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IMAGE INTERPRETATION · HEPATOBILIARY AND GI

Normal Hepatobiliary Scan Sequence (Mebrofenin)

Tc-99m mebrofenin hepatobiliary scan: 12 sequential frames over the first hour
Tc-99m mebrofenin hepatobiliary scan: 12 sequential frames over the first hour

Provided clinical image

Question

This dynamic series shows 12 sequential frames acquired over the first hour after injection of 5.5 mCi Tc-99m mebrofenin. What is the expected normal sequence of organ visualization in a properly functioning study?

  1. AKidneys → bladder → bowel, with the liver serving only as a transit organ and showing minimal retained activity by the sixth frame
  2. BLiver uptake first, followed by the bile ducts, then the gallbladder and bowel — either can appear before the other, but both should be visualized within 60 minutes in a normal study
  3. CHeart and blood pool → liver → delayed small bowel activity that appears only after 3–4 hours in a study with normal biliary function
  4. DStomach → duodenum → small bowel, with the liver showing only faint background activity throughout the first hour of dynamic imaging
Show the answer and explanation

B. Liver uptake first, followed by the bile ducts, then the gallbladder and bowel — either can appear before the other, but both should be visualized within 60 minutes in a normal study

On a normal Tc-99m mebrofenin hepatobiliary scan, the expected sequence is liver uptake (peak within 5–10 minutes), then filling of the intrahepatic bile ducts and common bile duct, followed by the gallbladder and bowel. Importantly, bowel activity can appear before gallbladder filling or vice versa — both are acceptable in a normal study as long as they appear within 60 minutes. Absence of bowel activity or gallbladder visualization by 60 minutes may indicate obstruction or cholecystitis.

More hepatobiliary and gi images

Tc-99m mebrofenin hepatobiliary scan: 12 sequential frames over the first hourPatient Preparation for a HIDA Scan Dynamic abdominal scan: sequential frames at 3 min/frame from 30 to 60 minutes post-injectionMeckel’s Diverticulum Scan with Tc-99m Pertechnetate Tc-99m HIDA scan post-morphine augmentation (2-minute frames, 0–70 min) — absent gallbladder filling despite biliary excretion, consistent with acute cholecystitisAcute Cholecystitis on HIDA Scan with Morphine Tc-99m HIDA with CCK infusion (LAO15, 4 min/frame) — gallbladder fills but GBEF = 22% at 59 min, consistent with biliary dyskinesiaLow Gallbladder Ejection Fraction on CCK HIDA Tc-99m HIDA scan (5–50 min and 4 hr) showing hepatic uptake with absent biliary excretion into bowel — pattern of biliary atresiaBiliary Atresia on Neonatal HIDA Scan Tc-99m RBC scan (ANT 60 min, sequential frames) — focal activity appearing in the right lower quadrant and migrating along the colon, indicating active GI hemorrhageActive Lower GI Bleed on Tagged RBC Scan
← Active Lower GI Bleed on Tagged RBC ScanPatient Preparation for a HIDA Scan →

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