Tc-99m BrIDA Hepatobiliary ("HIDA") Scan
This section covers nuclear imaging of the hepatobiliary system.
Patient Preparation
Fasting
Adult patients should fast 4 hours (ideally 6 hours) and no more than 24 hours for optimized emptying of gallbladder prior to study. Patients should be pre-treated with Sincalide if they have fasted beyond these limits.
Narcotics Interference
If adult patient's 1st dose of a narcotic such as morphine sulfate is within 24 hours of study, then patient may proceed with study without having to wait.
However, if patient's first dose of a narcotic is beyond 48 hours, it should be stopped for approximately 4 half-lives because of opiate effects on smooth muscle motility of biliary tree and gallbladder. Ideally then, discontinual should be:
- At least 8 hours for morphine sulfate PO or IV (terminal elimination half-life = 2 to 4 hours and 2.1 to 2.6 hours, respectively)
- At least 8 hours for Dilaudid or hydromorphone IV (half-life = 2.3 hours)
- At least 80 hours for fentanyl transdermal patch (half-life = 20 to 27 hours)
Sources of preparation information:
SNM Practice Guideline for Hepatobiliary Scintigraphy 4.0 (ver 4.0, 2010). Hosted by SNM.
Allen TW and Tulchinsky M. Nuclear Medicine Tests for Acute Gastrointestinal Conditions. Semin Nucl Med 2013; 43:88-101.
Adult patients should fast 4 hours (ideally 6 hours) and no more than 24 hours for optimized emptying of gallbladder prior to study. Patients should be pre-treated with Sincalide if they have fasted beyond these limits.
Narcotics Interference
If adult patient's 1st dose of a narcotic such as morphine sulfate is within 24 hours of study, then patient may proceed with study without having to wait.
However, if patient's first dose of a narcotic is beyond 48 hours, it should be stopped for approximately 4 half-lives because of opiate effects on smooth muscle motility of biliary tree and gallbladder. Ideally then, discontinual should be:
- At least 8 hours for morphine sulfate PO or IV (terminal elimination half-life = 2 to 4 hours and 2.1 to 2.6 hours, respectively)
- At least 8 hours for Dilaudid or hydromorphone IV (half-life = 2.3 hours)
- At least 80 hours for fentanyl transdermal patch (half-life = 20 to 27 hours)
Sources of preparation information:
SNM Practice Guideline for Hepatobiliary Scintigraphy 4.0 (ver 4.0, 2010). Hosted by SNM.
Allen TW and Tulchinsky M. Nuclear Medicine Tests for Acute Gastrointestinal Conditions. Semin Nucl Med 2013; 43:88-101.
Pharamcologic Intervention
Sincalide (CCK analog) pre-treatment
Infusion of Sincalide IV for 0.02 mcg/kg over 30 to 60 minutes prior to administration of radiopharmaceutical.
Morphine inter-study treatment
Slow push of 0.04 mg/kg morphine sulfate IV over 3 minutes.
* Prior to morphine administration, ensure bile activity is seen within the bowel.
* Contraindications to morphine: allergy to morphine or other opiates, respiratory depression, acute asthma, circulatory shock, BP compromised by hypovolemia, paralytic ileus. See other contraindications in the morphine sulfate package insert.
Sources of pharmacologic information:
SNM Practice Guideline for Hepatobiliary Scintigraphy 4.0 (ver 4.0, 2010). Hosted by SNM.
Allen TW and Tulchinsky M. Nuclear Medicine Tests for Acute Gastrointestinal Conditions. Semin Nucl Med 2013; 43:88-101.
Sources of half-life data for morphine sulfate PO and IV, hydromorphone IV, and fentanyl patch: DailyMed hosted by National Library of Medicine.
Infusion of Sincalide IV for 0.02 mcg/kg over 30 to 60 minutes prior to administration of radiopharmaceutical.
Morphine inter-study treatment
Slow push of 0.04 mg/kg morphine sulfate IV over 3 minutes.
* Prior to morphine administration, ensure bile activity is seen within the bowel.
* Contraindications to morphine: allergy to morphine or other opiates, respiratory depression, acute asthma, circulatory shock, BP compromised by hypovolemia, paralytic ileus. See other contraindications in the morphine sulfate package insert.
Sources of pharmacologic information:
SNM Practice Guideline for Hepatobiliary Scintigraphy 4.0 (ver 4.0, 2010). Hosted by SNM.
Allen TW and Tulchinsky M. Nuclear Medicine Tests for Acute Gastrointestinal Conditions. Semin Nucl Med 2013; 43:88-101.
Sources of half-life data for morphine sulfate PO and IV, hydromorphone IV, and fentanyl patch: DailyMed hosted by National Library of Medicine.
Protocol
SNM Practice Guideline for Hepatobiliary Scintigraphy 4.0 (ver 4.0, 2010)