Hepatobiliary scintigraphy for the assessment of biliary strictures after pediatric liver transplantation.
HBS is used in the management of liver transplantation, a significant complication of which is biliary stricture. Strictures may be intraparenchymal within segments and main duct (non-anastomotic) or at the biliary-enteric anastomosis (anastomotic). Strictures are definitively diagnosed, and often managed, by PTC. This is invasive, technically challenging, and requires general anesthesia in young children. HBS may allow early detection of these complications and is non-invasive. The aim of this study was to review the scintigraphic pattern of biliary strictures using (99m)TcDISIDA HBS following pediatric orthotopic liver transplantation, and to assess its role in the diagnostic algorithm of suspected biliary strictures. All available hepatobiliary studies performed post-transplant in 101 episodes of liver transplantation in 92 pediatric patients were reviewed. Twenty-three (23%) patients had known biliary strictures. Twenty-two patients had adequate studies available for review; five had intrahepatic (non-anastomotic) strictures alone, nine had a stricture of the anastomosis alone, and eight had both intrahepatic and anastomotic strictures. HBS patterns (either segmental or global changes) correlated very highly with clinically significant biliary strictures. All patients with known strictures had abnormal HBS; hence, in patients with abnormal liver function tests post-liver transplant, a normal HBS makes strictures very unlikely. We propose that HBS can thus be used to determine if further investigation is required.
Concannon
Rebecca C
RC
Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia.
Howman-Giles
Robert
R
Shun
Albert
A
Stormon
Michael O
MO
D002648:Child; D002779:Cholestasis / Q000000981:diagnostic imaging*; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D005260:Female; D015902:Gamma Cameras; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D019785:Technetium Tc 99m Disofenin
D019275:Radiopharmaceuticals; D019785:Technetium Tc 99m Disofenin