UTILITY OF TC-99M MEBROFENIN SCINTIGRAPHY IN THE ASSESSMENT OF INFANTILE JAUNDICE

Technetium-99m mebrofenin hepatobiliary excretory patterns were assess ed in 36 infants with hyperbilirubinemia. Phenobarbital was administer ed to 22 patients before imaging. Final diagnoses included: intrahepat ic cholestasis (14 patients), neonatal hepatitis (nine patients), bili ary atresia (eight patients), alpha-1-antitrypsin deficiency (two pati ents), Alagille's syndrome (two patients), and cystic fibrosis (one pa tient). No patient with biliary atresia showed bowel activity by 24 ho urs. Of the 28 infants without biliary atresia, 23 (82%) had bowel act ivity visualized by 6-8 hours and 26 (90%) had bowel activity by 24 ho urs. Two had no bowel activity at 24 hours: one had cystic fibrosis an d one had neonatal hepatitis. Of the 26 patients with bowel visualizat ion, the time to visualize bowel did not differ between patient groups with and without phenobarbital induction. All of the patients with he patitis, including those with marked dysfunction, showed good hepatic uptake. Mebrofenin scintigraphy is an important imaging technique in t he diagnostic evaluation of infants with hyperbilirubinemia. In additi on to biliary atresia, intrahepatic cholestasis due to cystic fibrosis and severe neonatal hepatitis may also cause bowel nonvisualization u p to 24 hours. The results of this study suggest phenobarbital inducti on may not be needed when Tc-99m mebrofenin scintigraphy is used for t he assessment of infantile jaundice.