Value of hepatobiliary scintigraphy combined with total bile acid and γ-glutamyltransferase detection in etiological diagnosis of the persistent jaundice in infants

Abstract

Objective To investigate the value of hepatobiliary scintigraphy combined with total bile acid(TBA) and γ-glutamyltransferase(γ-GT) detection in the differential diagnosis of persistent jaundice induced by infantile hepatitis syndrome(IHS) and congenital extrahepatic biliary atresia(EHBA). Methods A retrospective analysis of 60 infants with persistent jaundice undertaking 99Tcm- diethylacetanilide iminodiacetic acid(EHIDA) hepatobiliary scintigraphy was done in Nanfang Hospital by single photon emission computed tomography(SPECT). Meanwhile, these infants' sera were collected and separately detected by AU5431 automatic biochemical assay; the sensitivity, specificity and accuracy of hepatobiliary scintigraphy with TBA and γ-GT were evaluated. Results The sensitivity to 99Tcm-EHIDA hepatobiliary scintigraphy in the diagnosis of IHS and EHBA were 100.00%(17/17 cases) and 67.57%(25/37 cases), the specificity was 67.57%(25/37 cases) and 100.00%(17/17 cases), and the accuracy was 77.78%(42/54 cases) and 77.78%(42/54 cases), respectively.The levels of TBA and γ-GT were higher in infants with EHBA than those with IHS(U=209.0, 19.5, all P<0.05), and ROC curve analysis indicated that TBA in the IHS group and γ-GT in EHBA group had some diagnostic value[area under curve(AUC)=0.736, 0.968, respectively].99Tcm-EHIDA hepatobiliary scintigraphy combined with TBA and γ-GT analysis suggested when intestinal non-radioactive imaging was shown, TBA was 98.5 μmol/L and γ-GT was 298 U/L, the sensitivity, specificity and accuracy of diagnosis of EHBA were 100.00.00%(17/17 cases), 100.00%(37/37 cases) and 100.00%(54/54 cases) in a serial test. Conclusions Hepatobiliary scintigraphy combined with TBA and γ-GT examination can effectively identify EHBA and IHS earlier, noninvasively and safely, which have important role in further treatment in infants with persistent jaundice. Key words: Hepatobiliary scintigraphy; Infantile hepatitis syndrome; Extrahepatic biliary atresia; Differential diagnosis