualization of the gallbladder, or bile leaks, were excluded. Data are presented as percentages and means. P<0.05 was considered significant.
Results: Of 153 patients identified, 69% were females and the mean age was 55 years. There were 70 patients stimulated with CCK and 83 with FM. There was no difference between the two groups regarding age (53 vs 56 years, P = 0.3), gender (76% vs 64% females, P = 0.12), the presence of gallstones (27% vs 25%, P = 0.85), mean ejection fraction (52% vs 51%, P = 0.77), or time to visualization of the radiotracer in the gallbladder (18.4 vs 20.5 min, P = 0.34) and the duodenum (47 vs 46 min, P = 0.73). However, significantly more of the patients in the CCK group experienced symptoms upon stimulation as compared to the FM group (56% vs 23% P <0.01).
Conclusion: Stimulation of gallbladder contractility with CCK during HIDA scans produces more symptoms compared to FM despite similar ejection fractions and other parameters. Therefore, surgeons must take into account whether the pain reproduction during HIDA scan was associated with use of exogenous CCK or FM administration to stimulate gallbladder emptying.

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