J Korean Radiol Soc.  2003 Oct;49(4):337-344. 10.3348/jkrs.2003.49.4.337.

Usefulness of MR Cholangiography in the Evaluation of Neonatal Cholestasis: Comparison with 99mTc DISIDA Scan

• Kim J
• Kim MJ
• Yoon CS
• Lee JD
• Kim SY
• Han SJ
• Hwang EH

• KMID: 2199937
• DOI: http://doi.org/10.3348/jkrs.2003.49.4.337

Abstract

PURPOSE: To evaluate the diagnostic validity of MR cholangiography as a second-line imaging tool following sonography in the evaluation of neonatal cholestasis, we compared MR cholangiography with 99mTc DISIDA scan.
MATERIALS AND METHODS
We retrospectively evaluated sonography, 99mTc DISIDA scan and MR cholangiography in twenty-two neonates and infants (age range, 23-103 days; mean age, 57 days) presenting with conjugated hyperbilirubinemia. Of the 22 patients, 15 were diagnosed as biliary atresia by operative cholangiography and liver biopsy and six as neonatal hepatitis by imaging finding and clinical data. Remaining one patient was diagnosed as neonatal hepatitis by operative cholangiography and liver biopsy. Two independent observers for each study were assigned to review the images of 99mTc DISIDA scan and MR cholangiography without giving the final diagnosis or other clinical data. Diagnostic accuracy and interobserver variability for each study were evaluated.
RESULTS
On 99mTc DISIDA scan, biliary atresia was mistaken for neonatal hepatitis in eight patients and vice versa in four patients. On MR cholangiography, it was mistaken biliary atresia as neonatal hepatitis and vice versa in each two patients. Sensitivity, specificity, accuracy, positive and negative predictive values of 99mTc DISIDA scan were 48%, 47%, 48%, 66% and 30%, respectively, and those of MR cholangiography were 90%, 71%, 84%, 87% and 81%, respectively. Interobserver variabilities for 99mTc DISIDA scan and MR cholangiography were 0.62 and 0.85, respectively.
CONCLUSION
In the evaluation of patients with neonatal cholestasis, it would be advisable to use MR cholangiography, having superior diagnostic accuracy to 99mTc DISIDA scan, as a second-line imaging tool following sonography.

Keyword

Infants, newborn, gastrointestinal tract; Bile ducts, abnormalities; Bile ducts, MR; Magnetic resonance (MR), in infants and children; Ultrasound (US), in infants and children; Radionuclides, comparative studies

MeSH Terms

Biliary Atresia
Biopsy
Cholangiography*
Cholestasis*
Diagnosis
Hepatitis
Humans
Hyperbilirubinemia
Infant
Infant, Newborn
Liver
Observer Variation
Retrospective Studies
Sensitivity and Specificity
Technetium Tc 99m Disofenin*
Technetium Tc 99m Disofenin