{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T13:18:59Z","timestamp":1768915139239,"version":"3.49.0"},"reference-count":29,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2007,1,2]],"date-time":"2007-01-02T00:00:00Z","timestamp":1167696000000},"content-version":"vor","delay-in-days":1949,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Paediatrica"],"published-print":{"date-parts":[[2001,9]]},"abstract":"<jats:p>Hepatic technetium\u201099m\u2010mebrofenin iminodiacetate (<jats:sup>99m<\/jats:sup>Tc\u2010mebrofenin IDA) scans and serum \u03b3\u2010glutamyl transpeptidase (GGTP) have high sensitivity for extrahepatic biliary atresia (EHBA). This study was based on the hypothesis that the interpretation of results of <jats:sup>99m<\/jats:sup>Tc\u2010mebrofenin IDA scans and serum GGTP levels in series would result in a reduction of the false positivity observed with these tests individually. The aetiology of neonatal cholestasis in 132 study patients was: 25% (33\/132) EHBA, 45.5% (60\/132) neonatal hepatitis (NH) with an identifiable cause and 19.7% (26\/132) idiopathic NH. Of the various clinical, biochemical and imaging parameters that were significantly different between patient groups, sensitivity for EHBA was: serum GGTP \u2265 150 IU 1<jats:sup>\u22121<\/jats:sup>(100%), <jats:sup>99m<\/jats:sup>Tc\u2010mebrofenin IDA scans (100%), pale stools (82.8%) and total serum bilirubin \u2265 12mg d1<jats:sup>\u22121<\/jats:sup> (66%). However, specificity ranged from 48.5 to 79%. Of the 63 patients who had non\u2010excreting IDA scans, operative cholangiograms could be avoided on the basis of a specific aetiological diagnosis of NH, made concurrently, in only 9 infants. The rest (54) underwent operative cholangiograms; 21 (39%) of these had patent biliary trees and therefore underwent the procedure unnecessarily. If serum GGTP (&lt;150 IU 1<jats:sup>\u22121<\/jats:sup>) had been used as a screen after IDA scanning in these 54 patients, operative cholangiograms could have been avoided in another 12 patients and thereafter only 9\/42 (21%) of the operative cholangiograms would have been considered unnecessary.<\/jats:p><jats:p> <jats:italic>Conclusion<\/jats:italic>: A diagnostic algorithm is proposed wherein serum GGTP level (at a cut\u2010off level that maintains 100% sensitivity for EHBA) is used in series with non\u2010excreting <jats:sup>99m<\/jats:sup>Tc\u2010mebrofenin IDA scans (for patients with no specific aetiological label). This strategy reduces the false positivity of individual tests.<\/jats:p>","DOI":"10.1111\/j.1651-2227.2001.tb01351.x","type":"journal-article","created":{"date-parts":[[2010,8,7]],"date-time":"2010-08-07T03:18:18Z","timestamp":1281151098000},"page":"975-981","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Hepatic technetium\u201099m\u2010mebrofenin iminodiacetate scans and serum \u03b3\u2010glutamyl transpeptidase levels interpreted in series to differentiate between extrahepatic biliary atresia and neonatal hepatitis"],"prefix":"10.1111","volume":"90","author":[{"given":"NK","family":"Arora","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R","family":"Kohli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"DK","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"CS","family":"Bal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"AK","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"SD","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2007,1,2]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(89)90012-3"},{"key":"e_1_2_1_3_2","first-page":"729","article-title":"Neonatal cholestasis syndrome: an appraisal at a tertiary care centre","volume":"33","author":"Yaccha SK","year":"1996","journal-title":"Indian Paediatr"},{"key":"e_1_2_1_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01656322"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840030112"},{"key":"e_1_2_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(87)80396-7"},{"key":"e_1_2_1_7_2","first-page":"1279","article-title":"Outcome of hepatobiliary scanning in neonatal hepatitis syndrome","volume":"38","author":"Gilmour SM","year":"1997","journal-title":"J Nucl Med"},{"key":"e_1_2_1_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01194798"},{"key":"e_1_2_1_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s002470050505"},{"key":"e_1_2_1_10_2","first-page":"254","article-title":"Serum GGTP activity in diseases of the hepatobiliary system","volume":"14","author":"Radhakrishnan T","year":"1976","journal-title":"Indian J Exp Biol"},{"key":"e_1_2_1_11_2","first-page":"755","article-title":"\u03b3\u2010Glutamyl transpeptidase and infantile biliary obstruction","volume":"136","author":"Vazquez C","year":"1982","journal-title":"Am J Dis Child"},{"key":"e_1_2_1_12_2","first-page":"134","article-title":"Use of \u03b3\u2010glutamyl transpeptidase in the diagnosis of biliary atresia","volume":"135","author":"Wright K","year":"1981","journal-title":"Am J Dis Child"},{"key":"e_1_2_1_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005176-198504000-00009"},{"key":"e_1_2_1_14_2","first-page":"395","article-title":"Use of serum \u03b3\u2010glutamyl transpeptidase to differentiate extra hepatic biliary atresia and neonatal hepatitis","volume":"72","author":"Vajaradul C","year":"1989","journal-title":"J Med Assoc Thai"},{"key":"e_1_2_1_15_2","doi-asserted-by":"publisher","DOI":"10.1136\/adc.58.8.591"},{"key":"e_1_2_1_16_2","first-page":"69","volume-title":"The interpretation of diagnostic data In: Clinical epidemiology: a basic science for clinical medicine","author":"Sackett DL","year":"1991"},{"key":"e_1_2_1_17_2","first-page":"47","article-title":"Reaction rate method for \u03b3 glutamyl transferase activity in serum","volume":"8","author":"Szasz G","year":"1977","journal-title":"Selected Methods Clin Chem"},{"key":"e_1_2_1_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0001-2998(05)80166-7"},{"key":"e_1_2_1_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.510260121"},{"key":"e_1_2_1_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005176-199101000-00005"},{"key":"e_1_2_1_21_2","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1007\/BF01983406","article-title":"Evidence for defective primary bile acid secretion in children with progressive familial intrahepatic cholestasis (Byler's disease)","volume":"153","author":"Jacquiemin E","year":"1994","journal-title":"Eur J Paediatr"},{"key":"e_1_2_1_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(05)83280-9"},{"key":"e_1_2_1_23_2","first-page":"302","article-title":"Neonatal hepatitis and extra hepatic biliary atresia associated with cytomegalovirus infection in twins","volume":"145","author":"Hart MH","year":"1991","journal-title":"Am J Dis Child"},{"key":"e_1_2_1_24_2","volume-title":"Stata statistical software. 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