title: Tc-99m-BrIDA hepatobiliary (HIDA) scan has a low sensitivity for detecting biliary complications after orthotopic liver transplantation in patients with hyperbilirubinemia.
abstract: BACKGROUND
  Tc-99m-BrIDA hepatobiliary scans are noninvasive tests for detecting biliary leaks and obstructions. However, there is low sensitivity and specificity in patients with hyperbilirubinemia. Biliary complications (BC) are the Achilles heel of orthotopic liver transplantation (OLT). We questioned whether hyperbilirubinemia in liver transplant recipients rendered HIDA scanning less dependable.
  
  
  METHODS
  HIDA findings were compared to endoscopic retrograde cholangiopancreatography, laparotomy, and clinical course. Results were categorized as follows: true positive (TP), true negative (TN), false positive (FP), false negative (FN), or nondiagnostic/inconclusive. We searched for variables associated with erroneous or nondiagnostic tests which we defined as all examinations determined to be FP, FN and/or nondiagnostic/inconclusive.
  
  
  RESULTS
  Thirty-four patients underwent a HIDA scan. The sensitivity and specificity were 70 and 100%. The sensitivity of HIDA improved to 100% in patients with a total bilirubin (TB) <5 mg/dl. Inconclusive and FN patients had a total bilirubin >5 mg/dl. One FN had a TB <5 mg/dl, but was determined inconclusive due to the roux-en-Y.
  
  
  CONCLUSIONS
  HIDA scans performed when the total bilirubin was <5 mg/dl had a high sensitivity and specificity for detecting biliary complications after OLT. However, when the total bilirubin exceeded 5 mg/dl, the specificity was still 100% but the numbers of nondiagnostic/inconclusive and FN exams were increased.
authors.affiliation: Albert Einstein Medical Center, 5501 Old York Road, Klein Building Suite 510, Philadelphia, PA 19141, USA.
authors.forename: L Olivia
authors.initials: LO
authors.lastname: Hopkins
authors.forename: Eyob
authors.initials: E
authors.lastname: Feyssa
authors.forename: Afshin
authors.initials: A
authors.lastname: Parsikia
authors.forename: Kamran
authors.initials: K
authors.lastname: Khanmoradi
authors.forename: Radi
authors.initials: R
authors.lastname: Zaki
authors.forename: Stalin
authors.initials: S
authors.lastname: Campos
authors.forename: Victor
authors.initials: V
authors.lastname: Araya
authors.forename: Huyen
authors.initials: H
authors.lastname: Tran
authors.forename: Jorge
authors.initials: J
authors.lastname: Ortiz
mesh_terms: D000328:Adult; D000368:Aged; D000814:Aniline Compounds; D001659:Biliary Tract / Q000000981:diagnostic imaging*; D005260:Female; D005998:Glycine; D006801:Humans; D006932:Hyperbilirubinemia / Q000601:surgery*; D007098:Imino Acids; D008099:Liver / Q000000981:diagnostic imaging*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; C034837:technetium Tc 99m mebrofenin; D005998:Glycine