Hepatobiliary scintigraphy using iminodiacetic (IDA)
radiopharmaceuticals provides clinically useful information on the function of the biliary tract in a variety of
pathological processes in children, including
neonatal jaundice, gallbladder dysfunction,
trauma, and
liver transplantation.
Phenobarbital premedication (5 mg/kg per day for a minimum of 5 days in divided doses) is used in infants who are being examined for
neonatal jaundice to increase the accuracy of 99mTc-IDA scintigraphy in differentiating
extrahepatic biliary atresia from
neonatal hepatitis.
Biliary atresia can be ruled out in an infant if a patent biliary tree is shown with passage of activity into the bowel. If no
radiopharmaceutical is noted in the bowel on imaging up to 24 hours, distinction between severe hepatocellular disease and
biliary atresia cannot be made. The literature reports 91% accuracy, 97% sensitivity, and 82% specificity for hepatobiliary imaging in the diagnosis of
biliary atresia. The impairment of both intrahepatic and extrahepatic biliary drainage is an important cause of
liver disease in
cystic fibrosis. Hepatobiliary scintigraphy in
cystic fibrosis has shown characteristic patterns of dilatation of mainly the left hepatic duct, narrowing of the distal common bile duct, gallbladder dysfunction, and delayed bowel transit.
Cholecystitis in children may be acalculous. Sensitivity and specificity for the scintigraphic diagnosis of acute
acalculous cholecystitis is reported to range from 68% to 93% and 38% to 93%, respectively. Cholescintigraphy in a suspected bile leak provides information generally not available with other techniques, except for direct cholangiography. If the amount of intraperitoneal accumulation of the tracer is greater than that entering the gastrointestinal tract, surgery is usually indicated. Hepatobiliary imaging in children who have undergone
liver transplantation will assess graft vascularity, parenchymal function, biliary drainage, presence of a leak, and obstruction.