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.

CONCLUSION:

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: L Olivia Hopkins, Eyob Feyssa, Afshin Parsikia, Kamran Khanmoradi, Radi Zaki, Stalin Campos, Victor Araya, Huyen Tran, Jorge Ortiz
• Journal: Annals of nuclear medicine (Ann Nucl Med) Vol. 25 Issue 10 Pg. 762-7 (Dec 2011) ISSN: 1864-6433 [Electronic] Japan
• PMID: 21845382 (Publication Type: Journal Article)

Chemical References

• Aniline Compounds
• Imino Acids
• Organotechnetium Compounds
• technetium Tc 99m mebrofenin
• Glycine

Topics

• Adult
• Aged
• Aniline Compounds
• Biliary Tract (diagnostic imaging)
• Female
• Glycine
• Humans
• Hyperbilirubinemia (surgery)
• Imino Acids
• Liver (diagnostic imaging)
• Liver Transplantation (adverse effects)
• Male
• Middle Aged
• Organotechnetium Compounds
• Postoperative Complications (diagnostic imaging, etiology)
• Radionuclide Imaging
• Retrospective Studies
• Sensitivity and Specificity