The Value Of Hepatobiliary Section Imaging To The Diagnosis And Differential Diagnosis Of BA And IHS

Objective: The identification of radioactivity transited into the bowl of ^99MTc-EHIDA hepatobiliary section imaging was investigated to IHS, especially to those with serious cholestasis. By comparative study with ultrasonography and laboratory examination results, we further evaluated the value of combined hepatobiliary dynamic imaging, including planar and section imaging, to the diagnosis and differential diagnosis of BA and IHS.Materials and Methods: Complete clinic information, imaging studies and laboratory examination data were collected as the study protocol for retrospective study. With all results of the examinations, intraoperative cholangiography, bile duct drain, pathological results and clinical follow-up after regular treatment, a total of 78 persistent jaundiced patients were identified from January 2005 to October 2006. With the final diagnosis, the study cohort included BA (n=15: male 11, female 4); IHS (n=63: male 36, female 27).the mean age on admission was 58d and 60d respectively. All the examinations were taken after admission of the first time. All infants accepted ^99mTc-EHIDA routine hepatobiliary dynamic imaging, focusing on the presentation of functional gallbladder and/or radioactivity excreted into the gastrointestinal tract. 23 patients who showed no definite intestinal radioactivity or with body surface radioactivity pollution accepted 6～8h hepatobiliary section imaging and 24h delay imaging. All patterns were evaluated visually and diagnosed by more than two experienced nuclear medicine physicians. On ultrasonic examinations, it is focused on the visualization of the triangular cord sign and assessment of gallbladder length and its contraction. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of routine hepatobiliary imaging were calculated to BA and IHS. The influencing factors like age of referral and CMV infection were also analyzed in great details. The potential of the intestinal radioactivity presentation and body pollution exclusion were evaluated of 6～8h hepatobiliary section imaging .And the contrast analysis of diagnostic value to BA and IHS was also made with 24h delayed hepatobiliary planar imaging, ultrasonography and laboratory examination index. So the value of combined hepatobiliary dynamic imaging to the diagnosis and differential diagnosis of BA and IHS was further evaluated. Results:1 , The diagnostic sensitivity, specificity of hepatobiliary dynamic planar imaging to BA and IHS were 86.67%, 69.84%and 69.84%, 86.67%. Functional gallbladder imaging and/or definite gastrointestinal radioactivity were observed in 27(<59d, 81.82%) and 18(≥60d, 56.67%) patients with IHS respectively in its series, x²=4.02, p<0.05. The difference is of statistical significance. To the patients younger than 59d, the diagnostic value of routine hepatobiliary scintigraphy to CMV infection group is much lower than that without CMV infection. When referring to patients older than 60d, no statistical signifiance was found. 2, With the help of 6～8h hepatobiliary section imaging, the diagnostic specificity to BA and sensitivity to IHS improved from 63.49% to 87.30%, the differential diagnosis accuracy improved from 67.95% to 88.46%. And 71.43% patients with body surface radiopharmaceutical pollution got definitely diagnosed.3, In combination with 6～8h hepatobiliary section imaging, the diagnostic sensitivity,specificity,accuracy, positive predictive value, negative predictive value of hepatobiliary imaging to BA and IHS were93.33%, 87.30%, 88.46%, 63.64%, 98.21% and 87.30%, 93.33%, 88.46%, 98.21%, 63.64% respectively. whereas they were 60.00%, 73.02%, 70.51%, 33.33%, 90.20% and 73.02%, 60.00%, 70.51%, 90.20%, 33.33% of ultrasonography.4, The difference of (?)-GT between group BA (367.15±469.63 IU/L) and group IHS (578.59±236.95 IU/L) was significant, with p equals 0.03. The sensitivity,specificity,accuracy to the diagnosis of BA and IHS were 81.82%, 67.21%, 69.44% and 67.21%, 81.82%, 69.44% when (?)-GT≥300IU/L was served as the criteria. what is more, it was found that the difference of (?)-GT was much significant to those younger than 59d, with the sensitivity,specificity,accuracy reached up to 87.50%, 81.25%, 82.50% and 81.25%, 87.50%, 82.50%. If 7-GT was considered for the differential diagnosis of the 11 patients who showed non-visualization of functional gallbladder and radioactivity transited into the tract, the combined diagnostic sensitivity,specificity,accuracy to BA and IHS were 87.50%, 93.94%, 95.12% and 93.94%, 87.50%, 95.12%. The difference of 7-GT between BA and IHS (older than 60d) was of non statistic significance. Conclusion:1, Delay of referral and infection with CMV are two principal factors influencing the early diagnosis of BA and IHS by hepatobiliary dynamic planar imaging. Among multitude etiological factors, CMV infection tends to cause cholestasis and difficulty in definite diagnosis on planar imaging.2, 6～8h hepatobiliary section imaging has improved the diagnostic value of BA and IHS significantly, particularly depending on the great potential to show the intestinal radioactivity presentation and to exclude the influence of body surface radiopharmaceutical pollution or excess radioactivity distribution in abdominal organs. Its diagnostic value to BA and IHS is much higher than 24h delayed imaging.3, With the help of 6 ～ 8h hepatobiliary section imaging, the diagnostic sensitivity,specialty,accuracy of combined hepatobiliary dynamic imaging were much higher than ultrasonography and (?)-GT. And the combined hepatobiliary dynamic imaging can be served as the best screening means.4, There is combined application value of hepatobiliary imaging and 7-GT to the diagnosis and differential diagnosis of BA and IHS younger than 59d.