Correction to: Role of hepatobiliary scintigraphy with different semi-quantitative parameters along with histopathological scoring in differentiating biliary atresia from neonatal hepatitis

Abstract Background Biliary atresia (BA) and neonatal hepatitis (NH) are the two major causes of neonatal cholestasis (NC). However, both conditions had entirely different therapeutic schedule and prognosis. Considering BA as a surgical emergency, it is pretty important to accurately differentiate the two entities. The aim of the study is to evaluate the diagnostic utility of hepatobiliary scintigraphy (HBS) using a semi-quantitative technique as well as 15-point histopathological scoring system in differentiating BA from NH. Results The sensitivity, specificity, and overall accuracy of HBS in the diagnosis of BA was 90.5%, 80%, and 83.6%, respectively. The median values of kidney-liver ratio (KLR), intestinal-liver ratio (ILR), and background-liver ratio (BLR) were significantly higher in patients with BA, while that of the liver-kidney ratio (LKR) was significantly lower in cases with BA. Moreover, KLR had the largest area under curve (AUC); advocates it to be the best of the semi-quantitative parameters that can predicts BA. Histopathological scoring using a cutoff point ≥ 7 was helpful in discriminating BA from NH with 85.7% sensitivity, 95% specificity and 91.8% accuracy. Conclusions HBS is a non-invasive diagnostic tool frequently used in diagnosis of BA, yet it has a relatively low specificity. To overcome this challenge, we kindly recommend the use of semi-quantitative parameters that could possibly improve the accuracy of HBS for diagnosing BA. Additionally, the use of 15-point scoring for liver biopsy was useful.

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The role of CK7, Ki-67, CD34 and vimentin in the differentiation between biliary atresia and idiopathic neonatal hepatitis in Egyptian cholestatic neonates

Apmis ◽

10.1111/j.1600-0463.2011.02859.x ◽

2012 ◽

Vol 120 (7) ◽

pp. 529-538 ◽

Cited By ~ 2

Author(s):

HAYAM ABDEL SAMIE AIAD ◽

MONA ABDEL HALIM KANDIL ◽

REHAB MONIR SAMAKA ◽

MERVAT MAHMOUD SULTAN ◽

MOHAMED TAWFIK BADR ◽

...

Keyword(s):

Biliary Atresia ◽

Neonatal Hepatitis ◽

Ki 67 ◽

Idiopathic Neonatal Hepatitis

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Role of Hepatobiliary Scintigraphy and Ultrasonography in the Diagnosis of Biliary Atresia in Infant with Neonatal Jaundice – Experiences in NINMAS

Bangladesh Journal of Nuclear Medicine ◽

10.3329/bjnm.v18i1.34935 ◽

2017 ◽

Vol 18 (1) ◽

pp. 51-53

Author(s):

Nasreen Sultana ◽

Zeenat Jabin ◽

Md Bashir ◽

Rahima Parveen ◽

Shamim MF Begum ◽

...

Keyword(s):

Retrospective Study ◽

Gall Bladder ◽

Biliary Atresia ◽

False Positive ◽

Hepatic Dysfunction ◽

Hepatobiliary Scintigraphy ◽

Hida Scan ◽

Complementary Role

Objective: The purpose of this study was to determine whether gall bladder visualization can help to exclude the biliary atresia in hepatobiliary scintigraphic studies of infants with persistent jaundice.Methods: This is a retrospective study carried out at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS). Study subjects include infants with neo-natal jaundice who underwent Hepatobiliary scintigraphies for suspected biliary atresia and study period was 2 years. Food was withheld for 4 hours before the examination. Anterior images of liver and gall bladder were taken after i/v administration of 2 -3 mci 99m Tc labeled Brida (HIDA) at 5 min interval for 2 hours then at 4 hours and 24 hours. Non-visualization of bowel activity in HIDA scan in 24hours delayed images was considered as cases of diagnosis of biliary atresia.Results: Thirty-six patients were included in this retrospective study. Patent biliary channels was seen by scintigraphies in 17(47%) patients and biliary atresia was seen in 19(52%) patients. By abdominal US non- visualization of gall bladder were found in 25(69%) cases and gall bladder visualized in 11(30%) cases. Eight (22%) of 36 patients had biopsy confirmed biliary atresia; all of these had positive scintigraphies and (60%) had positive sonographic findings. Among the 5 false-positive scintigraphies caused by hepatic dysfunction and 2 had normal sonography. Thirty-six patients had periscintigraphic sonography. There were 25/36 (61%) abnormal studies, which included cases with small gallbladder (n = 8) and non-visualized gallbladder (n = 17), but not periportal fibrosis.Conclusion: Gall bladder was usually visible on Hepatobiliary scintigraphy of fasting patients with biliary patency. Both hepatobiliary scintigraphy and sonography are currently the standard imaging investigations for suspected biliary atresia. The complementary role, in which scintigraphy and sonography are important, and recommend follow-up imaging reassessment before making definitive surgical decisions. This will serve to decrease the frequency of false-positive imaging diagnoses of biliary atresia, and hence, avoid unnecessary surgeries.Bangladesh J. Nuclear Med. 18(1): 51-53, January 2015

