The role of hepato-biliary scintigraphy in Differentiation of Bilary atresia from other causes of neonatal Jaundice

Goal: The goal of this study was to assess the diagnostic value of hepatobiliary scin¬tigraphy using a 99mTc-MBrIDA compound to differentiate intrahepatic cholestasis from extra hepatic forms during the first months of life. Material and methods: Dynamic hepatobiliary scintigraphy was done in 12 neonate patients with extremely elevated values of total and direct bilirubinemia. After intravenously administration of 37 MBq 99mTc-MBrIDA, static images were carried out every 5 minutes during the normal pre¬defined study and further controls images in cases with absence of radioactivity in extra hepatic ducts and bowel were performed af¬ter 1, 3, 24, 48 and 72 hour. Three neonates with suspected bilary atresia, before re- peated scintigraphy were premedicated with cholecystokinin, 20ng/kg, intravenously during the three consecutive days. Results: Extremely high value of total (>200^imol/L) and direct bilirubinemia were registered at all 12 neonates (>100 ^mol/L) and gamma glytamyl transpeptidase GGT (>100 U/l.). All neonates were suspected for biliary atresia. During the normal predefined hepatobili¬ary scintigraphy, the radioactivity in extra hepatic biliary ducts and small bowel was noticed in one patient, whereas the absence of radioactivity in bowel and extra hepatic ducts were noticed in 11 patients). Eight patients of them were confirmed to be neonatal hepatitis because the minimal radioactivity in bowel were registered after 1 hour (one patient), 3 hours (3 patients) and 24 hour (two patients), whereas in three other patients the radioactivity in bowel were absence even after 24, 48 and after 72 hours. Three registered cases with absence of radioactivity in bowel even up 72 hours were suspected for biliary atresia. In repeated scintigraphy after premedication with CCK, we noticed intestinal activity in one patient, whereas in other two cases the intestinal radioactivity was absent even after 72 hours. One of them was confirmed as intrahepatic biliary atresia, while another patient was confirmed as extra hepatic biliary atresia. conclusion: Biliary scin- tigraphy represents a straightforward and non-invasive diagnostic method which enables the permeability of the biliary tract to be assessed in subjects with jaundice.