《DISIDA PAPER》.ppt

A new diagnostic approach to biliary atresia with emphasis on the ultrasonographic triangular cord sign: comparison of ultrasonography, hepatobiliary scintigraphy, and liver needle biopsy in the evaluation of infantile cholestasis. BACKGROUND/PURPOSE (1) the utility of ultrasonography (US), Tc-99m-DISIDA hepatobiliary scintigraphy (HS), and liver needle biopsy (NBx) in differentiating biliary atresia (BA) from intrahepatic cholestasis in 73 consecutive infants who had cholestasis. BACKGROUND/PURPOSE (2) Infantile cholestatic jaundice Kasai procedure US:screening, focus on shape or contractility of gallbladder AIM: reassess the relative accuracy and the role of US, HS, NBx in D/D cholestasis METHODS (1) US: 7.0-MHz transducer, focusing on the fibrous tissue at the porta hepatis. Triangular cord (TC): visualization of a triangular or tubular shaped echogenic density just cranial to the portal vein bifurcation on a transverse or longitudinal scan. METHODS(2) Time: Mar. 1992 ~Oct. 1996 73 infants, age:12~120 d/o with conjugated hyperbilirubinemia or clay- colored stool, average T/D: 109/6.3 US: TC →BA ; no TC→NH or other cause HS: no excretion of tracer in 24 hrs→BA ; excretion of tracer in 24 hrs→NH or other RESULTS (1) 17 / 20 BA infant : denoted TC on US, 43 no TC infants: either NH or other causes of cholestasis diagnostic accuracy: 95% Sensitivity: 85% Specificity: 100% RESULTS (2) 24 / 25 BA infants : no gut excretion on HS 16 / 46 infants who had either NH or other causes of cholestasis had gut excretion diagnostic accuracy: 56% Sensitivity: 96% Specificity: 35 % RESULTS (3) HS: gut excretion of tracer →excluded BA, no gut excretion of tracer →need further investigations as liver needle biopsy. 44 NBx: 19 BA infants 24 infants who had either NH or other causes of cholestasis. RESULTS (4) 18 / 20 correctly interpreted as having BA, 23 / 24 were correctly diagnosed either NH or other causes of cholestasis diagnostic accuracy: 93% Se