Accuracy of hepatobiliary scintigraphy for differentiation of neonatal hepatitis from biliary atresia: systematic review and meta-analysis of the literature

Abstract

Hepatobiliary scintigraphy is an important diagnostic modality for work-up of neonatal cholestasis. Therefore, our objective was to evaluate the literature regarding the accuracy of hepatobiliary scintigraphy in differentiating biliary atresia from non-biliary atresia causes of cholestasis (collectively called neonatal hepatitis). Our search included Medline, SCOPUS and Google Scholar. Only studies using Tc-99 m-labeled immunodiacetic acid (IDA) derivatives were included. Overall, 81 studies were included in the meta-analysis. Pooled sensitivity and specificity were 98.7% (range 98.1-99.2%) and 70.4% (range 68.5-72.2%), respectively. Factors that increased specificity included the use of radiotracers with high hepatic extraction, administration of hepatic-inducing drugs (such as phenobarbital), use of a calculated dose/kg and administration of a booster dose in cases of non-excretion of the tracer in the bowel. SPECT imaging and duodenal fluid sampling also had high specificity; however, they need further validation because of the low number of studies. Semiquantitative imaging methods do not seem to have any incremental value. We conclude that hepatobiliary scintigraphy using IDA derivatives can be very useful for diagnostic work-up of neonatal cholestasis. To improve the specificity, several measures can be followed regarding type and dose of the radiotracer and imaging protocols. Non-imaging methods seem to be promising and warrant further validation.

A screening algorithm for the efficient exclusion of biliary atresia in infants with cholestatic jaundice

“…This observation has been demonstrated in multiple prior reports [15,16], and well-summarized in a recent metaanalysis that yielded a pooled sensitivity of 98.7% (range 98.1-99.2%) and specificity of 70.4% (range 68.5-72.2%) of a nondraining HIDA scan for BA [17]. Premedication with a drug that augments hepatocyte function and bile flow (such as phenobarbital) may improve specificity by increasing the likelihood of drainage in patients with conditions such as neonatal hepatitis, but we did not see a significant effect from premedication in our study; further work is necessary to assess the utility of premedication for HIDA, as currently it represents the greatest contributor to diagnostic delay in the algorithm (median 5 days).…”

Shear wave elastography helps differentiate biliary atresia from other neonatal/infantile liver diseases

“…A recent large meta-analysis showed a pooled sensitivity of 98.7% and specificity of 70.4% for this imaging test in differentiating biliary atresia from neonatal hepatitis [17]. False- Fig.…”

“…Histological findings of biliary atresia include intrahepatic bile ductular proliferation, cholangiolar bile plugs, and liver fibrosis [17]. A study by Rastogi et al [18] showed that the sensitivity and specificity of percutaneous liver biopsy are both approximately 88%.…”

Biliary atresia: Where do we stand now?

“…However, in the background of elevated bilirubin levels and likely deranged liver function, ability to take up the agent may be compromised. To overcome this, cholegogues such as Ursodeoxy cholic acid, Phenobarbitone, Phenytoin are used as pre-treatment agents, to ensure adequate “priming”[53]. …”