title: Phenobarbital-enhanced hepatobiliary scintigraphy in the diagnosis of biliary atresia: two decades of experience at a tertiary center.
abstract: BACKGROUND
  Hepatobiliary scintigraphy is highly sensitive for diagnosing biliary atresia; however, its specificity has varied in the literature from 35% to 97%.
  
  
  OBJECTIVE
  The purpose of this study was to re-evaluate the accuracy of phenobarbital-enhanced hepatobiliary scintigraphy in differentiating biliary atresia from other causes of neonatal cholestasis.
  
  
  METHODS
  We retrospectively reviewed all hepatobiliary scans of infants with cholestasis at our institution from December 1990 to May 2011. Per our routine protocol the scans were obtained after pretreatment with phenobarbital (5 mg/kg/day for 5 days) to achieve a serum level of ≥15 mcg/ml. Normal hepatic uptake with no biliary excretion by 24 h was considered consistent with biliary atresia.
  
  
  RESULTS
  One hundred eighty-six infants with 210 hepatobiliary scans composed the study group. Forty-three (23%) infants had the final diagnosis of biliary atresia. Hepatobiliary scintigraphy was 100% sensitive, 93% specific and 94.6% accurate in diagnosing biliary atresia. Of the 186, 39/111 (35.1%) term and 2/68 (2.9%) preterm infants had biliary atresia; two of seven children with unknown gestational age also had biliary atresia. Other diagnoses included neonatal hepatitis, total parenteral nutrition cholestasis, Alagille syndrome, cystic fibrosis, choledochal cyst, hypothyroidism, alpha-1 antitrypsin deficiency and persistent cholestasis of unknown etiology.
  
  
  CONCLUSIONS
  Phenobarbital-enhanced hepatobiliary scintigraphy is highly accurate in differentiating biliary atresia from other causes of neonatal cholestasis. Biliary atresia is rare in premature infants.
authors.affiliation: Division of Diagnostic Imaging and Radiology, Children's National Medical Center, The George Washington University Medical Center, 111 Michigan Ave. NW, Washington, DC, 20010, USA.
authors.forename: Neha
authors.initials: N
authors.lastname: Kwatra
authors.forename: Eglal
authors.initials: E
authors.lastname: Shalaby-Rana
authors.forename: Srikala
authors.initials: S
authors.lastname: Narayanan
authors.forename: Parvathi
authors.initials: P
authors.lastname: Mohan
authors.forename: Sunil
authors.initials: S
authors.lastname: Ghelani
authors.forename: Massoud
authors.initials: M
authors.lastname: Majd
mesh_terms: D001656:Biliary Atresia / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015984:Causality; D002779:Cholestasis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D010634:Phenobarbital; D015995:Prevalence; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D062606:Tertiary Care Centers / Q000706:statistics & numerical data
chemical_list: D010634:Phenobarbital