Skip to main content
Log in

Contribution of acoustic radiation force impulse (ARFI) elastography to the ultrasound diagnosis of biliary atresia

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Fischler B, Lamireau T (2014) Cholestasis in the newborn and infant. Clin Res Hepatol Gastroenterol 38:263–267

    Article  CAS  PubMed  Google Scholar 

  2. Baumann U, Ure B (2012) Biliary atresia. Clin Res Hepatol Gastroenterol 36:257–259

    Article  PubMed  Google Scholar 

  3. Chardot C, Buet C, Serinet MO et al (2013) Improving outcomes of biliary atresia: French national series 1986–2009. J Hepatol 58:1209–1217

    Article  PubMed  Google Scholar 

  4. Nakamura K, Tanoue A (2013) Etiology of biliary atresia as a developmental anomaly: recent advances. J Hepatobiliary Pancreat Sci 20:459–464

    Article  PubMed  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. Takamizawa S, Zaima A, Muraji T et al (2007) Can biliary atresia be diagnosed by ultrasonography alone? J Pediatr Surg 42:2093–2096

    Article  PubMed  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. Shah I, Bhatnagar S, Dhabe H (2012) Clinical and biochemical factors associated with biliary atresia. Trop Gastroenterol 33:214–217

    Article  PubMed  Google Scholar 

  10. 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

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. 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

    Article  PubMed  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. 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

    Article  PubMed  Google Scholar 

  16. 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

    Article  CAS  PubMed  Google Scholar 

  17. Hartley JL, Davenport M, Kelly DA (2009) Biliary atresia. Lancet 374:1704–1713

    Article  PubMed  Google Scholar 

  18. 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

    Article  PubMed  Google Scholar 

  19. 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

    Article  PubMed  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. Humphrey TM, Stringer MD (2007) Biliary atresia: US diagnosis. Radiology 244:845–851

    Article  PubMed  Google Scholar 

  22. 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

    Article  PubMed  Google Scholar 

  23. 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

    Article  PubMed Central  PubMed  Google Scholar 

  24. 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

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Isabelle Bosquet, nurse of pediatric radiology Children’s Hospital Geneva, Switzerland, for data management.

Conflicts of interest

None

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sylviane Hanquinet.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-015-3352-6

Keywords

Navigation