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Role of Hepatobiliary Scintigraphy and Preoperative Liver Biopsy for Exclusion of Biliary Atresia in Neonatal Cholestasis Syndrome

The Indian Journal of Pediatrics ◽

10.1007/s12098-017-2408-z ◽

2017 ◽

Vol 84 (9) ◽

pp. 685-690 ◽

Cited By ~ 4

Author(s):

Ankur Mandelia ◽

Richa Lal ◽

Nijagal Mutt

Keyword(s):

Liver Biopsy ◽

Biliary Atresia ◽

Hepatobiliary Scintigraphy ◽

Neonatal Cholestasis

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Aetio-Clinical Profile of Cholestatic Jaundice During Infancy- Study of 30 Cases in a Tertiary Care Hospital

Bangladesh Medical Journal ◽

10.3329/bmj.v41i2.18804 ◽

2014 ◽

Vol 41 (2) ◽

pp. 34-39

Author(s):

F Hamid ◽

A Afroza ◽

PC Ray

Keyword(s):

Liver Biopsy ◽

Biliary Atresia ◽

Tertiary Care ◽

Significant Proportion ◽

Clinical Profile ◽

Neonatal Hepatitis ◽

Hepatobiliary Scintigraphy ◽

Care Hospital ◽

Young Infants ◽

Significant Difference

Cholestasis in young infants has a varied etiology. There is considerable delay in presentation of cholestatic cases, both in India (average delay of 3 months in referral centers) and Bangladesh (3.5 months). Early diagnosis is important as the effects of cholestasis are profound and wide-spread. EHBA comprises a significant proportion of cases of cholestatic diseases. If treatment of EHBA is delayed beyond the first 90 days of life, the only option thereafter is liver transplantation, which is not presently feasible on a large scale in developing countries. So, the aim and objective of this study is to determine the cause and to categorize the clinical profile and treatment options of conjugated hyperbilirubinaemia in infancy. A total of 30 patients, who fulfilled inclusion and exclusion criteria were included. A detailed history and physical examination was done daily. Complete blood count, liver function tests, HBsAg and TORCH screening, thyroid function test, Urine was tested for non-glucose reducing substances. Ultrasonography of the hepatobiliary system and hepatobiliary scintigraphy was done. Liver biopsy was done in appropriate patients. Patients were followed up daily during hospital stay. The management and its response were also monitored and recorded. Out of 30 patients 24 (80%) were male and 6 (20%) were female. 63% were term and 37% were preterm. Out of 12 patients in BA, 11 were term and only 1 was preterm, whereas in NH group, out of 18 babies, 10 were preterm. Most of the patients were male in both studied groups. Mean value of birth weight in BA was 2.65±0.13 and in NH was 2.40±0.31. Mean age (days) at onset of jaundice in 2 groups were 3.92 ± 2.43 in BA and 6.5 ±4.5 in NH. Most patients of BA (91%) had persistent acholic stool, whereas in Neonatal hepatitis group 83% had intermittent acholic stool. No statistically significant difference was observed when hepatosplenomegaly and ALT values were considered in 2 studied groups. In BA group 33% & In NH group 72% babies had positivity for CMV infection. Normal ultrasonic findings were seen in 2 patients of BA group, and 7 in NH group. No patient had shown contracted gall bladder after meal in BA, Choledocal cyst was found to be responsible for 5 (42%) patients in BA group and none in NH group. HIDA showed 47% had biliary atresia, 43% neonatal hepatitis and 10.0% had normal liver. Liver biopsy revealed that 12 (40.0%) had biliary atresia and 18 (60.0%) had neonatal hepatitis. Out of 12 babies in Biliary atresia group almost all, 11(92%) received surgical management where as in Neonatal hepatitis group; all 18 babies (100%) received medical treatments. Early detection of cholectatic cases by observing stool colour is very important for physicians to direct the very specific investigations to find out the cause and start appropriate treatment immediately. DOI: http://dx.doi.org/10.3329/bmj.v41i2.18804 Bangladesh Medical Journal 2012 Vol. 41 No. 2: 34-39

