Article Abstract

A novel timesaving and semiquantitative method for radionuclide hepatobiliary scintigraphy for suspected biliary atresia

Authors: Hui Zhou, Junhong Li, Hailian Wei, Aifeng Li, Xiuping Wang, Xiaonan Zhang, Qiteng Lu, Siyuan Chen, Zhixiao Wei


Background: To optimize the performance of the hepatobiliary scintigraphy (HS) for suspected biliary atresia (BA) using a timesaving and semiquantitative method without a loss in diagnostic accuracy.
Methods: A retrospective analysis of 185 patients with persistent jaundice who underwent surgery were included. According to the surgical evaluation and pathological diagnosis, patients were divided into a BA group (99 cases) and an infant hepatitis syndrome (IHS) group (86 cases). 99mTc-labeled diethylacetanilide- iminodiacetic acid (99mTc-EHIDA) HS was performed before surgery. The average intestinal radioactivity uptake value minus the background average of radioactivity uptake value at 6 h after label injection (abbreviated as 6-h I-B) was calculated and the difference in 6-h I-B between the two groups was evaluated. The difference in diagnostic efficacy between 6-h I-B and the conventional 24-h HS in BA was also evaluated.
Results: A significant difference in 6-h I-B between the two groups was found (t=−5.975, P<0.001) and a high level of efficacy of 6-h I-B in the diagnosis of BA was detected. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 6-h I-B in the diagnosis of BA were 87.88%, 47.67%, 69.19%, 65.91%, and 77.36% respectively, while the corresponding parameters of the 24-h hepatobiliary imaging were 90.91%, 36.05%, 65.41%, 62.07%, and 77.50% respectively, with no significant difference between these values in the diagnosis of BA.
Conclusions: HS plays an important role in the diagnosis of infantile jaundice due to conjugated hyperbilirubinemia. The timesaving and semiquantitative method of the 6-h hepatobiliary static imaging showed the same high sensitivity and NPV of the conventional 24-h HS in preventing unnecessary surgery. In the setting of suspected BA, imaging resource utilization could be improved via reducing the acquisition time and simplifying the examination process. The 24-h delay in imaging was considered unnecessary because it was not significantly superior.