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Novel Scoring Systems and Age-Based Hepatic Shear Wave Stiffness Cut-Offs for Improving Sonographic Diagnosis of Biliary Atresia

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Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objectives

To make sonographic evaluation for biliary atresia (BA) more objective and reproducible using scoring systems, and evaluate hepatic shear wave elastography (SWE) as an adjunct in sonographic diagnosis of BA.

Methods

Sixty-four infants with cholestatic jaundice were enrolled between June 2016 and March 2018 in this prospective observational cohort study. Sonography and SWE was performed with SuperSonic Aixplorer system. Novel scoring systems were developed incorporating established sonographic parameters and hepatic stiffness values and analysed using SPSS software.

Results

Of the 18 patients confirmed as BA, 3 were misdiagnosed on conventional sonography (16.7%) as non-BA. Gall bladder (GB) wall irregularity and fasting GB length were the most accurate (93.8%) and most specific (97.8%) individual parameters, respectively. A significant difference was noted in the triangular cord (TC) thickness of BA and non-BA infants (p <0.001), with a high specificity of 95.6% for a 4 mm cut-off value for a positive TC sign. Comparison of hepatic SWE stiffness among age-matched groups of BA and non-BA showed significant differences (≤60 d: p = 0.003; >60 d: p <0.001) but with a reduced accuracy (93.8%). Diagnostic accuracy of greyscale scoring system (96.9%), greyscale + elastography scoring system in ≤60 d (94.4%) and >60 d (97.8%) were better than that of conventional sonographic diagnosis (93.8%).

Conclusions

Grey scale scoring system improves the accuracy of sonographic diagnosis of BA without any additional cost or time penalty along with making it universally reproducible. SWE has only an adjunctive role, if any, in the sonographic diagnosis of BA.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India

    Praveen Kesav Ramaswamy, Manisha Jana, Raju Sharma, Devasenathipathy Kandasamy & Arun Kumar Gupta

  2. Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India

    Veereshwar Bhatnagar & Sandeep Agarwala

  3. Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India

    Rohan Malik

  4. Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

    Prasenjit Das & Siddhartha Datta Gupta

Authors
  1. Praveen Kesav Ramaswamy
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  2. Manisha Jana
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  3. Raju Sharma
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  4. Devasenathipathy Kandasamy
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  5. Arun Kumar Gupta
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  6. Veereshwar Bhatnagar
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  7. Sandeep Agarwala
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  9. Prasenjit Das
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  10. Siddhartha Datta Gupta
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Contributions

PKR: Patient evaluation, follow-up, data compilation and manuscript writing; MJ: Concept, manuscript review, patient and imaging data review; RS, DK, AKG: Manuscript and literature review; VB, SA: Surgical data input, manuscript and literature review; RM: Clinical details, manuscript and literature review; PD, SDG: Pathology input, manuscript and literature review. RS will act as guarantor for this manuscript.

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Correspondence to Manisha Jana.

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Ramaswamy, P.K., Jana, M., Sharma, R. et al. Novel Scoring Systems and Age-Based Hepatic Shear Wave Stiffness Cut-Offs for Improving Sonographic Diagnosis of Biliary Atresia. Indian J Pediatr (2023). https://doi.org/10.1007/s12098-023-04607-8

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