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KMID : 1130320060490070737
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Korean Journal of Pediatrics
2006 Volume.49 No. 7 p.737 ~ p.744
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Diagnostic limitation and usefulness of 99mTc-DISIDA hepatobiliary scanning on neonatal cholestasis
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Kim Jung-Mi
Choe Byung-Ho
Jang You-Cheol
Oh Ki-Won
Cho Min-Hyun
Lee Kyung-Hee
Park Jin-Young
Kim Haeng-Mi
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Abstract
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Purpose: To assess the usefulness of (99m)Tc-DISIDA scanning in the early evaluation of neonatal cholestasis and to verify the diagnostic value of this test in the differential diagnosis of biliary atresia.
Methods: DISIDA scannings were performed and analyzed in 87 children(58 males and 29 females; age, 18-139 days, mean, 59.1 days) with neonatal cholestasis. Five groups according to the final diagnosis and the results of DISIDA scanning were analyzed by scatter plots using the parameters of age and the level of liver function tests(direct bilirubin, AST, ALT, ALP, GGT). The diagnostic sensitivity, specificity and accuracy of DISIDA scanning in the diagnosis of biliary atresia were compared between a higher bilirubin group and a lower bilirubin group(direct bilirubin level >5 mg/dL vs. <5 mg/dL) decided by the pattern of scatter plots.
Results: DISIDA scannings in the diagnosis of biliary atresia were analyzed by high sensitivity(100 percent, 16/16) but lower specificity(70.4 percent, 50/71) and accuracy(75.9 percent, 66/87). False positivity(29.6 percent, 21/71) was higher in patients with a higher direct bilirubin level(42.5 percent for >5 mg/dL vs. 9.7 percent for <5 mg/dL, P<0.01). The age and the level of liver function tests(AST, ALT, ALP, GGT) analyzed by scatter plots revealed neither diagnostic value in predicting final diagnosis nor estimated the accuracy rate of DISIDA scanning in the evaluation of neonatal cholestasis.
Conclusion: We suggest that DISIDA scannings should not be routinely used in evaluating neonatal cholestasis with elevated direct bilirubin level(>5 mg/dL), especially if it delays early diagnosis and surgical intervention.
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KEYWORD
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Cholestasis, Biliary atresia, Hepatitis, 99mTc-DISIDA, Diagnosis, Neonates
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