Comparison of di-isopropyl iminodiacetic acid with methyl isobutyl isonitrile in the work-up of infants with prolonged jaundice

The study group comprised of 16 jaundiced children [mean age 3.16 months] with bilirubin levels of more than 8mg/dl. The clinical differential diagnosis included biliary atresia versus neonatal hepatitis. Informed consent was taken from all the parents. Parents were advised to omit the morning feed. All children were pretreated with phenobarbitone [5mg/ kg/day for 5 days] and imaged twice on two different days: first with Tc-99m-DISIDA and dose of 37MBq was injected intravenously. Liver images were obtained at 1, 2, 3 and 24 hours following injection. Then injection of Tc-99m-MIBI with a dose of 37MBq was injected intravenously. Anterior abdominal images with 350k counts were obtained at 10, 20, 30 and 40 minutes post injection and where appropriate delayed additional views were taken to optimize radionuclide intestinal transit. Two nuclear medicine physicians visually analyzed the scintigrams. On the basis of biliary-enteric kinetics the patients were subdivided into sub-groups: Group 1: Included 12 patients with no bowel activity with DISIDA scan but demonstrable bowel activity with MIBI liver scan with the appearance of central or peripheral abdominal activity. Group 2: Consisted of 4 patients with no bowel activity with both DISIDA and MIBI liver scans. Of the 4 patients 2 had biliary atresia confirmed at laparotomy whilst 2 children were lost to follow-up since the children had traveled from remote parts of the country