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Cholescintigraphy with 99m-Tc labeled iminodiacetic acid (IDA) derivatives has proved to be extremely reliable in the evaluation of suspected acute cholecystitis. The major diagnostic feature of the study is the presence (cystic duct patency) or absence (cystic duct obstruction) of gallbladder visualization. Secondary findings include degree and rate of liver uptake, visualization and caliber of the intrahepatic and common bile ducts, and the presence of intestinal activity as well as rapidity of biliary tract-to-bowel transit of the radiotracer. Various combinations of these secondary parameters result in a spectrum of cholescintigraphic patterns which can assist in determining the cause of the patient's acute clinical problem.

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Technetium-99m iminodiacetic acid (IDA) cholescintigraphy was performed in 15 patients with acute acalculous cholecystitis. Fourteen of the 15 patients with acute disease had positive findings, indicating the presence of cystic duct or common duct obstruction. One case in which the gallbladder was visualized failed to respond to sincalide stimulation; this was classified as a suggestive finding of disease. The diagnostic accuracy of 99mTc-IDA cholescintigraphy was far superior to the other imaging studies used (8 sonograms, 1 intravenous cholangiogram, 3 oral cholecystograms, 1 percutaneous transhepatic cholangiogram). The 99mTc-IDA study is recommended as the imaging procedure of choice for examining patients with suspected acute acalculous cholecystitis.