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The significance of functioning gallbladder visualization on hepatobiliary scintigraphy in infants with persistent
1Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung, Taiwan, Republic of China.
Insights
Gallbladder visualization on hepatobiliary scintigraphy helps rule out biliary atresia in jaundiced infants. A visible, functioning gallbladder indicates biliary patency, improving diagnostic accuracy.
Area of Science:
- Pediatric Imaging
- Hepatobiliary System
- Diagnostic Nuclear Medicine
Background:
- Persistent jaundice in infants often necessitates differentiating biliary atresia from other causes.
- Hepatobiliary scintigraphy is a key diagnostic tool, but its accuracy in excluding biliary atresia can be enhanced.
Purpose of the Study:
- To evaluate the utility of gallbladder visualization during hepatobiliary scintigraphy for excluding biliary atresia in infants with persistent jaundice.
Main Methods:
- A study involving 152 infants with persistent jaundice (49 with biliary atresia, 103 with biliary patency) using hepatobiliary scintigraphy and abdominal sonography.
- Infants underwent imaging after fasting and administration of (99m)Tc-disofenin, with feeding protocols to assess gallbladder visualization and contractility.
Main Results:
- Gallbladder visualization was absent in all biliary atresia cases but present in 74% of infants with biliary patency via hepatobiliary scintigraphy.
- Abdominal sonography visualized the gallbladder in 63% of patent biliary cases.
- Including gallbladder visualization and bowel radioactivity increased specificity for excluding biliary atresia to 86%.
Conclusions:
- Gallbladder visibility on hepatobiliary scintigraphy is common in infants with biliary patency.
- A visualized and functioning gallbladder, with or without bowel radioactivity, reliably indicates biliary patency, aiding in the exclusion of biliary atresia.
Unlabelled:
The purpose of this study was to determine whether gallbladder visualization can help exclude biliary atresia in hepatobiliary scintigraphic studies of infants with persistent jaundice.
Methods:
One hundred fifty-two infants with persistent jaundice (49 patients with a final diagnosis of biliary atresia and 103 with biliary patency) were studied using both hepatobiliary scintigraphy and abdominal sonography. Food was withheld for 4 h before the examination, and the infants were fed nothing but glucose until 6 h after the initial injection of (99m)Tc-disofenin or until the gallbladder was seen. If the gallbladder was seen, the infants were fed milk, and imaging was continued to observe gallbladder contractility.
Results:
In none of the 49 patients with biliary atresia could the gallbladder be seen with hepatobiliary scintigraphy, but abdominal sonography revealed 9 normal-sized gallbladders. Of the 103 patients with biliary patency, hepatobiliary scintigraphy detected the gallbladder more frequently (74%, 76/103) than did abdominal sonography (63%, 65/103). All visualized gallbladders contracted after the infants were fed milk. If we include visualization of both the gallbladder and bowel radioactivity as criteria, the specificity of biliary atresia on hepatobiliary scintigraphy increases to 86% (89/103).
Conclusion:
Gallbladders were usually visible on hepatobiliary scintigraphy of fasting patients with biliary patency. A functioning gallbladder, with or without visualization of bowel radioactivity, indicated biliary patency.