E2143. Pediatric Hepatobiliary Scintigraphy: Biliary Atresia and Beyond
  1. Hassan Aboughalia; Children's National Hospital; George Washington University
  2. Islam Zaki; Children's National Hospital
  3. Eglal Shalaby-Rana; Children's National Hospital; George Washington University
  4. Narendra Shet; Children's National Hospital; George Washington University
Congenital and acquired hepatobiliary pathologies are frequent occurrences in the pediatric population; the spectrum of these varies according to age. Hepatobiliary scintigraphy utilizes Tc-99m-labeled hepatobiliary scintigraphic agents to provide crucial functional information that supplements the anatomic information provided by conventional imaging to ensure a correct diagnosis and a sound management plan. This exhibit aims to review the optimum technique to perform hepatobiliary scintigraphy in the pediatric clinical setting and the clinical scenarios in which hepatobiliary scintigraphy provides additional helpful information that is of significant value to the clinical team.

Educational Goals / Teaching Points
The embryological development of the gallbladder and biliary tree correlates with abnormalities that can manifest in the neonatal period and beyond. Appropriate examination preparation for hepatobiliary scintigraphy is crucial to obtain optimal results for interpretation and patient management. Cystic dilatation of the common bile duct does not always represent a type 1 choledochal cyst; in the absence of radiotracer excretion into the bowel or biliary tree, consider cystic biliary atresia in the differential diagnosis. Gallbladder (GB) dysfunction does not always mean low ejection fraction; a hyperactive GB can also cause patient discomfort. In the postoperative state, hepatobiliary scintigraphy is crucial in differentiating bile leak from an abscess.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Normal development of the GB as part of the hepatic diverticulum. Optimum patient preparation and proper scan technique for pediatric hepatobiliary scintigraphy. Normal biodistribution of hepatic biliary scintigraphy agents with emphasis on normal variants, not to be mistaken for pathologies. Neonatal period: biliary atresia and its differential, including Alagille syndrome, neonatal hepatitis, and choledochal cyst. Pediatric cholelithiasis and acute cholecystitis. Functional GB disorders; GB dyskinesia, hyperexcitable GB. Postoperative complications: biliary leakage.

Hepatobiliary scintigraphy provides valuable complementary information in pediatric patients with suspected biliary pathologies. Optimizing the scintigraphic technique to suit the pediatric population and evaluate for the pathologic condition in question is essential to ensure the appropriate diagnosis.