Hepatobiliary Scintigraphy as an Diagnostic Tool in the Evaluation and Differentiation of Biliary Atresia from Neonatal Hepatitis

Abstract

This study aims to evaluate the role of hepatobiliary scintigraphy in diagnosing biliary atresia, neonatal hepatitis, and idiopathic cholestasis. 99mTc-labeled iminodiacetic acid (IDA) derivatives are a radiopharmaceutical that provides not only morphological and functional information of the liver, but also assesses the degree of obstruction in the bile ducts of biliary tract and gallbladder obstruction. Analyses also included measurement of gallbladder ejection fraction (GBEF), and in selected cases pharmacological interventions with phenobarbital and ursodeoxycholic acid were used to increase diagnostic specificity. A retrospective analysis was performed on 50 cases referred from January 2010 to February 2017. Of the total 50 cases analyzed (41 newborns and 9 children aged 4.5 months to 3 years), 34 infants (68%) had neonatal cholestasis secondary to neonatal hepatitis. 7 infants (14%) were diagnosed with biliary atresia, and 9 pediatric cases (18%) had normal scintigraphy results. Normal GBEF values (>35%) were identified in 35 cases (70%), while in 8 cases (16%) GBEF was intermediate (22-34%). This method offers high sensitivity for detecting hepatobiliary tract disorders. When combined with pretreatment with phenobarbital and ursodeoxycholic acid, it significantly increases the specificity of the diagnosis in differentiating neonatal hepatitis from biliary atresia.