Hepatobiliary scintigraphy in clinical practice: a protocol-driven approach at King’s College Hospital, London
Hepatobiliary scintigraphy, widely known as the HIDA scan, remains an indispensable functional imaging tool for the assessment of hepatocyte function, biliary patency and gallbladder contractility. Despite the maturity of the technique, day-to-day delivery is anything but uniform: the same radiopharmaceutical is asked to answer very different clinical questions, from suspected acute cholecystitis and biliary dyskinesia to post-operative bile leak, biliary atresia in the neonate, or future-liver-remnant assessment before partial hepatectomy. Each indication imposes different demands on acquisition timing, pharmacological stimulation, hybrid SPECT/CT and quantitative processing.
This article describes the structured, protocol-driven approach used by King’s College Hospital in which all HIDA referrals are mapped onto one of four base protocols (A–D). Protocol A is for biliary dyskinesia in patients with an intact gallbladder and comprises two dynamic sequences with Calogen stimulation in between. Protocol B is for sphincter of Oddi dysfunction in patients with previous cholecystectomy and comprises a dynamic followed by Calogen and static imaging. Protocol C is a leak-detection pathway built around early SPECT/CT and extended delayed static imaging, occasionally up to 24 hours. Protocol D is a dynamic with optional delayed statics and supports biliary atresia, auxiliary transplant with incorporation of split-function quantification, and the gamut of conditions associated with intrahepatic cholestasis.
We outline the rationale for protocol selection, the technical acquisition parameters used on our cameras, the role of SPECT/CT and the most common interpretive pitfalls. The intention is to share a workable framework that can be adapted to other centres, and to highlight the value of standardising practice through a small set of clearly indicated, evidence-based pathways rather than improvising on a case-by-case basis.
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