The Significance Of Shortening The Time Used In Nuclide Hepatobiliary Imaging And The Imaging Combinated With Serum γ-GT And5’-NT In The Diagnosis Of Biliary Atresia

Objective：To investigate the clinical application value of99mTc-EHIDA hepatobiliarydynamic imagining combined serum glutamyl transpeptidase (γ-GT) and5’–nucleotidase (5’-NT) in children and differential diagnosis of congenital biliaryatresia (BA) and infantile hepatitis syndrome (IHS).Methods：Retrospectively analyze the cases from June,2010to January,2013concerning197infantile patients (male121, female76) who were hospitalized in the Children’shospital of Jiangxi Province for the first time. All the patients were aged from3to205day（s63.9d for the mean age）and underwent the admeasurements of serum γ-GTand5’-NT as soon as they were admitted to hospital. Select30cases of normal andhealthy children without hepatobiliary disease, aged from3to79days as the controlgroup, which also received the admeasurements of serum γ-GT and5’-NT. Afterinternal standardization treatment for7-10days, all the patients, excluding those whosuffered from congenital genetic metabolic disease, sepsis, common bile duct cyst, etc,underwent99mTc-EHIDA nuclide hepatobiliary dynamic imaging. Among them,86jaundiced patients (male60, female26) recovered completely or got better. Theywere finally diagnosed with IHS according to the clinic results and follow-up visits.The other111patients (male61, female50) remained jaundiced or got worse, amongwhom84patients were subsequently sent to the surgical department where theyreceived laparoscopic biliary imaging and (or) liver biopsy, which turned out to be80BA and4IHS; the other27patients gave up surgical treatment or were transmitted toother hospital for various reasons, who were proved to have suffered from BAthrough clinical diagnosis (communication, etc.). Respectively draw the ROC curvesof the patient’s hepatobiliary imaging with1h,6h and24h, and then compare theirAUC. Analyze the efficiency (sensitivity, specificity, accuracy, positive predictivevalue and negative predictive value) of the nuclide hepatobiliary dynamic imaging indiagnoses of BA and HIS within6hours and24hours and compare the imaging diagnostic efficiency within two different time periods. According to BA, IHS, theadmeasurements of serum γ-GT and5’-NT of the normal control group, we canobtain γ-GT and5’-NT and the diagnose receiver operating characteristic (ROC)curve through software SPASS, make the maximum Youden index (sensitivity+specificity-1) of both diagnostic ways as the optimal diagnostic cut-off point (thecriteria) and analyze the efficiency of the two diagnostic ways in diagnosis of BA.Evaluate the clinical application value of time-shortened nuclide hepatobiliaryimaging connected with the admeasurements of serum γ-GT and5’-NT in thediagnosis of BA.Results：1. The AUC of the patient’s hepatobiliary imaging were separately0.696,0.829and0.779. By comparing the AUC of the imaging within1h and6h, it proved that pwas less than0.05(z=2.66),while it proved that p was more than0.05(z=0.434) bycomparing the AUC of the imaging within6h and24h.2、The sensitivity, specificity, accuracy, positive predictive value and negativepredictive value of the nuclide hepatobiliary imaging within24hours in diagnoses ofBA and IHS were89.72%,78.89%,84.77%,83.48%,86.59%and78.89%,89.72%,84.77%,86.59%,83.48%. The sensitivity, specificity, accuracy, positive predictivevalue and negative predictive value of the nuclide hepatobiliary imaging within6hours in diagnoses of BA and IHS were90.65%,74.44%,83.25%,80.83%,87.01%and72.04%,90.65%,83.25%,87.01%,80.83%. There was no obvious difference(p>0.05) between the diagnostic efficiency of the two different kinds of nuclideimaging time.3、Serum γ-GT of the control group, BA group and IHS group were separately14.7000±4.24386IU／L,561.0374±353.41245IU／L and230.6556±173.00121IU／L. By comparing any two groups, there was obvious difference (p＜0.05);5’-NT ofeach group were4.1000±1.32222U／L,32.3925±31.13202U／L and13.7000±11.42386U／L. By comparing any two groups, there was obvious difference (p＜0.05).4、The areas of γ-GT and5’-NT under AUCROC(p＜0.70) equals0.833and0.77, showing both had better diagnostic value for BA. According to the analysis of SPASSsoftware ROC curve, it’s obtained that maximum Youden index of serum γ–GT and5’-NT were respectively325IU/L and16U/L. With γ-GT≥325IU/L as the criteriafor the diagnosis of BA, the sensitivity, specificity, accuracy, positive predictivevalue and negative predictive value were70.1%,80%,74.62%,80.65%, and63.16%.With5’-NT≥16U/L as the criteria for the diagnosis of BA, the sensitivity, specificity,accuracy, positive predictive value and negative predictive value were61.68%,76.67%,68.53%,78.56%and62.73%. The comparison was no significant difference(p>0.05).5、Compared the BA diagnostic efficiency of6h nuclide hepatobiliary imagingand the admeasurements of serum γ-GT and5’-NT, there was obvious difference insensitivity, accuracy and negative predictive value (p<0.05); while there was noobvious difference in specificity and positive predictive value (p>0.05).6、Among the90cases of BA confirmed by nuclide hepatobiliary imaging, therewere23cases which did not in accordance with pathological and clinical follow-upresults, so the false positive rate in imaging was25.56%(23/90), the nuclidehepatobiliary imaging within6hours in diagnoses of BA were74.44%and83.25%.Connected with the admeasurements of serum γ–GT, the specificity and accuracywere increased to93.33%and91.88%. There was obvious difference (P＜0.05).Connected with the admeasurements of serum5’-NT, the specificity and accuracywere increased to92.22%and91.37%. There was obvious difference (P＜0.05).Connected the6h nuclide hepatobiliary imaging with the admeasurements of serum γ–GT and5’-NT the specificity and accuracy were increased to94.44%and92.39%,There was obvious difference（P＜0.05）.Conclusion：In order to reduce the checking time for the children patients,6h nuclidehepatobiliary imaging can be a replacement for24h delayed nuclide hepatobiliaryimaging.In the diagnosis of BA, the efficacy of6h nuclide hepatobiliary imaging issuperior to the admeasurements of serum γ-GT or5’-NT. Nuclide hepatobiliary imaging is the important preferable index. The combination of6h nuclidehepatobiliary imaging and serum γ-GT and5’-NT, which has important joint clinicvalue, can notably drop the false positive rate in the diagnosis of BA and increase thespecificity and accuracy.