Comparison of Tc-99m DISIDA Hepatobiliary Scintigraphy and Percutaneous Needle Biopsy in the Diagnosis of Biliary Atresia from Intrahepatic Cholestasis

ABSTRACT

We retrospectively evaluated the utility of Tc-99m DISIDA hepatobiliary scintigraphy and percutaneous needle biopsy in differentiating biliary atresia from intraheaptic cholestasis in 60 consecutive infants. Twenty three patients proved to have biliary atresia and remaining 37 patients had intraheaptic cholestasis such as neonatal heaptitis (34 patients), TPN induced jaundice (2 patients) and Dubin-Johnson syndrome (1 patient). All sixty patients underwent Tc-99m DISIDA hepatobiliary scintigraphy with phenobarbital pretreatment. Of 23 patients with biliary atresia, 22 were correctly interpreted showing 96% sensitivity while of 37 patients with intraheaptic cholestasis, only 12 had intestinal excretion of radionuclide showing 32% specificity. Forty needle biopsies were carried out in 17 patients with biliary atresia and 23 patients with intraheaptic cholestasis. Of 40 biopses, 37 were correctly interpreted as either having biliary atresia or intrahepatic cholestasis showing overall diagnostic accuracy of 93%. Of 3 misdiagnostic cases, the histologic findings of two patients with biliary atresia (aged 43 days and 54 days at the first needle biopsy) essentially were the same as those of neonatal heaptitis but follow-up biopsies showed the findings consistent with biliary atresia. The histologic findings of the 3rd patient (VLBW premie with history of 8 weeks TPN) showed mild ductal proliferation and portal fibrosis being interpreted suspicious biliary atresia, but jaundice resolved gradually. In short, the patients who have intestinal excretion of radionuclide on Tc-99m DISIDA hepatobiliary scintigraphy, biliary atresia can be ruled out. But the patients who do not have intestinal excretion of radionuclide should have further investigation as needle biopsy because of high degree of accuracy of percutaneous needle biopsies in differentiating biliary atresia from intrahepatic cholestasis. We conclude that judicious use of a combination of Tc-99m DISIDA hepatobiliary scintigraphy and percutaneous needle biopsy gives correct diagnosis in 95% or more of infantile cholestasis.