Sequential hepatobiliary scintigraphy

What is it?

Hepatobiliary scintigraphy is based on the administration of lipophilic tracers mimetic of bilirubin (Tc-99m IDA derivatives), which when injected intravenously are captured by hepatocytes, excreted in the biliary tree, collected in the gallbladder and then excreted in the intestine. This test allows to evaluate the hepatocyte function, the patency of the main biliary tracts (intra and extra-hepatic), the contractility of the gallbladder and the transit of radioactive bile in the duodenal loops.

When is this exam indicated?

Sequential liver scintigraphy is recommended for the assessment of extrahepatic bile duct and biliary tree obstructions after surgery, for the identification of bile reflux in the stomach or esophagus, for the diagnosis of biliary atresia and other congenital disorders of the biliary tract after administration of phenobarbital, in the functional evaluation of the transplanted liver, in the functional evaluation of chronic cholecystitis and sphincter of Oddi dysfunction, in the diagnosis of acute cholecystitis, in the evaluation of biliary extravasation in the peritoneum and in the evaluation of liver function in relation to hepatectomy procedures.

  • extrahepatic biliary obstruction
  • biliary refluxes
  • diagnosis of biliary tract atresia
  • biliary tract tumor
  • functional evaluation of transplanted liver
  • assessment of liver function before hepatectomy

How is it performed?

The scintigraphic examination requires fasting for at least 6 hours; liquids are allowed. When possible it is advisable to suspend the intake of antispastics and morphine. The examination is performed with the use of a gamma camera that enables the execution not only planar studies but also tomographic ones combined with low-dose CT, allowing to obtain values of pre-surgical liver function as close as possible to reality. In our center, pre-surgical liver studies are performed in the presence of the surgeon who will conduct the surgery. In case of major liver resection, this method, along with others, becomes part of the examination panel that allows, by evaluating liver function, to minimize the risk of post-surgical liver failure. The time of stay in the ward is about two hours. It is advisable to keep away from pregnant women and small children during the day of examination.


Pregnancy: very high levels of bilirubin in the blood may interfere with the result of the examination and hamper its execution.

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