One More Problem with HIDA Scans

A recent case study (A Adeyemi et al. J Pediatr 2020; 220: 245-8) provides information on 6 infants with a subsequent diagnosis of biliary atresia who had HIDA scans which reported excretion.

Methods: HIDA scans from 1992-2012 were reviewed from CHOP, this included 223 infants up to 4 months of age.

Key findings:

  • While there were six cases with HIDA scans that showed excretion into the bowel, none of these infants had truly normal HIDA scans.
  • 4 of the 6 patients had excretion qualified as slight, mild, or subtle and faint.
  • 5 of the 6 patients did not have the gallbladder visualized on HIDA.


  • HIDA scans are well-known to have a high sensitivity but a low specificity for biliary atresia (even with pretreatment choleretic agents). Liver biopsies have a higher diagnostic accuracy.
  • Since biliary atresia is a progressive disease, some excretion on HIDA does not exclude the diagnosis.  Though, age at HIDA was not a significant variable in this small series.

My takes:

  • Don’t rely too much on any test, including HIDA scans.  Equivocal findings need to be reported as such.
  • Fortunately, MMP-7 has emerged as another quick way with good (not perfect) specificity for biliary atresia.
  • Another related caveat is to look carefully at ultrasounds in this age group.  Often a small or retracted gallbladder is overlooked and could be an important clue to the diagnosis of biliary atresia.

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  1. Pingback: Online Aspen Webinar (Part 5) -Biliary Atresia Diagnosis and Screening | gutsandgrowth

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