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Outcome of hepatobiliary scanning in neonatal hepatitis syndrome
S M Gilmour1, M Hershkop, R Reifen
1Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Hepatobiliary scanning in infants with conjugated hyperbilirubinemia can be diagnostic. However, nondraining scans require careful interpretation, as they may indicate severe neonatal hepatitis or bile duct paucity.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Hepatology
Background:
- Conjugated hyperbilirubinemia in infants necessitates accurate diagnosis.
- Hepatobiliary scanning is a key imaging modality for evaluating infant cholestasis.
Purpose of the Study:
- To assess the diagnostic utility of hepatobiliary scanning in infants with conjugated hyperbilirubinemia.
- To correlate hepatobiliary scan findings with percutaneous liver biopsy results.
Main Methods:
- Retrospective review of 86 infants (<= 4 months old) with conjugated hyperbilirubinemia.
- Analysis of technetium iminodiacetic hepatobiliary scans and percutaneous liver biopsies.
- Blinded review of hepatobiliary scans and hospital charts.
Main Results:
- Hepatobiliary scanning failed to show biliary excretion in 53/86 infants; 40 had extrahepatic biliary atresia.
- Among infants without biliary excretion and no atresia, diagnoses included neonatal hepatitis and bile duct paucity.
- No patient with extrahepatic biliary atresia showed bile drainage; 50% with bile duct paucity and 25% with neonatal hepatitis had nondraining scans.
Conclusions:
- Hepatobiliary scanning provides valuable diagnostic information but requires cautious interpretation.
- Nondraining scans in infants with conjugated hyperbilirubinemia may suggest severe neonatal hepatitis or interlobular bile duct paucity.
- Hepatocellular extraction is not a reliable differentiator for neonatal hepatitis in nondraining scans.
Unlabelled:
To evaluate the diagnostic information gained from hepatobiliary scanning in infants, we reviewed 86 consecutive infants who were < or = 4 mo old and were treated for conjugated hyperbilirubinemia at the Hospital for Sick Children in Toronto between 1985 and 1993 and who had technetium iminodiacetic hepatobiliary scanning and a percutaneous liver biopsy performed in close temporal proximity.
Methods:
Retrospective reviews of hospital charts and blinded reviews of hepatobiliary scans were performed.
Results:
There were 58 male and 28 female infants (age range, 2-124 days; mean = 65 days). Hepatobiliary scanning failed to show biliary excretion into the gastrointestinal tract in 53 of 86 patients. Forty of these 53 had extrahepatic biliary atresia. The remaining 33 patients demonstrated biliary excretion into the gastrointestinal tract; 24 of 33 had neonatal hepatitis. Among 13 of the 53 patients who had no evidence of biliary excretion and who also did not have extrahepatic biliary atresia, 8 had idiopathic neonatal hepatitis, 4 had interlobular bile duct paucity and 1 had total parenteral nutrition-associated cholestasis. In this large series, no patient with extrahepatic biliary atresia showed bile drainage on hepatobiliary scanning. Fifty percent of patients with interlobular bile duct paucity but no extrahepatic obstruction failed to show biliary excretion of radionuclide. Twenty-five percent of patients (8 of 32) with idiopathic neonatal hepatitis demonstrated no biliary excretion. Hepatocellular extraction was examined by semiquantitative analysis in the nondraining, nonbiliary atresia patients (12 of 53). Four of these 12 patients demonstrated poor liver extraction. Three patients had idiopathic neonatal hepatitis, and one had bile duct paucity. Therefore, four of eight neonatal hepatitis patients had normal extraction, suggesting that poor versus good liver hepatocyte clearance cannot accurately identify neonatal hepatitis.
Conclusion:
Hepatobiliary scanning requires cautious interpretation. Nondraining scans may indicate severe neonatal hepatitis or the presence of interlobular bile duct paucity.