Gilmour S M, Hershkop M, Reifen R, Gilday D, Roberts E A
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
J Nucl Med. 1997 Aug;38(8):1279-82.
To evaluate the diagnostic information gained from hepatobiliary scanning in infants, we reviewed 86 consecutive infants who were < or = 4 mo old and were treated for conjugated hyperbilirubinemia at the Hospital for Sick Children in Toronto between 1985 and 1993 and who had technetium iminodiacetic hepatobiliary scanning and a percutaneous liver biopsy performed in close temporal proximity.
Retrospective reviews of hospital charts and blinded reviews of hepatobiliary scans were performed.
There were 58 male and 28 female infants (age range, 2-124 days; mean = 65 days). Hepatobiliary scanning failed to show biliary excretion into the gastrointestinal tract in 53 of 86 patients. Forty of these 53 had extrahepatic biliary atresia. The remaining 33 patients demonstrated biliary excretion into the gastrointestinal tract; 24 of 33 had neonatal hepatitis. Among 13 of the 53 patients who had no evidence of biliary excretion and who also did not have extrahepatic biliary atresia, 8 had idiopathic neonatal hepatitis, 4 had interlobular bile duct paucity and 1 had total parenteral nutrition-associated cholestasis. In this large series, no patient with extrahepatic biliary atresia showed bile drainage on hepatobiliary scanning. Fifty percent of patients with interlobular bile duct paucity but no extrahepatic obstruction failed to show biliary excretion of radionuclide. Twenty-five percent of patients (8 of 32) with idiopathic neonatal hepatitis demonstrated no biliary excretion. Hepatocellular extraction was examined by semiquantitative analysis in the nondraining, nonbiliary atresia patients (12 of 53). Four of these 12 patients demonstrated poor liver extraction. Three patients had idiopathic neonatal hepatitis, and one had bile duct paucity. Therefore, four of eight neonatal hepatitis patients had normal extraction, suggesting that poor versus good liver hepatocyte clearance cannot accurately identify neonatal hepatitis.
Hepatobiliary scanning requires cautious interpretation. Nondraining scans may indicate severe neonatal hepatitis or the presence of interlobular bile duct paucity.
为评估从婴儿肝胆扫描中获得的诊断信息，我们回顾了1985年至1993年间在多伦多病童医院接受治疗的86例年龄小于或等于4个月且患有结合胆红素血症的连续婴儿，这些婴儿均进行了锝亚氨基二乙酸肝胆扫描并在相近时间内进行了经皮肝活检。
对医院病历进行回顾性分析，并对肝胆扫描进行盲法分析。
有58例男婴和28例女婴（年龄范围为2至124天；平均为65天）。86例患者中有53例肝胆扫描未显示胆汁排入胃肠道。这53例中的40例患有肝外胆道闭锁。其余33例患者显示胆汁排入胃肠道；33例中的24例患有新生儿肝炎。在53例无胆汁排泄证据且无肝外胆道闭锁的患者中，13例中有8例患有特发性新生儿肝炎，4例小叶间胆管稀少，1例患有全胃肠外营养相关性胆汁淤积。在这个大样本系列中，没有肝外胆道闭锁的患者在肝胆扫描中显示胆汁引流。小叶间胆管稀少但无肝外梗阻的患者中有50%未显示放射性核素的胆汁排泄。特发性新生儿肝炎患者中有25%（32例中的8例）未显示胆汁排泄。对无胆汁引流、无胆道闭锁的患者（53例中的12例）进行半定量分析以检查肝细胞摄取情况。这12例患者中有4例显示肝脏摄取不良。3例患有特发性新生儿肝炎，1例患有胆管稀少。因此，8例新生儿肝炎患者中有4例摄取正常，这表明肝脏肝细胞清除率差与好不能准确识别新生儿肝炎。
肝胆扫描需要谨慎解读。无胆汁引流的扫描可能提示严重的新生儿肝炎或小叶间胆管稀少的存在。
