Indian Journal of Nuclear Medicine
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Year : 2013  |  Volume : 28  |  Issue : 5  |  Page : 3  


Date of Web Publication29-Nov-2013

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How to cite this article:
. Hepatobiliary. Indian J Nucl Med 2013;28, Suppl S1:3

How to cite this URL:
. Hepatobiliary. Indian J Nucl Med [serial online] 2013 [cited 2022 Jan 28];28, Suppl S1:3. Available from:


Increased gamma-glutamyl transpeptidase level increases the diagnostic accuracy of HIDA scans in biliary atresia patients

Madhur Kumar Srivastava, Kumarvel Sambandan 1 ,

Sreenivas K Reddy, L Peethamber,

Madhusudhanan Ponnusamy, H Dhanapathi,

Nandini Pandit

Departments of Nuclear Medicine, and 1 Pediatric Surgery, JIPMER, Puducherry, India

Objective: Hepatic technetium-99m-mebrofenin iminodiacetate (99m Tc-Mebrofenin) scans is an important investigation in diagnosis of extrahepatic biliary atresia (EHBA). It has almost 100% negative predictive value, but, has a low sensitivity. Serum gamma-glutamyl transpeptidase (GGTP) has high sensitivity for EHBA. The aim was to study whether serum GGTP increased the accuracy of 99m Tc-Mebrofenin scan in diagnosis of EHBA. Materials and Methods: Patients underwent hepatobiliary scan with intravenous injection of 1 mCi of 99m Tc-Mebrofenin. Dynamic images were acquired for 30 min followed by static images till 24 h. Liver function tests (LFT) were performed within 1 week of the scan. Result: A total of 98 patients with diagnosis of jaundice with conjugated hyperbilirubinemia underwent 120 hepatobiliary scans. Their average age was 2.4 ± 2.1 months. In 26 patients, intestinal tracer activity was not visualized till 24 h. Of these 14 patients (Group A) were positive for EHBA on per-operative cholangiogram (53.8%) and underwent Kasai procedure. In rest 12 patients (Group B), either per-operative cholangiogram was negative or repeat hepatobiliary scan showed patent hepatic-bilio-enteric pathway. The GGTP values (normal range <51 IU/L) showed sensitivity of 92.86%, specificity of 16.67%, PPV of 56.52%, NPV of 66.7% and accuracy of 57.69%. However when we considered GGTP level >200 IU/L, the sensitivity increased to 92.86%, specificity to 91.67%, PPV to 92.86%, NPV to 91.67% and accuracy to 92.31%.However the accuracy was reduced to 84.61% when GGTP level >250 was considered. The GGTP level was also significantly raised (P < 0.001) in Group A (502.07 ± 322.95) than in Group B (115.0 ± 90.48). Other LFT parameters like bilirubin, AST, ALT and ALP were not statistically different in both groups. Conclusion: GGTP level >200 IU/L with non visualization of intestinal activity on 99m Tc-Mebrofenin scan can reliably predict presence of biliary atresia. This increase in accuracy of combining the two studies will significantly decrease the number of patients undergoing negative laparotomy and avoid the child receiving unnecessary anesthesia and an avoidable procedure i.e., laparotomy and per operative cholangiogram. However, the numbers are still small and a larger study will provide more robust statistical evidence.


99m Tc-mebrofenin hepatobiliary scintigraphy with single-photon emission computed tomography for the assessment of liver functional volume before partial liver resection

Murthy Siddegowda, Sanjay Gambhir, Sukanta Barai, Rajan Saxena 1 , Suruchi Jain, Gowri Shankar, Deepa Singh

Departments of Nuclear Medicine, and 1 Surgical Gastroenterology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Aim: Standardization and assessment of functional liver volume with 99m Tc Mebrofenin SPECT. Materials and Methods: 8 patients worked up for liver resection were included. They underwent standard battery of pre-surgical tests. CT volumetry was performed using a 64-slice (Phillips) CT scanner, before the SPECT/CT. Hepatobiliary scintigraphy performed with 99m Tc-labeled (2,4,6-trimethyl-3-bromo) Iminodiacetic acid ( 99m Tc-mebrofenin) using SPECT/CT camera (Infinia; GE Healthcare) before surgery to calculate functional liver volume. Based on biochemical liver functions patients were grouped into normal and abnormal liver function group. Results: The TL-FV (measured by SPECT) was compared with morphologic NT TL-V (measured by CeCT volumetry). The TL-FV had a strong and significant correlation with the NT TL-V (Pearson r = 0.89) in patients with a normal liver parenchyma, indicating the accuracy of 99m Tc-mebrofenin SPECT for the measurement of hepatic volume. However, in patients with a compromised liver parenchyma TL-FV was significantly less than NT TL-V. Conclusion: HBS is a valuable technique to assess the functional liver volume in patients undergoing major liver resection, especially in patients with uncertain quality of the liver parenchyma. Therefore, additional HBS can improve risk assessment in patients requiring extensive liver resection.


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