The Diagnostic Accuracy of Hepatobiliary Scintigraphy and Ultrasonography in Cholestatic Jaundice Infants

Abstract

Objective: Biliary atresia (BA) and neonatal hepatitis syndrome (NHS) are major causes of cholestatic jaundice, but the two conditions are symptomatically very similar and it is difficult for pediatricians to distinguish between them when making a diagnosis. The aim of this study was to compare the diagnostic accuracy of hepatobiliary scintigraphy (HS) with ultrasonography (US) in cholestatic jaundice infants to exclude biliary atresia. Material and Methods: Of 124 patients suffering from cholestatic jaundice from January 1996 to June 2007 were seen in Songklanagarind Hospital; 68 patients underwent HS and 70 patients underwent US. A laparotomy finding of either atretic common bile duct or gallbladder, or evidence of bile duct obstruction from intraoperative cholangiography, was considered as the final diagnosis of BA, and the results were compared. Results: Based on the operative noted above, 44 patients (54.3%) had BA. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of HS in the diagnosis of BA were 97.0%, 42.9%, 61.5%, and 93.75%, respectively. The overall accuracy of HS was 69.1%. The sensitivity, specificity, PPV and NPV of the US were 28.9%, 75.0%, 57.9%, and 47.1%, respectively. The overall accuracy of US evaluations was 50.0%. Conclusion: HS is an important imaging technique in the diagnostic evaluation of infants with cholestatic jaundice. It is a convenient and reliable method of differentiating BA from NHS, with a diagnostic accuracy superior to that of US.

Keywords

• biliary atresia
• cholestatic jaundice
• hepatobiliary scintigraphy
• infants
• ultrasound