Evaluation of mebrofenin hepatoscintigraphy in neonatal-onset jaundice.
BACKGROUND
The prognosis of infants with prolonged neonatal jaundice is dependent on early diagnosis because of the need for prompt surgical management of biliary atresia.


OBJECTIVE
To evaluate the usefulness of 99 mTcm-trimethylbromo-iminodiacetic acid (TBIDA, mebrofenin) in the investigation of infantile jaundice.


METHODS
A retrospective study was undertaken of 58 patients with unexplained prolonged neonatal jaundice. Sixty-eight scans were reviewed.


RESULTS
Mebrofenin scintigraphy confirmed the presence of a choledochal cyst in three of the four cases with that diagnosis. There were no false negative results in the nine patients with extrahepatic biliary atresia (EHBA). Three further infants had an incorrect histological diagnosis of EHBA. A gall bladder was identified by US in each case and in one of these, scintigraphy showed gut excretion. In the 16 patients with no gut excretion by 24 h, the final diagnoses were intrahepatic cholestasis (n = 7), Alagille's syndrome (n = 3), neonatal hepatitis (n = 3), alpha-1-antitrypsin deficiency (n = 2) and juvenile xanthogranuloma (n = 1). Seven infants had repeat scintigraphy after the administration of ursodeoxycholic acid (URSO). This changed five non-excretors with hepatitis into excretors. Two infants with hepatitis continued to show non-excretion after URSO, but a gallbladder was identified by US in both.


CONCLUSIONS
Mebrofenin scintigraphy is accurate in confirming the presence of a choledochal cyst and in refuting the diagnosis of EHBA. While histology and scintigraphy are each 100 % sensitive for the diagnosis of EHBA, neither, individually, is accurate and the investigation of prolonged neonatal jaundice requires a multi-modality imaging strategy.
Johnson
K
K
Radiology Department, Birmingham Children's Hospital NHS Trust, Steelhouse Lane, Birmingham B4 6NH, UK.
Alton
H M
HM
Chapman
S
S
D000814:Aniline Compounds; D001656:Biliary Atresia / Q000150:complications / Q000000981:diagnostic imaging; D015529:Choledochal Cyst / Q000150:complications / Q000000981:diagnostic imaging; D005998:Glycine; D006505:Hepatitis / Q000150:complications / Q000151:congenital / Q000000981:diagnostic imaging; D006801:Humans; D007098:Imino Acids; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000000981:diagnostic imaging* / Q000209:etiology; D008099:Liver / Q000000981:diagnostic imaging*; D015609:Organotechnetium Compounds; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies
D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C034837:technetium Tc 99m mebrofenin; D005998:Glycine