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99mTc sestamibi imaging

Nuklearmedizin ◽

10.3413/nukmed-0205 ◽

2009 ◽

Vol 48 (03) ◽

pp. 100-103 ◽

Cited By ~ 1

Author(s):

H. R. Kianifar ◽

V. R. D. Kakhki ◽

R. Zakavi ◽

K. Ansari ◽

R. Sadeghi

Keyword(s):

Differential Diagnosis ◽

Biliary Atresia ◽

Neonatal Hepatitis ◽

Hepatobiliary Scintigraphy ◽

Neonatal Cholestasis ◽

Major Disadvantage ◽

99Mtc Mibi ◽

Diagnostic Work ◽

Mibi Scintigraphy ◽

99Mtc Sestamibi

Summary Aim: Hepatobiliary scintigraphy is an integral part in the diagnostic work-up of the neonatal cholestasis syndrome. However, less than optimal specificity is its major disadvantage. Differentiation between biliary atresia and neonatal hepatitis is nearly impossible in some cases with poor hepatocellular function. 99mTc sestamibi (MIBI) is a cationic lipophilic agent which is a substrate of P-glycoprotein. This glycoprotein is normally expressed in biliary canalicular surfaces of hepatocytes. This property provides a hepatic excretory mechanism which is different from bilirubin excretion. In this study we evaluated the value of 99mTc MIBI in differential diagnosis of neonatal cholestasis. Patients, methods: 20 infants with a mean age of 2.41 months (range, 0.1–5 months) were included in the study. Ten infants turned out to have extrahepatic biliary atresia and the other ten had neonatal hepatitis. Hepatobiliary (with 99mTc BrIDA) and 99mTc MIBI scintigraphy were performed for all the patients. Results: 99mTc MIBI scintigraphy has shown bowel activity in all patients, including the patients with biliary atresia. Hepatobiliary scintigraphy revealed bowel activity only in five patients with neo natal hepatitis. Conclusion: Bowel visualization with 99mTc MIBI may be seen in patients with biliary atresia and 99mTc MIBI has limited value in differential diagnosis of neonatal chole stasis.

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Efficacy of Cardiac Blood Pool Activity in Hepatobiliary Scintigraphy for Diagnosis of Neonatal Hepatitis in Patients with Suspected Biliary Atresia

Bangladesh Journal of Nuclear Medicine ◽

10.3329/bjnm.v20i2.37396 ◽

2018 ◽

Vol 20 (2) ◽

pp. 124

Author(s):

Noorjahan Khan ◽

Shamim MF Begum ◽

Pupree Mutsuddy ◽

Sadia Sultana

Keyword(s):

Biliary Atresia ◽

Success Rate ◽

Predictive Value ◽

Cardiac Activity ◽

Blood Pool ◽

Neonatal Hepatitis ◽

Hepatobiliary Scintigraphy ◽

Cardiac Blood ◽

Blood Pool Activity ◽

Cardiac Blood Pool

Background: Biliary atresia (BA) is the commonest fatal liver disorder in children. It results from developmental anomaly due to fibrosis of extra hepatic bile ducts. The reported global incidence of biliary atresia varies from 5/100,000 to 32/100,000 live births. Accurate diagnosis is important before 8 weeks of age, since hepatoportoenterostomy (Kasai’s procedure) has a 90% success rate at this stage whereas success rate drops to 20% beyond 3 months. On the other hand, neonatal hepatitis (NH) which is other most common cause of neonatal cholestasis (NC) needs conservative treatment. So, differentiation of biliary atresia from neonatal hepatitis is very crucial. Hepatobiliary scintigraphy (HBSG) is most popular method to differentiate biliary atresia from neonatal hepatitis. But in severe neonatal hepatitis the diagnosis become inconclusive when excretion of radiotracer in bowel become absent along with prolonged cardiac activity. Prolonged cardiac blood pool activity in hepatobiliary scintigraphy is an indication of hepatocyte destruction in neonatal hepatitis. The aim of the study was to assess the efficacy of cardiac blood pool in hepatobiliary scintigraphy for diagnosis of neonatal hepatitis in suspected biliary atresia patient.Patients and methods: A total of 24 infants with history of conjugated hyperbilirubinaemia underwent HBSG showed prompt cardiac blood pool activity (9 infants) and also with prolonged cardiac blood pool (15 infants) with no excretion of radiotracer in bowel either in early or delayed images was included in the study. The findings of HBSG were compared with percutaneous liver biopsy findings and analyzed.Result: Among 24 infants prolonged cardiac blood pool activity in HBSG was observed in 11 (73.3%) BA infants and 4 (44.4%) of NH infants. Absent bowel activity with prompt clearance of cardiac blood pool activity was observed in 4 (26.7%) BA infants and 5 (55.6%) NH infants. The difference was not statistically significant (p>0.05).The calculated sensitivity of cardiac blood pool activity in HBSG for evaluation of NH was 44.4%, specificity was 26.7%, accuracy was 33.3%, positive predictive value (PPV) was 26.7% and negative predictive value (NPV) was 44.4%. The sensitivity, specificity, PPV, NPV and accuracy were low due to large number of false positive infants which might be due to complete obstruction of bile duct or due to early hepatocyte destruction (within 3 months of age).Conclusion: Although prolonged cardiac blood pool activity was considered as diagnostic criteria for the diagnosis of NH in suspected BA patient but it could not be able to differentiate these two conditions.Bangladesh J. Nuclear Med. 20(2): 124-128, July 2017

