ROLE OF TC-99M DISIDA SCINTIGRAPHY IN INFANTS WITH SUSPECTED OF BILIARY ATRESIA: A 6-YEAR EXPERIENCE

Abstract

Hepatobiliary scintigraphy using Technetium-99m diisopropyl iminodiacetic acid(Tc-99m DISIDA scintigraphy) performed in 105 infants with predominantly con- jugated hyperbilirubinemia and suspected of biliary atresia(BA) were reviewed. Radio- nuclide hepatobiliary scintigraphy is well recognized as the only noninvasive diagnos- tic method to demonstrate the patency of biliary system. All patients had the Tc-99m DISIDA scintigraphy performed after 5 days of phenobarbital therapy. Of the 55 infants with no evidence of radiotracer excretion into the biliary and/or gastrointestinal (GI) tract up to 24 hours after injection, 47 had a final diagnosis as BA proven by surgery. Whereas the remaining 8 patients, 2 were diagnosed as biliary hypoplasia, 2 were diag- nosed as bile-plug syndrome, and 4 had a diagnosis as infectious neonatal hepatitis(NH). All of these were proven by laparotomy with intraoperative cholangiography and fol- low up clinical course. The remaining 50 patients demonstrated definite excretion of the radiotracer into the GI tract, thus entirely excluded the diagnosis of BA. Of these, 22 had a final diagnosis as idiopathic NH, 19 were diagnosed as infectious NH, and 9 had a diagnosis as having cholestatic jaundice of unknown cause. In our series, we found that the sensitivity, specificity and accuracy of Tc-99m DISIDA scintigraphy for the diagnosis of BA were 100%, 86% and 92%, respectively. The positive and negative predictive value were 85% and 100%. The results of our study indicate that Tc-99m DISIDA scintigraphy is a sensitive and highly accurate method in the diagnosis of BA. Therefore, it is highly recommended as a routine screening investigation of choice in evaluating infants with suspected of BA.