Usefulness of MR Cholangiography in the Evaluation of Neonatal Cholestasis: Comparison with 99mTc DISIDA Scan.
10.3348/jkrs.2003.49.4.337
- Author:
Jinna KIM
1
;
Myung Joon KIM
;
Choon Sik YOON
;
Jong Doo LEE
;
Si Yeon KIM
;
Seok Joo HAN
;
Eui Ho HWANG
Author Information
1. Department of Diagnostic Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine. mjkim@yumc.yonsei.ac.kr
- Publication Type:Original Article ; Comparative Study
- Keywords:
Infants, newborn, gastrointestinal tract;
Bile ducts, abnormalities;
Bile ducts, MR;
Magnetic resonance (MR), in infants and children;
Ultrasound (US), in infants and children;
Radionuclides, comparative studies
- MeSH:
Biliary Atresia;
Biopsy;
Cholangiography*;
Cholestasis*;
Diagnosis;
Hepatitis;
Humans;
Hyperbilirubinemia;
Infant;
Infant, Newborn;
Liver;
Observer Variation;
Retrospective Studies;
Sensitivity and Specificity;
Technetium Tc 99m Disofenin*
- From:Journal of the Korean Radiological Society
2003;49(4):337-344
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: To evaluate the diagnostic validity of MR cholangiography as a second-line imaging tool following sonography in the evaluation of neonatal cholestasis, we compared MR cholangiography with 99mTc DISIDA scan. MATERIALS AND METHODS: We retrospectively evaluated sonography, 99mTc DISIDA scan and MR cholangiography in twenty-two neonates and infants (age range, 23-103 days; mean age, 57 days) presenting with conjugated hyperbilirubinemia. Of the 22 patients, 15 were diagnosed as biliary atresia by operative cholangiography and liver biopsy and six as neonatal hepatitis by imaging finding and clinical data. Remaining one patient was diagnosed as neonatal hepatitis by operative cholangiography and liver biopsy. Two independent observers for each study were assigned to review the images of 99mTc DISIDA scan and MR cholangiography without giving the final diagnosis or other clinical data. Diagnostic accuracy and interobserver variability for each study were evaluated. RESULTS: On 99mTc DISIDA scan, biliary atresia was mistaken for neonatal hepatitis in eight patients and vice versa in four patients. On MR cholangiography, it was mistaken biliary atresia as neonatal hepatitis and vice versa in each two patients. Sensitivity, specificity, accuracy, positive and negative predictive values of 99mTc DISIDA scan were 48%, 47%, 48%, 66% and 30%, respectively, and those of MR cholangiography were 90%, 71%, 84%, 87% and 81%, respectively. Interobserver variabilities for 99mTc DISIDA scan and MR cholangiography were 0.62 and 0.85, respectively. CONCLUSION: In the evaluation of patients with neonatal cholestasis, it would be advisable to use MR cholangiography, having superior diagnostic accuracy to 99mTc DISIDA scan, as a second-line imaging tool following sonography.
