Document Detail

The use of hepatocyte extraction fraction to evaluate neonatal cholestasis.
MedLine Citation:
PMID:  10478739     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Hepatobiliary scintigraphy is used routinely to evaluate infants with neonatal cholestasis. Hepatobiliary scintigraphy determines biliary patency by detecting radioactivity in the bowel on imaging, in duodenal and gastric aspirates, or all of these. During hepatobiliary scintigraphy, the hepatocyte extraction fraction (HEF) is calculated by deconvolution analysis. Normal values of HEF are more than 90%. It is believed that HEF may predict hepatic dysfunction, because, during hepatobiliary scintigraphy, the radiopharmaceutical used in this test is extracted by the hepatocytes from the blood stream. Therefore, a low value of HEF is seen with more severe hepatocellular disease. The goal of this study was to determine whether HEF has any correlation with synthetic liver function, whether HEF can differentiate obstructive from nonobstructive lesions that cause neonatal cholestasis, and whether HEF can predict the outcome of the different causes of neonatal cholestasis. METHODS: A retrospective analysis of 68 hepatobiliary scintigraphy results was done in patients with neonatal cholestasis for a period covering 6 years. RESULTS: The HEF was available in 67 of these 68 patients, with a median value of 25% (range, 3.3% to 100%). The results of synthetic liver function tests (i.e., albumin and prothrombin time) were normal in all infants with neonatal cholestasis. No significant correlation was detected between HEF and the serum levels of total and direct bilirubin, albumin, alkaline phosphatase, and prothrombin time by exploratory data analysis (R = 0.08; small, P > 0.2). The HEF values in different causes of neonatal cholestasis were compared: extrahepatic biliary atresia, neonatal hepatitis, and a miscellaneous category consisting of alpha1-antitrypsin deficiency, ischemic hepatitis, paucity of bile ducts, and others. The outcomes of these diseases were assessed as resolution, continuing disease, transplantation, or death, but no predictive correlation was found with HEF. CONCLUSIONS: A single determination of HEF is of no value in assessing synthetic liver function (as assessed by albumin and prothrombin time), specific diagnoses, and outcomes in patients with neonatal cholestasis. Therefore, a low isolated value of HEF should not be considered suggestive of poor prognosis and outcome in these patients.
V Tolia; S R Kottamasu; D Tabassum; P Simpson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical nuclear medicine     Volume:  24     ISSN:  0363-9762     ISO Abbreviation:  Clin Nucl Med     Publication Date:  1999 Sep 
Date Detail:
Created Date:  1999-10-21     Completed Date:  1999-10-21     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7611109     Medline TA:  Clin Nucl Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  655-9     Citation Subset:  IM    
Department of Pediatrics, Children's Hospital of Michigan, Detroit, USA.
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MeSH Terms
Biliary Tract / radionuclide imaging*
Bilirubin / analysis
Cholestasis / blood,  radionuclide imaging*
Fourier Analysis
Infant, Newborn
Liver / radionuclide imaging*
Predictive Value of Tests
Retrospective Studies
Serum Albumin / analysis
Technetium Compounds / diagnostic use
Treatment Outcome
Reg. No./Substance:
0/Serum Albumin; 0/Technetium Compounds; 635-65-4/Bilirubin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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