Hepatobiliary scintigraphy in current pediatric practice.

Hepatobiliary scintigraphy is the only non-invasive technique providing real-time assessment of hepatocytes function and bile progression from the liver to the intestine; for this reason it is of great importance in the study of jaundice and many other disorders of the liver and the biliary tract in children. Ultrasonography is the initial method of evaluating the intra- and extrahepatic bile ducts dilatation; the differential diagnosis between biliary atresia and neonatal hepatitis cannot however be done without hepatobiliary scintigraphy. Cystic fibrosis patients also require hepatobiliary scintigraphy; liver and biliary tract disease can really occur independently of the underlying disease severity and the presence of steatorrhea. Hepatobiliary imaging in children who have undergone liver transplantation is of major importance; it can assess vascularity, parenchymal function, biliary drainage, possible presence of a bile leak and obstruction; it has very good sensitivity and specificity for the detection of biliary leak and biliary stricture. Due to these important clinical conditions being studied in pediatrics, both qualitative and quantitative informations (functional indices obtained from radioactivity/time curve analysis) need to be extracted; in addition, SPECT acquisition allows more accurate evaluation of abdominal activity during the excretory phase.