Department of Nuclear Medicine, Aalborg University Hospital, Hobrovej 18-22, DK-9000 Aalborg, Aalborg, Denmark.
Hell J Nucl Med. 2021 May-Aug;24(2):108-113. doi: 10.1967/s002449912350. Epub 2021 Aug 6.
Hepatobiliary scintigraphy (HBS) is an important tool in diagnosing biliary atresia in infants. There is limited evidence on the use of single photon emission computed tomography/computed tomography (SPECT/CT) as an additional imaging method to planar imaging. We evaluated the value of SPECT/CT in unclear cases of planar HBS.
Consecutive patients with suspected biliary atresia who underwent guideline-compliant HBS from January 2010 until March 2020 were reviewed, and cases with SPECT/CT were identified. Each step within the imaging procedure (dynamic, static [early and late], and SPECT/CT) was blindly reread in consensus by two observers and categorized based on a 5-point scale: 0, definitely no bowel excretion (i.e., atresia confirmed); 1, probably positive; 2,equivocal; 3, probably negative; and 4, definite negative (i.e., atresia not confirmed). In this analysis, categories were dichotomized as negative for biliary atresia (scores 3-4) or positive (scores 0-2, including equivocal scans). Available follow-up information constituted the standard of truth (SoT).
Twenty-three infants had HBS, among which ten (4 boys and 6 girls; mean age 36 days; range 8-108) underwent SPECT/CT. Single photon emission computed tomography SPECT/CT was performed as early examination (<8h) in 3 subjects and late (8 to 24 h) in 7 infants. Reread SPECT/CT was categorized as positive for atresia in three infants and negative in seven infants. The SoT showed biliary atresia in one of ten patients. Single photon emission computed tomography/CT was true positive in one case, false positive in two, and true negative in seven. No false negative cases were noted. The diagnostic performance of SPECT/CT showed a sensitivity of 100%, specificity of 78%, positive predictive value (PPV) of 33%, negative predictive value (NPV) of 100%, and accuracy of 90%. For comparison, the diagnostic performance of planar HBS showed a sensitivity of 100%, specificity of 67%, PPV of 25%, NPV of 100%, and accuracy of 70%. In summary, the addition of SPECT/CT to planar HBS improved specificity andaccuracyand marginally improved PPV. Single photon emission computed tomography/CT provided more confidence in the final conclusion in 8/10 patients. In the remaining two cases, SPECT/CT did not improve the level of confidence (one remained equivocal, and one changed from probably no excretion to equivocal).
These preliminary data demonstrated increased accuracy of add-on SPECT to planar HBS predominantly due to improved specificity. This finding is consistent with the existing but limited literature and supports the recommendation of routine use of SPECT/CT or SPECT.
肝胆闪烁扫描（HBS）是诊断婴儿胆道闭锁的重要工具。关于单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）作为平面成像的附加成像方法的应用，证据有限。我们评估了 SPECT/CT 在平面 HBS 不明确病例中的价值。
回顾 2010 年 1 月至 2020 年 3 月期间，根据指南进行 HBS 检查的疑似胆道闭锁的连续患者，并确定进行 SPECT/CT 的病例。由两名观察者盲法共识重读成像过程的每个步骤（动态、静态[早期和晚期]和 SPECT/CT），并根据 5 分制进行分类：0，肯定无肠道排泄（即，闭锁确认）；1，可能阳性；2，不确定；3，可能阴性；4，明确阴性（即，闭锁未确认）。在本分析中，类别分为胆道闭锁阴性（评分 3-4）或阳性（评分 0-2，包括不确定扫描）。可用的随访信息构成了金标准（SoT）。
23 名婴儿进行了 HBS，其中 10 名（4 名男孩和 6 名女孩；平均年龄 36 天；范围 8-108）进行了 SPECT/CT。3 名患儿行早期（<8h）单光子发射计算机断层 SPECT/CT 检查，7 名患儿行晚期（8-24h）检查。重读 SPECT/CT 结果在 3 名患儿中归类为胆道闭锁阳性，在 7 名患儿中归类为阴性。SoT 显示 10 名患者中有 1 名患有胆道闭锁。SPECT/CT 的真阳性为 1 例，假阳性为 2 例，真阴性为 7 例。未发现假阴性病例。SPECT/CT 的诊断性能显示敏感性为 100%，特异性为 78%，阳性预测值（PPV）为 33%，阴性预测值（NPV）为 100%，准确性为 90%。相比之下，平面 HBS 的诊断性能显示敏感性为 100%，特异性为 67%，PPV 为 25%，NPV 为 100%，准确性为 70%。总的来说，SPECT/CT 的加入提高了平面 HBS 的特异性和准确性，并略微提高了 PPV。SPECT/CT 在 8/10 名患者的最终结论中提供了更多的信心。在其余 2 例中，SPECT/CT 并未提高信心水平（1 例仍为不确定，1 例从可能无排泄变为不确定）。
这些初步数据表明，由于特异性的提高，平面 HBS 加 SPECT 的准确性提高。这一发现与现有但有限的文献一致，并支持推荐常规使用 SPECT/CT 或 SPECT。