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Hepatobiliary Scintigraphy with 99mTc-PIPIDA in the Evaluation of Neonatal Jaundice

PEDIATRICS ◽

10.1542/peds.67.1.140 ◽

1981 ◽

Vol 67 (1) ◽

pp. 140-145

Author(s):

Massoud Majd ◽

Richard C. Reba ◽

R. Peter Altman

Keyword(s):

Oral Administration ◽

Biliary Atresia ◽

Intrahepatic Cholestasis ◽

Neonatal Jaundice ◽

Intestinal Tract ◽

Iminodiacetic Acid ◽

Neonatal Hepatitis ◽

Hepatobiliary Scintigraphy ◽

Hepatic Extraction ◽

Technetium 99M

Hepatobiliary scintigraphy with technetium 99m-labeled p-isopropylacetanilido iminodiacetic acid (99mTc-PIPIDA) was used to evaluate 22 neonates with mixed jaundice. Ten patients were proved to have biliary atresia; ten others were diagnosed as having neonatal hepatitis. In the remaining two, jaundice was secondary to prolonged hyperalimentation. Initial studies in all ten patients with biliary atresia showed no evidence of excretion of the tracer into the intestinal tract. Following three to seven days of oral administration of phenobarbital, repeat studies were performed in six of the ten patients. None showed evidence of excretion. Initial studies of the 12 patients with intrahepatic cholestasis showed definite excretion in five, questionable evidence of excretion in two, and no demonstrable excretion in five. Studies after phenobarbital therapy in five of the seven patients with questionable or no excretion on the initial studies showed definite excretion in four. Only in one patient who had poor hepatic extraction did the phenobarbital therapy not change the scintigraphic pattern. The authors conclude that hepatobiliary scintigraphy with 99mTc-PIPIDA after three to seven days of phenobarbital therapy is a highly accurate test for differentiating biliary atresia from other causes of neonatal jaundice.

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Accuracy of hepatobiliary scintigraphy for differentiation of neonatal hepatitis from biliary atresia: systematic review and meta-analysis of the literature

Pediatric Radiology ◽

10.1007/s00247-013-2623-3 ◽

2013 ◽

Vol 43 (8) ◽

pp. 905-919 ◽

Cited By ~ 46

Author(s):

Hamid Reza Kianifar ◽

Shahrzad Tehranian ◽

Pardis Shojaei ◽

Zohreh Adinehpoor ◽

Ramin Sadeghi ◽

...

Keyword(s):

Systematic Review ◽

Biliary Atresia ◽

Meta Analysis ◽

Neonatal Hepatitis ◽

Hepatobiliary Scintigraphy

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Enterogastric Reflux: an Uncommon Diagnosis Analyzed by Hepatobiliary Imaging

Journal of Case Reports in Medicine ◽

10.25149/jcrm.v8i2.178 ◽

2019 ◽

Vol 8 (2) ◽

Author(s):

Peter Wang

Keyword(s):

Abdominal Pain ◽

Digestive Enzymes ◽

Gallbladder Disease ◽

Hepatobiliary Scintigraphy ◽

Hepatobiliary Imaging ◽

Upper Gi ◽

Gi Symptoms ◽

Upper Abdominal ◽

Enterogastric Reflux

Enterogastric reflux (EGR) is the reflux of bile and digestive enzymes from the small bowel into the stomach. While it is a normal physiologic process in small amounts, excessive reflux and chronic EGR can cause upper GI symptoms often mimicking more common diseases such as gallbladder disease and GERD that often leads to its underdiagnosis. Identifying EGR is significant as it has been associated with the development of gastroesophogeal pathology including gastritis, esophagitis, ulcers, and mucosal metaplasia. This article presents a 22-year-old male with enterogastric reflux causing upper abdominal pain and will discuss the role of hepatobiliary scintigraphy in its diagnosis.

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