Hepatobiliary Scintigraphy with Technetium-99m Disofenin in the Evaluation of Neonatal Cholestasis

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Abstract
Summary To assess the reliability of technetium-99m disofenin scanning in evaluating neonatal cholestasis. 33 neonates (3 months of age) with direct hyperbilirubinemia were evaluated prospectively by cholescintigraphy. Results of this test were compared to those of standard serum tests of liver function, ultrasonography, and liver biopsy. The diagnosis of biliary atresia was suggested by a serum γ-glutamyl transpeptidase (γ-GTP) 300 units, absence of the gallbladder on ultrasonography, and a lack of delectable radioisotope in the gastrointestinal and or extrahepatic biliary tract on cholescintigraphy. Each of these tests lacked sensitivity and or specificity when compared to liver biopsy. Of the nine neonates with biliary atresia, three had gallbladders identified In ultrasonography and two had γ-GTP 300 units Of the 24 neonates without biliary atresia, eight had cholescintigraphy without detectable radioisotope excretion, four had ultrasonography that failed to visualize the gallbladder, and nine had γ-GTP 300 units. Cholescintigraphy excluded the diagnosis of biliary atresia when gut and or extrahepatic biliary excretion of isotope was seen. However, cholescintigraphy required more time. 6–8 days, and was less specific than ultrasonography and liver biopsy. We recommend that cholescintigraphy should not be routinely used in evaluating neonatal cholestasis, especially if it delays surgical intervention.