Hepatobiliary scintigraphy in persistent direct hyperbilirubinemia in the neonate

ABSTRACT

To present the value and usefulness of hepatobiliary scintigraphy in the investigation of infants with persistent hyperbilirubinemia through our experience in King Khaled University Hospital at King Saud University, Riyadh. King Khalid University Hospital, Departments of Nuclear Medicine, Pediatrics and Pediatric Surgery. Patients and methods: Seventy-seven patients aged between 5 days and 6 months [average 62 days], 43 females and 34 males, 65 Saudi and 12 non-Saudi were investigated. Laboratory tests, abdominal ultrasound, hepatobiliary scintigraphy. liver biopsy, explorative laparatomy and intraoperative cholangiography were performed whenever indicated. The findings on hepatobiliary scintigraphy of non-visualization of the gallbladder and no activity in the bowel up to 24 hours post injection [p.i] were considered consistent with the diagnosis of biliary atresia. Thirty four infants were diagnosed by hepatobiliary scintigraphy as having biliary atresia. Only 3 of the 34 were false positives as compared to liver biopsy results. Twenty-nine of the other 43 patients showed bowel activity sometime between 6 and 8 hours p.i. whereas the other 14 showed it at 24 hours p.i. Fourteen cases of the 19 with hepatitis showed decreased and delayed liver uptake in an irregular pattern. The other 5 cases of hepatitis showed good liver uptake similar to that seen in cases with biliary atresia. Hepatobiliary scintigraphy has become an essential part of the investigational work-up plan of infants with persistent hyperbilirubinemia before and after surgery because it is a simple and noninvasive technique