Saqib Khan, Durre Sabih, Ali Nawaz Khan, Amir Aziz, Zahida Sabih, Muhammad Iqbal.
Comparison of Di-Isopropyl Iminodiacetic acid with Methyl Isobutyl Isonitrile in the work-up of infants with prolonged jaundice.
J Coll Physicians Surg Pak Jan ;15(3):168-9.

The study group comprised of 16 jaundiced children (mean age 3.16 months) with bilirubin levels of more than 8mg/dl. The clinical differential diagnosis included biliary atresia versus neonatal hepatitis. Informed consent was taken from all the parents. Parents were advised to omit the morning feed. All children were pretreated with phenobarbitone (5mg/ kg/day for 5 days) and imaged twice on two different days: first with Tc-99m-DISIDA and dose of 37MBq was injected intravenously. Liver images were obtained at 1, 2, 3 and 24 hours following injection. Then injection of Tc-99m-MIBI with a dose of 37MBq was injected intravenously. Anterior abdominal images with 350k counts were obtained at 10, 20, 30 and 40 minutes post injection and where appropriate delayed additional views were taken to optimize radionuclide intestinal transit. Two nuclear medicine physicians visually analyzed the scintigrams. On the basis of biliary-enteric kinetics the patients were subdivided into sub-groups: Group 1: Included 12 patients with no bowel activity with DISIDA scan but demonstrable bowel activity with MIBI liver scan with the appearance of central or peripheral abdominal activity. Group 2: Consisted of 4 patients with no bowel activity with both DISIDA and MIBI liver scans. Of the 4 patients 2 had biliary atresia confirmed at laparotomy whilst 2 children were lost to follow-up since the children had traveled from remote parts of the country.

USER COMMENTS

This abstract does not elaborate what was outcome of the study? Is MIOBi better than DISIDA or vice versa?
Posted by: shaziaumar on Mar 2005

This abstract does not elaborate what was outcome of the study? Is MIBI better than DISIDA or vice versa?
Posted by: shaziaumar on Mar 2005

MIBI is better than DISIDA in a very particular circumstance - to rule out biliary atresia. If there is activity in gut not seen on DISIDA but seen on MIBI then atresia is ruled out. However it is not a good test to diagnose atresia per se. The results (2 positives in 4 cases where MIBI showed no activity in gut - atresia patients)
Posted by: nukedoc on Apr 2005

MIBI may be better than DISIDA but as our group did experiment and saw MIBI coming in gut at 5 minutes and sometime even before that how can we rule out that MIBI is not excreted in the gut instead of coming through billary pathways?
Posted by: shaziaumar on Apr 2005

study the pharmacology of MIBI - it is "proven" that it is NOT excreted in the gut on animal models - unless you can prove otherwise. Yes MIBI has much faster dynamics than DISIDA and appears in the gut early - which goes in favour of it. We are NOT imaging the hepatobiliary system or gut - the MAIN AIM of the study is to RULE OUT biliary atresia - so if you see MIBI in the gut then the atresia is ruled out and you stop the study .. if you dont see MIBI in the gut even at delayed 24 hour images - then report "high likelihood" - it is NOT diagnostic of atresia Keep this in mind
Posted by: nukedoc on Jun 2005

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