Diagnostic value of hepatobiliary imaging combined with serum γ-GT/TBA ratio in children with congenital extrahepatic biliary atresia / 中华核医学与分子影像杂志

ABSTRACT

Objective To study the diagnostic value of hepatobiliary imaging at 6 h post-injection of 99 Tcm-diethyl iminodiacetic acid ( EHIDA) ( HI-6) combined with serum gamma-glutamyltransferase (γ-GT)/total bile acid ( TBA) ratio ( combined diagnosis) in children with congenital extrahepatic biliary atre-sia (CEBA). Methods Clinical data of 194 pediatric patients (118 males, 76 females, mean 70.9 d) with jaundice from May 2013 to March 2017 were retrospectively analyzed. All patients underwent surgery. According to the operation and pathologic diagnosis, patients were divided into CEBA group ( 113 cases) , infant hepatitis syndrome ( IHS) group ( 81 cases) . Serumγ-GT, TBA and the ratio ofγ-GT/TBA of the 2 groups were compared. Receiver operating characteristic ( ROC) curves were drawn to determine threshold values of the 3 parameters for diagnosis of CEBA. Patients also underwent 99 Tcm-EHIDA hepatobiliary dy-namic imaging. The diagnostic efficacies of HI-6, γ-GT, γ-GT/TBA ratio, and combined diagnosis were compared. Two-sample t test and χ2 test were used to analyze the data. Results There were significant differences in γ-GT/TBA ratio,γ-GT and TBA content between the 2 groups (t values8.217, 9.298 and 2.426, all P<0.05). The serumγ-GT andγ-GT/TBA ratio had high diagnostic accuracies (area under ROC curve ( AUC)0.884 and 0.863) . The sensitivity, specificity, accuracy and positive predictive value of HI-6 in the diagnosis of CEBA were 91.15％(103/113), 39.51％(32/81), 69.59％(135/194) and 67.76％(103/152);the parameters of γ-GT were 69.91％(79/113), 93.83％(76/81), 79.90％(155/194) and 94.05％(79/84);and those ofγ-GT/TBA ratio were 71.68％(81/113), 92.59％(75/81), 80.41％(156/194) and 93.10％(81/87). The sensitivity of HI-6 was significantly higher than that of γ-GT and GGT/TBA ratio (χ2 values16.256 and 14.154, both P<0.05) , but the specificity, accuracy and positive predic-tive value were significantly lower than those ofγ-GT/TBA ratio (χ2 values50.899, 6.062 and 20.054, all P<0.05). The specificity, accuracy and positive predictive value of the combined diagnosis were 95.06％(77/81), 92.78％(180/194) and 96.26％(103/107) respectively, which were significantly higher than those of HI-6 (χ2 values56.786, 34.168 and 31.335, all P<0.05) . Conclusions HI-6 combined withγ-GT/TBA ratio can significantly improve the diagnostic specificity and accuracy for CEBA. This method is more time-saving, simple and reliable, and has important clinical value.