Hepatobiliary scintigraphy for detecting biliary strictures after living donor liver transplantation

World J Gastroenterol. 2011 Jun 7;17(21):2626-31. doi: 10.3748/wjg.v17.i21.2626.


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

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Bile Ducts / diagnostic imaging*
  • Bile Ducts / pathology
  • Biliary Tract Diseases / diagnostic imaging
  • Biliary Tract Diseases / pathology
  • Biliary Tract Diseases / surgery
  • Cholangiography / methods
  • Constriction, Pathologic / diagnostic imaging*
  • Constriction, Pathologic / etiology*
  • Female
  • Humans
  • Liver / diagnostic imaging*
  • Liver / pathology
  • Liver Diseases / diagnostic imaging
  • Liver Diseases / pathology
  • Liver Diseases / surgery
  • Liver Transplantation / adverse effects*
  • Liver Transplantation / diagnostic imaging*
  • Living Donors*
  • Male
  • Middle Aged
  • Postoperative Complications / diagnostic imaging
  • Radionuclide Imaging
  • Retrospective Studies