The significance of functioning gallbladder visualization on hepatobiliaryscintigraphy in infants with persistent jaundice

The purpose of this study was to determine whether gallbladder visualizatio n can help exclude biliary atresia in hepatobiliary scintigraphic studies o f infants with persistent jaundice. Methods: One hundred fifty-two infants with persistent jaundice (49 patients with a final diagnosis of biliary atr esia and 103 with biliary patency) were studied using both hepatobiliary sc intigraphy and abdominal sonography. Food was withheld for 4 h before the e xamination, and the infants were fed nothing but glucose until 6 h after th e initial injection of Tc-99m-disofenin or until the gallbladder was seen. if the gallbladder was seen, the infants were fed milk, and imaging was con tinued to observe gallbladder contractility. Results: In none of the 49 pat ients with biliary atresia could the gallbladder be seen with hepatobiliary scintigraphy, but abdominal sonography revealed 9 normal-sized gallbladder s. Of the 103 patients with biliary patency, hepatobiliary scintigraphy det ected the gallbladder more frequently (74%, 76/103) than did abdominal sono graphy (63%, 65/103). All visualized gallbladders contracted after the infa nts were fed milk. If we include visualization of both the gallbladder and bowel radioactivity as criteria, the specificity of biliary atresia on hepa tobiliary scintigraphy increases to 86% (89/103). Conclusion: Gallbladders were usually visible on hepatobiliary scintigraphy of fasting patients with biliary patency. A functioning gallbladder, with or without visualization of bowel radioactivity, indicated biliary patency.