Appropriate Use Criteria for Hepatobiliary Scintigraphy in Abdominal Pain: Summary and Excerpts.

99mTc-labeled hepatobiliary iminodiacetic acid (HIDA) scintigraphy is an important adjunct to the evaluation of patients with abdominal pain. The introduction of radiopharmaceuticals that allowed the performance of these studies in patients with elevated bilirubin levels expanded the clinical use of this important diagnostic imaging technology. The proper use of HIDA scintigraphy requires an understanding of the physiology of the hepatobiliary system in both health and disease states, the metabolism of hepatobiliary radiopharmaceuticals, the sensitivity and specificity of currently used radiopharmaceuticals for biliary collecting system abnormalities during normal and abnormal hepatocellular function, the radiation dosimetry of hepatobiliary radiopharmaceuticals, and the accuracy and risks of alternative diagnostic studies (1). Describing the proper use of scintigraphic techniques in the diagnosis of abdominal pain, therefore, requires input from experts in nuclear imaging and in gastroenterology. This document describes the appropriate use of HIDA scintigraphy in patients with abdominal pain and has been constructed with input from expert representatives from the Society of Nuclear Medicine and Molecular Imaging (SNMMI), the European Association of Nuclear Medicine (EANM), and the American Gastroenterological Association (AGA). These experts reviewed the current literature and current practice for the management of patients with abdominal pain and developed this consensus document. The process was performed in accordance with Public Law Number 113–93 (April 1, 2014) (2), mandating the development of appropriate use criteria (AUC) for certain diagnostic imaging and nuclear medicine procedures. This AUC is intended to assist referring medical practitioners in the management of patients with abdominal pain, in particular by describing the utility of HIDA scintigraphy.