Korean Journal of Pediatrics 2006;49(7):737-744.
Published online July 15, 2006.
Diagnostic limitation and usefulness of 99mTc-DISIDA hepatobiliary scanning on neonatal cholestasis
Jung Mi Kim1, Byung-Ho Choi1, You Cheol Jang1, Ki Won Oh1, Min Hyun Cho1, Kyung Hee Lee1, Jin-Young Park2, Heng Mi Kim1
1Departments of Pediatrics, Kyungpook National University Hospital, Daegu, Korea
2Departments of Surgery, Kyungpook National University Hospital, Daegu, Korea
신생아 담즙정체성 간 질환에서 담도 폐쇄증 감별을 위한 DISIDA 스캔의 진단적 한계성과 유용성
김정미1, 최병호1, 장유철1, 오기원1, 조민현1, 이경희1, 박진영2, 김행미1
1경북대학교 의과대학 소아과학교실
2경북대학교 의과대학 외과학교실
Correspondence: 
Byung-Ho Choi, Email: bhchoi@knu.ac.kr
Abstract
Purpose
: To assess the usefulness of 99mTc-DISIDA scanning in the early evaluation of neonatal cholestasis and to verify the diagnostic value of this test in the differential diagnosis of biliary atresia.
Methods
: DISIDA scannings were performed and analyzed in 87 children(58 males and 29 females; age, 18-139 days, mean, 59.1 days) with neonatal cholestasis. Five groups according to the final diagnosis and the results of DISIDA scanning were analyzed by scatter plots using the parameters of age and the level of liver function tests(direct bilirubin, AST, ALT, ALP, GGT). The diagnostic sensitivity, specificity and accuracy of DISIDA scanning in the diagnosis of biliary atresia were compared between a higher bilirubin group and a lower bilirubin group(direct bilirubin level >5 mg/dL vs. <5 mg/dL) decided by the pattern of scatter plots.
Results
: DISIDA scannings in the diagnosis of biliary atresia were analyzed by high sensitivity(100 percent, 16/16) but lower specificity(70.4 percent, 50/71) and accuracy(75.9 percent, 66/87). False positivity(29.6 percent, 21/71) was higher in patients with a higher direct bilirubin level(42.5 percent for >5 mg/dL vs. 9.7 percent for <5 mg/dL, P<0.01). The age and the level of liver function tests(AST, ALT, ALP, GGT) analyzed by scatter plots revealed neither diagnostic value in predicting final diagnosis nor estimated the accuracy rate of DISIDA scanning in the evaluation of neonatal cholestasis.
Conclusion
: We suggest that DISIDA scannings should not be routinely used in evaluating neonatal cholestasis with elevated direct bilirubin level(>5 mg/dL), especially if it delays early diagnosis and surgical intervention.
Key Words: Choleatasis , Biliary atresia , Hepatitis , 99mTc-DISIDA , Diagnosis , Neonates


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