^99mTc sestamibi imaging

Summary

Aim: Hepatobiliary scintigraphy is an integral part in the diagnostic work-up of the neonatal cholestasis syndrome. However, less than optimal specificity is its major disadvantage. Differentiation between biliary atresia and neonatal hepatitis is nearly impossible in some cases with poor hepatocellular function. ^99mTc sestamibi (MIBI) is a cationic lipophilic agent which is a substrate of P-glycoprotein. This glycoprotein is normally expressed in biliary canalicular surfaces of hepatocytes. This property provides a hepatic excretory mechanism which is different from bilirubin excretion. In this study we evaluated the value of ^99mTc MIBI in differential diagnosis of neonatal cholestasis. Patients, methods: 20 infants with a mean age of 2.41 months (range, 0.1–5 months) were included in the study. Ten infants turned out to have extrahepatic biliary atresia and the other ten had neonatal hepatitis. Hepatobiliary (with ^99mTc BrIDA) and ^99mTc MIBI scintigraphy were performed for all the patients. Results: ^99mTc MIBI scintigraphy has shown bowel activity in all patients, including the patients with biliary atresia. Hepatobiliary scintigraphy revealed bowel activity only in five patients with neo natal hepatitis. Conclusion: Bowel visualization with ^99mTc MIBI may be seen in patients with biliary atresia and ^99mTc MIBI has limited value in differential diagnosis of neonatal chole stasis.

Zusammenfassung

Ziel: Die hepatobiliäre Szintigraphie ist wesentlicher diagnostischer Bestandteil beim neonatalen cholestatischen Syndrom. Ihr größter Nachteil ist die suboptimale Spezifität. Eine Differenzierung zwischen Gallengangsatresie und neonataler Hepatitis ist in manchen Fällen mit eingeschränkter Leberfunktion fast unmöglich. ^99mTc- Sestamibi (MIBI ), ein lipophiles Kation, ist ein Substrat des P-Glykoproteins. Dieses Glykoprotein wird normalerweise auf der Oberfläche der Gallenkanälchen der Hepatozyten exprimiert. Daraus ergibt sich ein von der Bilirubinaus - scheidung differierender hepatischer Exkretionsmechanismus. In dieser Studie untersuchten wir die Bedeutung von ^99mTc-MIBI für die Differenzialdiagnose der neonatalen Cholestase. Patienten, Methoden: 20 Kinder, mittleres Alter 2,41 (0,1–5) Monate, nahmen an der Studie teil. 10 Kinder hatten eine extra hepatische Gallengangsatresie, die anderen 10 eine neonatale Hepatitis. Bei allen Patienten wurden eine hepatobiliäre (mit ^99mTc-BrIDA) und eine ^99mTc-MIBI-Szintigraphie durchgeführt. Ergebnisse: Das ^99mTc-MIBISzintigramm zeigte Darmaktivität bei allen Patienten, auch bei denen mit biliärer Atresie, die hepatobiliäre Szintigraphie jedoch nur bei 5 Patienten mit neonataler Hepatitis. Schlussfolgerung: Mit ^99mTc-MIBI ist die Darstellung des Darms bei Gallengangsatresie möglich, daher ist ^99mTc-MIBI in der Diagnostik der neonatalen Cholestase von begrenztem Wert.

Keywords

Biliary atresia - ^99mTc BrIDA - ^99mTc MIBI - P-glycoprotein - cholestasis syndrome

Schlüsselwörter

Gallengangsatresie - ^99mTc-BrIDA - ^99mTc-MIBI - P-Glykoprotein - cholestatisches Syndrom

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