Luljeta Z Abdullahu¹*, Ismet Bajrami¹*, Bujar Gjikolli², Basri Z Lenjani³, Vjollca I Dedushaj Fazliu⁴, Fitore Murati⁵ and Mustafë Buzoku²

¹Clinical Service of Nuclear Medicine University Clinical Centre of Kosovo, Republic of Kosovo
²Clinical of Radiology, University Clinical Centre of Kosovo, Republic of Kosovo
³Emergency Clinic, University Clinical Centre of Kosovo, Republic of Kosovo
⁴Interne Medicine and Master of Nuclear Medicine Et Private Heal Care, Republic of Kosovo
⁴Department of Physiotherapeutic, University Clinical Centre of Kosovo, Republic of Kosovo

*Corresponding Author: Luljeta Z Abdullahu and Ismet Bajrami, Clinical Service of Nuclear Medicine University Clinical Centre of Kosovo, Republic of Kosovo..

Received: December 03, 2024; Published: December 23, 2024

Abstract

Purpose: This study aims to evaluate the role of hepatobiliary scintigraphy in diagnosing biliary atresia, neonatal hepatitis, and idiopathic cholestasis.

Methodology: 99mTc-labeled iminodiacetic acid (IDA) derivatives are a radiopharmaceutical that provides not only morphological and functional information of the liver, but also assesses the degree of obstruction in the bile ducts of biliary tract and gallbladder obstruction. Analyses also included measurement of gallbladder ejection fraction (GBEF), and in selected cases pharmacological interventions with phenobarbital and ursodeoxycholic acid were used to increase diagnostic specificity.

Results: A retrospective analysis was performed on 50 cases referred from January 2010 to February 2017. Of the total 50 cases analyzed (41 newborns and 9 children aged 4.5 months to 3 years), 34 infants (68%) had neonatal cholestasis secondary to neonatal hepatitis. 7 infants (14%) were diagnosed with biliary atresia, and 9 pediatric cases (18%) had normal scintigraphy results. Normal GBEF values (>35%) were identified in 35 cases (70%), while in 8 cases (16%) GBEF was intermediate (22-34%).

Discussion: This method offers high sensitivity for detecting hepatobiliary tract disorders. When combined with pretreatment with phenobarbital and ursodeoxycholic acid, it significantly increases the specificity of the diagnosis in differentiating neonatal hepatitis from biliary atresia.

 Keywords: Hepatobiliary Scintigraphy; 99mTc-HIDA; Neonatal Cholestasis; Biliary Atresia; Phenobarbitone; Ursodeoxycholic Acid

References

1. Bailey J and Harewood L. “Hepatobiliary Scintigraphy: Advances and Clinical Utility”. Journal of Nuclear Medicine8 (2013): 1235-1245.
2. Code: LB20.21 Foundation.
3. Poddar U., et al. “Neonatal cholestasis: differentiation of biliary atresia from neonatal hepatitis in a developing country”. Acta Paediatrics 98 (2009): 1260-1264.
4. Gholamrezanezhad A., et al. “Hepatobiliary imaging in pediatric nuclear medicine: A comprehensive review”. Clinical Nuclear Medicine2 (2016): 146-154.
5. Dolgin SE. “Answered and unanswered controversies in the surgical management of extra hepatic biliary atresia”. Pediatric Transplantation 8 (2004): 628-631.
6. Majd M., et al. “The role of hepatobiliary scintigraphy in neonatal cholestasis”. Radiology 3 (2009): 856-868.
7. Bartolotta T., et al. “Diagnostic accuracy of hepatobiliary scintigraphy in neonatal cholestasis: A meta-analysis”. Pediatrics and Nuclear Medicine5 (2018): 250-257.
8. Ziessman H A. “Hepatobiliary scintigraphy and gallbladder ejection fraction: Correlation with clinical outcomes”. Seminars in Nuclear Medicine2 (2014): 121-134.
9. Koga H., et al. “Advances in diagnostic imaging for biliary atresia”. Pediatric Surgery International6 (2018): 655-662.
10. Kalloo AN., et al. “Gallbladder ejection fraction: nondiagnostic for sphincter of Oddi dysfunction in patients with intact gallbladders”. Clinical Nuclear Medicine 19 (1994): 713-719.
11. Ziessman HA. “Functional hepatobiliary disease: chronic acalculous gallbladder and chronic acalculous biliary disease”. Seminar on Nuclear Medicine 36 (2006): 119-132.
12. Tulchinsky M., et al. “SNM practice guideline for hepatobiliary scintigraphy 4.0”. Journal of Nuclear Medicine Technology 38 (2010): 210-218.
13. Weissmann HS., et al. “Spectrum of 99mTc-IDA cholescintigraphic patterns in acute cholecystitis”. Radiology 138 (1981): 167-175.
14. Choy D., et al. “Cholescintigraphy in acute cholecystitis: use of intravenous morphine”. Radiology 151 (1984): 203-207.
15. Weissmann HS., et al. “The biliary tract”. In: Freeman LM, ed. Freeman and Johnson’s Clinical Radionuclide Imaging. 3^rd Philadelphia, PA: W.B. Saunders Company; (1984).
16. Al-Sheikh W., et al. “A sign of symptomatic chronic cholecystitis on biliary scintigraphy”. AJR 140 (1983): 283-285.
17. Freeman LM., et al. “Role of cholecystokinetic agents in 99mTc-IDA cholescintigraphy”. Seminar on Nuclear Medicine 11 (1981): 186-193.
18. Chamarthy M and Freeman LM. “Hepatobiliary scan findings in chronic cholecystitis”. Clinical Nuclear Medicine 35 (2010): 244-251.

Citation

Citation: Luljeta Z Abdullahu and Ismet Bajrami., et al. “Hepatobiliary Scintigraphy as an Diagnostic Tool in the Evaluation and Differentiation of Biliary Atresia from Neonatal Hepatitis”.Acta Scientific Medical Sciences 9.1 (2025): 100-104.

Copyright

Copyright: © 2025 Luljeta Z Abdullahu and Ismet Bajrami., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.