The Diagnostic Value Of Modified Hepatobiliary Imaging Combined With Liver Biochemical Index For Congenital Biliary Atresia

Objective:To evaluate the diagnostic value of modified radionuclide^99mTc-diethyl iminodiaceticacid（EHIDA）hepatobiliary dynamic imaging at 6 h combined with biochemical indexes of liver function in infants with congenital biliary atresia（CBA）.Methods:A retrospective analysis of 159 children with persistent jaundice,All the children were treated with surgical treatment.Before operation,Sixteen biochemical indexes of liver function of each child were measured and radionuclide^99mTc-EHIDAhepatobiliarydynamicimagingwas performed.There were 98 males and 61 females,with an average age of 69d.According to surgical evaluation and pathological diagnosis,they were divided into group CBA（82 cases）and infant hepatitis syndrome（IHS）group（77 cases）.To compare the difference of biochemical indexes in liver function between the two groups,the receiver operating characteristic curves were drawn for those with different contents,and the diagnostic threshold was determined for those with better diagnostic value of CBA.The comparison of pass rate determined the biochemical index of liver function with high diagnostic efficacy（assumed to be A）.At the same time,hepatobiliary dynamic imaging at 1 h or 2 h or 6 h,routine hepatobiliary dynamic imaging at 24 h,A content and hepatobiliary dynamic scintigraphy at 6 h combined A（combined diagnosis）were compared to the diagnostic efficacy of CBA.T test and chi square test were used to analyze the data.Results:Among the 16 biochemical indexes of liver function,there was no significant difference in the content of total bilirubin（TBIL）,direct bilirubin（DBIL）,indirect bilirubin（IBIL）,direct/total bilirubin ratio（DB/TB）,aspartate aminotransferase（AST）,alanine aminotransferase（ALT）,aspartate/alanine ratio（AST/ALT）,alkaline phosphatase（ALP）,prealbumin（PA）,cholinesterase（CHE）between the two groups（all P>0.05）.There were significant differences in the content of total protein（TPN）,albumin（ALB）,globulin（GLOA）,albumin/globulin（A/G）,glutamyl transpeptidase（GGT）,total bile acid（TBA）between the two groups（all P<0.05）,and the value of GGT、TP in the diagnosis of CBA was better than others in the area under the ROC curve（ROC AUC respectively were 0.895,0.727）.the sensitivity,specificity,accuracy and positive predictive value and negative predictive value of Serum GGT in the diagnosis for CBA were 74.39%（61/82）,90.91%（70/77）,82.39%（131/159）,89.71%（61/68）,76.92%（70/91）;the corresponding parameters of serum TP were 80.49%（66/82）,63.64%（49/77）,72.33%（115/159）,70.21%（66/94）,66.15%（49/65）;those of hepatobiliary scintigraphy at 6 h were 91.46%（75/82）,31.17%（24/77）,62.26%（99/159）,58.59%（75/128）,77.42%（24/31）;the conventional hepatobiliary scintigraphy at 24 h parameter were 84.15%（69/82）,38.96%（30/77）62.26%,（99/159）,59.48%（69/116）,69.77%（30/43）.Compared with the diagnostic efficiency of GGT and TP for CBA,the specificity,accuracy and positive predictive value of GGT for CBA diagnosis were higher than those of TP（all P<0.05）.There was no difference in sensitivity and negative predictive value between them（all P>0.05）.There was no significant difference in sensitivity,specificity,accuracy,positive predictive value and negative predictive value between hepatobiliary dynamic scintigraphy at 6 h and conventional hepatobiliary dynamic scintigraphy at 24 h for CBA diagnosis（all P>0.05）.Comparison hepatobiliary imaging at 6 h and GGT in the diagnosis of CBA,the sensitivity of hepatobiliary scintigraphy at 6 h is better than that of GGT（P=0.004）,but the specificity,accuracy and positive predictive value are lower than the content of GGT（all P=0.000）,There is no statistical difference in negative predictive value between them（P=0.955）.Combined diagnosis compared to the single use of hepatobiliary dynamic imaging at 6 h in the diagnosis of CBA,specificity,accuracy and positive predictive value increased（all P=0.000）,which reached 93.51%（72/77）,92.45%（147/159）and93.75%（75/80）,respectively.Conclusions:In the sixteen biochemical indexes of routine liver function,serum GGT has a higher diagnostic efficiency for CBA and has a certain auxiliary diagnostic significance.Modified hepatobiliary dynamic imaging at 6h can replace conventional hepatobiliary scintigraphy at 24 h.It can not only maintain good diagnostic efficiency for CBA,but also win time for early diagnosis and treatment of CBA,which is worth promoting.The specificity,accuracy and positive predictive value of the combined diagnosis of CBA are improved,and it has important clinical diagnostic value,it is worth further study.