Original Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jun 7, 2011; 17(21): 2626-2631
Published online Jun 7, 2011. doi: 10.3748/wjg.v17.i21.2626
Hepatobiliary scintigraphy for detecting biliary strictures after living donor liver transplantation
Yu Jin Kim, Kyu Taek Lee, Young Cheol Jo, Kwang Hyuck Lee, Jong Kyun Lee, Jae-Won Joh, Choon Hyuck David Kwon
Yu Jin Kim, Kyu Taek Lee, Young Cheol Jo, Kwang Hyuck Lee, Jong Kyun Lee, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea
Jae-Won Joh, Choon Hyuck David Kwon, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
Author contributions: Lee KT, Joh JW and Kwon CHD designed the research; Kim YJ and Jo YC performed data collection, analysis and interpretation; Kim YJ and Lee KT drafted the article; Lee KH, Lee JK, Joh JW and Kwon CHD contributed to critical revision of the article.
Supported by The IN-Sung Foundation for Medical Research and Samsung Biomedical Research Institute, Grant No. SBRI C-B1-118-1
Correspondence to: Kyu Taek Lee, Professor, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, South Korea. happymap@skku.edu
Telephone: +82-2-34103409 Fax: +82-2-34106983
Received: December 26, 2010
Revised: January 28, 2011
Accepted: February 4, 2011
Published online: June 7, 2011
Abstract

AIM: To investigate the diagnostic accuracy of hepatobiliary scintigraphy (HBS) in detecting biliary strictures in living donor liver transplantation (LDLT) patients.

METHODS: We retrospectively reviewed 104 adult LDLT recipients of the right hepatic lobe with duct-to-duct anastomosis, who underwent HBS and cholangiography. The HBS results were categorized as normal, parenchymal dysfunction, biliary obstruction, or bile leakage without re-interpretation. The presence of biliary strictures was determined by percutaneous cholangiography or endoscopic retrograde cholangiopancreatography (ERCP).

RESULTS: In 89 patients with biliary strictures, HBS showed biliary obstruction in 50 and no obstruction in 39, for a sensitivity of 56.2%. Of 15 patients with no biliary strictures, HBS showed no obstruction in 11, for a specificity of 73.3%. The positive predictive value (PPV) was 92.6% (50/54) and the negative predictive value (NPV) was 22% (11/50). We also analyzed the diagnostic accuracy of the change in bile duct size. The sensitivity, NPV, specificity, and PPV were 65.2%, 27.9%, 80% and 95%, respectively.

CONCLUSION: The absence of biliary obstruction on HBS is not reliable. Thus, when post-LDLT biliary strictures are suspected, early ERCP may be considered.

Keywords: Living donor liver transplantation; Tc99m mebrofenin; Radionucleotide imaging; Hepatobiliary scintigraphy; Biliary stricture