| Objective Both extrahepatic biliary atresia(EHBA) and Infant hepatitis syndrome(IHS) are the most frequent etiological factor which cause persistent jaundice in infants. The incidence rate of EHBA is different in different territory and race of people. The incidence rate of oriental is or so 1/8000, and the incidence rate in Japan and china is higher than the other territory. The ratio of male and female is or so 1:2. The morbility is not regularly in IHS. It is difficult to diagnosis EHBA and IHS in clinic. Image medical examinations were all insufficient. The insufficiency is low specificity to EHBA and low saitivity to IHS, for hepatobiliary dynamic surface imaging.In this study,138 infants with persistent jaundice underwent hepatobiliary dynamic surface imaging and hepatobiliary section imaging, the results of two imagings were compared, objective was to discuss the differential diagnosis value of hepatobiliary section imaging to EHBA and IHS.Materials and Methods There were 138 infants with persistent jaundice,112 from paediatrics ward of qilu hospital of Shan dong university,26 from paediatrics clinic. Male 68, female 70, their ages were from 35 to 120 days. The gold standard is the consequences of operation, pathematology, and clinical turnover. The retrospective analytical methods were adopted to the symptoms, physical signs, and the correlating examination results, for the infants with jaundice.The ages, the emergence time of persistent jaundice, and dejecta colors were recorded by questionnaire. The liver size, and spleen size were written down by medical examination. The laboratory examination results were taken down.All cases underwent hepatobiliary dynamic surface imaging and hepatobiliary section imaging. The detecting head of the SPECT were played the surface of the region of liver and intestinal tract, the hepatobiliary dynamic surface imaging were deployed in 5 minutes,10 minutes,20 minutes,30 minutes,40 minutes,60 minutes after the imaging agent was injected. Supposing the radioaction didn't emerge in intesinal tract, the delayed imaging were adopted in 3 to 4 hour,6 to 8 hour, and 24 hour. The hepatobiliary shape and excretion of radionuclide were observed. When radionuclide was found in intesinal tract, the imagings were stopped. The hepatobiliary section imagings were undertaken immediately after the delayed imagings were completed. The data from collection system of VG Acq were sent to image processing system. The section imagings of transverse plane, sagittal plane, coronal plane were gained by computer software. The pictures were observed by the nuclear medicine doctor with plentiful clinical experience. Regardless of hepatobiliary dynamic surface imaging and hepatobiliary section imaging, as long as adioaction emerged in intestinal tract within 24 hour, the infants were diagnosised as IHS. Supposing adioaction was not found in intestinal tract within 24 hour, the infants were diagnosised as EHBA.About clinical data and laboratory examinations, the measurement data from different groups were compared by t-test, the enumeration data from different groups were compared by x2-test of four-fold table or line×array table, there are statistical significance when probability is less than 0.05. Sensibility, specificity, accuracy, positive predictive value, and negative predictive value were calculated and expressed by percentage, respectively, for hepatobiliary dynamic surface imaging and hepatobiliary section imaging. The results of the two methods were compared by x2-test of four-fold table, there are statistical significance when probability is less than 0.05.Results1,According to the consequences of operation, pathematology, and clinical treatment,39 infants were diagnosised as EHBA,male 15, female 24,99 infants were confirmded as IHS,male 53, female 46. Compare the symptoms, physical signs, and laboratory examination results from 39 EHBA and 99 IHS:1.1 There were not statistical significance in the ages, the emergence time of persistent jaundice, dejecta colors, liver size, and spleen size, for EHBA and IHS.1.2 There was not statistical significance in the infection rate of CMV, for EHBA and IHS.1.3 There were not statistical significance in the contents of ALT, AST, AKP, for EHBA and IHS. But the activity ofγ-GT in EHBA was significantly higher than in IHS。1.4 There were not statistical significance in TBIL, DBIL, and D/T, for EHBA and IHS.2,The results of hepatobiliary dynamic surface imaging2.1 The diagnosis results to EHBA is true positive 32, false positive 40, true negative 59, false negative 7, false positive rate40.4%(40/99), false negative rate17.9%(7/39). The diagnostic evaluation index is saitivity 82.1%(32/39), specificity 59.6%(59/99), accuracy 65.9%(91/138), positive predictive value 44.4%(32/72), negative predictive value 89.4%(59/66).2.2 The diagnosis results to IHS is true positive 59, false positive 7, true negative 32, false negative 40. The diagnostic evaluation index is saitivity 59.6%(59/99), specificity 82.1%(32/39), accuracy 65.9%(91/138), positive predictive value 89.4%(59/66), negative predictive value 44.4%(32/72).2.3 The disposition percentage of 59 true positive IHS in 3 to 4 hour to 8 hour,24 hour were18.6%,42.4%,39.0%, respectively.3,The results of hepatobiliary section imaging3.1 The diagnosis results to EHBA is true positive 39, false positive 24, true negative 75, false negative 0, false positive rate24.2%(24/99), alse negative rate0(0/39). The diagnostic evaluation index is saitivity 100.0%(39/39), specificity 75.7%(75/99),accuracy82.6%(114/138), positive predictive value 61.9%(39/63), negative predictive value 100.0%(75/75). 3.2 The diagnosis results to IHS is true positive 75, false positive 0, true negative 39, false negative 24. The diagnostic evaluation index is saitivity 75.7%(75/99), specificity 100%(39/39), accuracy 82.6%(114/138), positive predictive value 100%(75/75), negative predictive value 61.9%(39/63).3.3 The disposition percentage of 75 true positive IHS in 3 to 4 hour,6 to 8 hour,24 hour were 33.3%,44.0%,22.7%, respectively.4,The comparison of the rerults from two imaging methods4.1 The hepatobiliary section imaging was significantly higher than hepatobiliary dynamic surface imaging in saitivity, specificity,accuracy, positive predictive value, and negative predictive value, for EHBA.4.2 The hepatobiliary section imaging was significantly higher than hepatobiliary dynamic surface imaging in saitivity, specificity, accuracy, positive predictive value, and negative predictive value, for IHS.4.3 The hepatobiliary section imaging was significantly lower than hepatobiliary dynamic surface imaging in false positive rate and false negative rate, for EHBA.4.4 The time which diagnosed IHS by hepatobiliary section imaging.was significantly shorter than by hepatobiliary dynamic surface imaging.Conclusions1,It is hard to differentiate EHBA from IHS by single clinical manifestation and common laboratory examination.2,The deficients of hepatobiliary dynamic surface imaging are low specificity to EHBA and low saitivity to IHS.3,The hepatobiliary section imaging can depress the false positive rate, dismiss the false negative rate of EHBA, elevate the differential diagnosis efficacy to EHBA and IHS, and shorten the time of diagnosising IHS.4,There is still false positive when EHBA is diagnosised by the hepatobiliary section imaging. |
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