The Effect of Phenobarbital on the Accuracy of Techne
tium-99m Diisopropyl Iminodiacetic Acid Hepatobiliary
Scintigraphy in Differentiating Biliary Atresia from Neo
natal Hepatitis Syndrome
PRAKAT CHAREARNRAD, MD*• **, VORANUSH CHONGSRISAWAT,MD*,
SUPATPORN TEPMONGKOL, MD***, YONG POOVORA WAN, MD*
Affiliation : * Department of Pediatrics, Faculty of Medicine, Chulalongkom University, Bangkok 10330,
** Phon Thong Hospital, Roi Et 45110,
***Department of Radiology, Faculty of Medicine, Chulalongkom University, Bangkok 10330, Thailand.
AbstractBiliary atresia (BA) and neonatal hepatitis syndrome (NHS) are major causes of cholestatic
jaundice in infancy. Technetium-99m diisopropyl iminodiacetic acid hepatobiliary scintigraphy (99mTc
DISIDA scan) is widely used in the differentiation of these two entities. The objective of this study
was to evaluate the effect of phenobarbital premedication on the accuracy of 99mTc-DISIDA scan.
Ninety-five cholestatic infants (38 females and 57 males) with an age range of 2 weeks to 4 months
(mean 2.1 mo) who underwent 99mTc-DISIDA scan testing were retrospectively reviewed. The patients
were divided into 3 groups according to the history of phenobarbital administration prior to 99mTc
= =
DISIDA scan examination. Group l (n = 48), group 2 (n 29), and group 3 (n 18) received pheno
barbital at the dosage of 5 mg/kg/day for at least 5 days, less than 5 mg/kg/day or less than 5 days,
and no premedication, respectively. The accuracy of 99mrc-DISIDA scan in differentiating BA from
NHS in group l, 2, and 3 was 72.92 per cent, 89.66 per cent, and 100 per cent, respectively. No signi
ficant difference was seen between the patients who received and did not receive phenobarbital in terms
of age at presentation, age at onset of jaundice, and liver function tests. In conclusion, phenobarbital
therapy may not be necessary prior to 99mTc-DISIDA scan examination in the evaluation of cholestatic
infants and thus a delay in diagnosis and surgical therapy of BA can be avoided.
Keywords : Scintigraphy, Phenobarbital, Biliary Atresia, Neonatal Hepatitis
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