Abstract
Background
Children with biliary atresia rapidly develop liver fibrosis secondary to inflammatory destruction of the biliary tract. Noninvasive detection of liver fibrosis in neonatal/infantile cholestasis is an additional criterion for the diagnosis of biliary atresia, leading to prompt surgical exploration.
Objective
To assess the value of US with acoustic radiation force impulse (ARFI) elastography to detect biliary atresia in the workup of neonatal/infantile cholestasis.
Materials and methods
In this retrospective study, 20 children with cholestasis suspected of having biliary atresia were investigated by US and ARFI. We evaluated the association between US findings and the diagnosis of biliary atresia and with two scores of liver fibrosis obtained from liver biopsy.
Results
In univariate analyses, gallbladder size, triangular cord sign, spleen size and ARFI values were found to be associated with biliary atresia, though only the triangular cord sign remained significant when elevated gamma glutamyltransferase (GGT) was included as a predictor. In contrast, spleen size and ARFI correlated with the degree of liver fibrosis on biopsy (r > 0.70, P < 0.001), which remained significant when gamma glutamyltransferase elevation was included as a predictor.
Conclusion
The addition of ARFI to a standard abdominal US in the initial workup of the neonate with possible infantile cholestasis can provide reliable information on liver fibrosis and help in the diagnosis of biliary atresia.
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References
Fischler B, Lamireau T (2014) Cholestasis in the newborn and infant. Clin Res Hepatol Gastroenterol 38:263–267
Baumann U, Ure B (2012) Biliary atresia. Clin Res Hepatol Gastroenterol 36:257–259
Chardot C, Buet C, Serinet MO et al (2013) Improving outcomes of biliary atresia: French national series 1986–2009. J Hepatol 58:1209–1217
Nakamura K, Tanoue A (2013) Etiology of biliary atresia as a developmental anomaly: recent advances. J Hepatobiliary Pancreat Sci 20:459–464
Serinet MO, Wildhaber BE, Broue P et al (2009) Impact of age at Kasai operation on its results in late childhood and adolescence: a rational basis for biliary atresia screening. Pediatrics 123:1280–1286
Takamizawa S, Zaima A, Muraji T et al (2007) Can biliary atresia be diagnosed by ultrasonography alone? J Pediatr Surg 42:2093–2096
Donia AE, Ibrahim SM, Kader MS et al (2010) Predictive value of assessment of different modalities in the diagnosis of infantile cholestasis. J Int Med Res 38:2100–2116
Mittal V, Saxena AK, Sodhi KS et al (2011) Role of abdominal sonography in the preoperative diagnosis of extrahepatic biliary atresia in infants younger than 90 days. AJR Am J Roentgenol 196:W438–W445
Shah I, Bhatnagar S, Dhabe H (2012) Clinical and biochemical factors associated with biliary atresia. Trop Gastroenterol 33:214–217
Diaz JJ, Gura KM, Roda J et al (2013) Aspartate aminotransferase to platelet ratio index correlates with hepatic cirrhosis but not with fibrosis in pediatric patients with intestinal failure. J Pediatr Gastroenterol Nutr 57:367–371
Noruegas MJ, Matos H, Goncalves I et al (2012) Acoustic radiation force impulse-imaging in the assessment of liver fibrosis in children. Pediatr Radiol 42:201–204
Hanquinet S, Rougemont AL, Courvoisier D et al (2013) Acoustic Radiation Force Impulse (ARFI) elastography for the noninvasive diagnosis of liver fibrosis in children. Pediatr Radiol 43:545–551
Shin NY, Kim MJ, Lee MJ et al (2014) Transient elastography and sonography for prediction of liver fibrosis in infants with biliary atresia. J Ultrasound Med 33:853–864
Leschied JR, Dillman JR, Bilhartz J et al (2015) Shear wave elastography helps differentiate biliary atresia from other neonatal/infantile liver diseases. Pediatr Radiol 45:366–375
Hanquinet S, Courvoisier D, Kanavaki A et al (2013) Acoustic radiation force impulse imaging-normal values of liver stiffness in healthy children. Pediatr Radiol 43:539–544
Chevallier M, Guerret S, Chossegros P et al (1994) A histological semiquantitative scoring system for evaluation of hepatic fibrosis in needle liver biopsy specimens: comparison with morphometric studies. Hepatology 20:349–355
Hartley JL, Davenport M, Kelly DA (2009) Biliary atresia. Lancet 374:1704–1713
Tan Kendrick AP, Phua KB, Ooi BC et al (2003) Biliary atresia: making the diagnosis by the gallbladder ghost triad. Pediatr Radiol 33:311–315
Wildhaber BE, Coran AG, Drongowski RA et al (2003) The Kasai portoenterostomy for biliary atresia: a review of a 27-year experience with 81 patients. J Pediatr Surg 38:1480–1485
Jiang LP, Chen YC, Ding L et al (2013) The diagnostic value of high-frequency ultrasonography in biliary atresia. Hepatobiliary Pancreat Dis Int 12:415–422
Humphrey TM, Stringer MD (2007) Biliary atresia: US diagnosis. Radiology 244:845–851
El-Guindi MA, Sira MM, Konsowa HA et al (2013) Value of hepatic subcapsular flow by color Doppler ultrasonography in the diagnosis of biliary atresia. J Gastroenterol Hepatol 28:867–872
Liu P, Li P, He W et al (2009) Liver and spleen volume variations in patients with hepatic fibrosis. World J Gastroenterol 15:3298–3302
Rendón-Macías ME, Villasís-Keever MA, Castañeda-Muciño G et al (2008) Improvement in accuracy of gamma-glutamyl transferase for differential diagnosis of biliary atresia by correlation with age. Turk J Pediatr 50:253–259
Acknowledgments
The authors thank Isabelle Bosquet, nurse of pediatric radiology Children’s Hospital Geneva, Switzerland, for data management.
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Hanquinet, S., Courvoisier, D.S., Rougemont, AL. et al. Contribution of acoustic radiation force impulse (ARFI) elastography to the ultrasound diagnosis of biliary atresia. Pediatr Radiol 45, 1489–1495 (2015). https://doi.org/10.1007/s00247-015-3352-6
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DOI: https://doi.org/10.1007/s00247-015-3352-6