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Original ArticleOpen Access
The Effect of Phenobarbital on the Accuracy of Technetium-99m Diisopropyl Iminodiacetic Acid Hepatobiliary Scintigraphy in Differentiating Biliary Atresia from Neonatal Hepatitis Syndrome
Charearnrad P 
,
Chongsrisawat V ,
Tepmongkot M ,
Poovorawan Y
,
Chongsrisawat V ,
Tepmongkot M ,
Poovorawan Y VORANUSH CHONGSRISAWAT,MD*,
YONG POOVORA WAN, MD*
Biliary 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.
Key word : Scintigraphy, Phenobarbital, Biliary Atresia, Neonatal Hepatitis
YONG POOVORA WAN, MD*
Biliary 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.
Key word : Scintigraphy, Phenobarbital, Biliary Atresia, Neonatal Hepatitis
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