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Phenobarbital-enhanced hepatobiliary scintigraphy in the diagnosis of biliary atresia: two decades of experience at a tertiary center

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Abstract

Background

Hepatobiliary scintigraphy is highly sensitive for diagnosing biliary atresia; however, its specificity has varied in the literature from 35% to 97%.

Objective

The purpose of this study was to re-evaluate the accuracy of phenobarbital-enhanced hepatobiliary scintigraphy in differentiating biliary atresia from other causes of neonatal cholestasis.

Materials and methods

We retrospectively reviewed all hepatobiliary scans of infants with cholestasis at our institution from December 1990 to May 2011. Per our routine protocol the scans were obtained after pretreatment with phenobarbital (5 mg/kg/day for 5 days) to achieve a serum level of ≥15 mcg/ml. Normal hepatic uptake with no biliary excretion by 24 h was considered consistent with biliary atresia.

Results

One hundred eighty-six infants with 210 hepatobiliary scans composed the study group. Forty-three (23%) infants had the final diagnosis of biliary atresia. Hepatobiliary scintigraphy was 100% sensitive, 93% specific and 94.6% accurate in diagnosing biliary atresia. Of the 186, 39/111 (35.1%) term and 2/68 (2.9%) preterm infants had biliary atresia; two of seven children with unknown gestational age also had biliary atresia. Other diagnoses included neonatal hepatitis, total parenteral nutrition cholestasis, Alagille syndrome, cystic fibrosis, choledochal cyst, hypothyroidism, alpha-1 antitrypsin deficiency and persistent cholestasis of unknown etiology.

Conclusion

Phenobarbital-enhanced hepatobiliary scintigraphy is highly accurate in differentiating biliary atresia from other causes of neonatal cholestasis. Biliary atresia is rare in premature infants.

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Authors and Affiliations

  1. Division of Diagnostic Imaging and Radiology, Children’s National Medical Center, The George Washington University Medical Center, 111 Michigan Ave. NW, Washington, DC, 20010, USA

    Neha Kwatra, Eglal Shalaby-Rana, Srikala Narayanan & Massoud Majd

  2. Department of Gastroenterology, Hepatology and Nutrition, Children’s National Medical Center, Washington, DC, USA

    Parvathi Mohan

  3. Department of Pediatrics, Children’s National Medical Center, Washington, DC, USA

    Sunil Ghelani

Authors
  1. Neha Kwatra
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  2. Eglal Shalaby-Rana
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  3. Srikala Narayanan
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  4. Parvathi Mohan
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  5. Sunil Ghelani
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  6. Massoud Majd
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Corresponding author

Correspondence to Massoud Majd.

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Kwatra, N., Shalaby-Rana, E., Narayanan, S. et al. Phenobarbital-enhanced hepatobiliary scintigraphy in the diagnosis of biliary atresia: two decades of experience at a tertiary center. Pediatr Radiol 43, 1365–1375 (2013). https://doi.org/10.1007/s00247-013-2704-3

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  • DOI: https://doi.org/10.1007/s00247-013-2704-3

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