REF014 - Hepatobiliary (HIDA) Imaging Referral Criteria

See REF000 - Referring to Nuclear Medicine (NLAG) for details on how to refer.

The radiopharmaceutical used for hepatobiliary imaging is a technetium-99m labelled iminodiacetic acid (IDA) derivative usually referred to as HIDA (hepatic IDA). This is cleared from the circulation by hepatocytes and then secreted into bile by carrier mechanisms identical to bilirubin. It is used for imaging of the gall bladder and visualising the major ducts in the biliary tree.

Once gall bladder filling has been demonstrated, contraction efficiency can be shown by imaging the gall bladder after the patient consumes a fatty meal.

Good biliary visualisation can be consistently achieved when bilirubin levels are normal or slightly elevated. As hepatic function deteriorates and bilirubin levels progressively rise however, a greater proportion of the radiopharmaceutical is excreted via the kidneys and less via the hepatobiliary route.

NB: It may be necessary to use an unlicensed version of the radiopharmaceutical for this test which will be supplied pre-prepared and tested by another Trust (currently Sheffield Teaching Hospitals). By referring a patient for this test you are agreeing that this is acceptable for your patient.

• The referrer may be any clinician holding a current valid medical qualification and currently employed in Secondary Care.
• Referrals from Primary Care will be accepted if the investigation has been suggested by a Consultant Radiologist in a report from a previous investigation or following discussion with a Consultant Radiologist or Secondary Care Specialist. Details of such suggestions or discussions should be included on the request form.

• Sodium chloride for parenteral use (0.9% w/v).

• Pregnancy
• A theoretic possibility of allergic reactions should be considered in patients who receive multiple doses of hepatobiliary compound^[1]

• Adults: Fast for a minimum of 2 hours but preferably 6 hours before the appointment time.^[1][2]
• Children: Fast for 2-4 hours before the appointment time.^[2]
• Infants: Fast for 2 hours before the appointment time. Clear fluids are allowed if medically necessary.^[2]
• Patients fasting for longer than 24 hours (including those on total parenteral nutrition) can cause the gallbladder not to fill with radiotracer within the normally expected time frame. In these cases, pre-treatment with sincalide might be necessary^[2]. Discuss with the ARSAC licence holder.
• For patients being investigated for suspected biliary atresia, pre-treat with 5mg/kg/day of Phenobarbitone for 5 days before the appointment.