99mTC sestamibi imagingCan it be a useful substitute for hepatobiliary scintigraphy in infantile jaundice?

摘要

Aim: Hepatobiliary scintigraphy is an integral part in the diagnostic work-up of the neonatal cholestasis syndrome. However, less than optimal specificity is its major disadvantage. Differentiation between biliary atresia and neonatal hepatitis is nearly impossible in some cases with poor hepatocellular function. ~(99m)Tc sestamibi (MIBI) is a cationic lipophilic agent which is a substrate of P-glycoprotein. This glycoprotein is normally expressed in biliary canalicular surfaces of hepatocytes. This property provides a hepatic excretory mechanism which is different from bilirubin excretion. In this study we evaluated the value of ~(99m)Tc MIBI in differential diagnosis of neonatal cholestasis. Patients, methods: 20 infants with a mean age of 2.41 months (range, 0.1-5 months) were included in the study. Ten infants turned out to have extrahe-patic biliary atresia and the other ten had neonatal hepatitis. Hepatobiliary (with ~(99m)Tc BrIDA) and ~(99m)Tc MIBI scintigraphy were performed for all the patients. Results: ~(99m)Tc MIBI scintigraphy has shown bowel activity in all patients, including the patients with biliary atresia. Hepatobiliary scintigraphy revealed bowel activity only in five patients with neonatal hepatitis. Conclusion: Bowel visualization with ~(99m)Tc MIBI may be seen in patients with biliary atresia and ~(99m)Tc MIBI has limited value in differential diagnosis of neonatal cholestasis.