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European Radiology

, Volume 28, Issue 4, pp 1771–1777 | Cite as

Early US findings of biliary atresia in infants younger than 30 days

  • Sook Min Hwang
  • Tae Yeon JeonEmail author
  • So-Young Yoo
  • Yon Ho Choe
  • Suk-Koo Lee
  • Ji Hye Kim
Paediatric

Abstract

Purpose

To investigate and compare ultrasound (US) findings for the diagnosis of biliary atresia (BA) in infants younger than 30 days with those of infants older than 30 days.

Materials and Methods

From 2000 to 2015, we reviewed hepatobiliary US images in 12 BA infants younger than 30 days (younger BA group) and 62 BA infants older than 30 days (older BA group) before Kasai procedure. Eight (67%) of younger BA group underwent follow-up US examinations before Kasai procedure. Our review of the images focused on triangular cord sign, gallbladder (GB) abnormalities, vascular changes, and signs of portal hypertension.

Results

The triangular cord sign was present in 17% of younger BA group and in 56% of older BA group (P=.024). GB abnormalities were commonly identified in both groups. The hepatic artery diameter was significantly smaller in younger BA group than in older BA group (P<.001). Signs of portal hypertension were less common in younger BA group (17%) than in older BA group (84%) (P<.001). Follow-up US of two infants in younger BA group showed a new appearance of the triangular cord sign.

Conclusion

BA infants younger than 30 days showed atypical US findings compared with those older than 30 days.

Key Points

BA infants younger than 30 days show atypical US findings.

GB abnormalities were common in both younger and older BA group.

Subsequent US examination may be helpful to diagnose BA in young infants.

Keywords

Biliary atresia Ultrasound Paediatric imaging Hepatobiliary imaging Infant 

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Tae Yeon Jeon.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• case-control study

• performed at one institution

References

  1. 1.
    Sokol RJ, Shepherd RW, Superina R, Bezerra JA, Robuck P, Hoofnagle JH (2007) Screening and outcomes in biliary atresia: summary of a National Institutes of Health workshop. Hepatology 46:566–581CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    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 123:1280–1286CrossRefPubMedGoogle Scholar
  3. 3.
    Hartley JL, Davenport M, Kelly DA (2009) Biliary atresia. Lancet 374:1704–1713CrossRefPubMedGoogle Scholar
  4. 4.
    El-Guindi MA, Sira MM, Sira AM et al (2014) Design and validation of a diagnostic score for biliary atresia. J Hepatol 61:116–123CrossRefPubMedGoogle Scholar
  5. 5.
    Saxena AK, Mittal V, Sodhi KS (2012) Triangular cord sign in biliary atresia: does it have prognostic and medicolegal significance? Radiology 263:621 author reply 621-622CrossRefPubMedGoogle Scholar
  6. 6.
    Lee SY, Kim GC, Choe BH et al (2011) Efficacy of US-guided percutaneous cholecystocholangiography for the early exclusion and type determination of biliary atresia. Radiology 261:916–922CrossRefPubMedGoogle Scholar
  7. 7.
    Azar G, Beneck D, Lane B, Markowitz J, Daum F, Kahn E (2002) Atypical morphologic presentation of biliary atresia and value of serial liver biopsies. J Pediatr Gastroenterol Nutr 34:212–215CrossRefPubMedGoogle Scholar
  8. 8.
    Lee HJ, Lee SM, Park WH, Choi SO (2003) Objective criteria of triangular cord sign in biliary atresia on US scans. Radiology 229:395–400CrossRefPubMedGoogle Scholar
  9. 9.
    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–W445CrossRefPubMedGoogle Scholar
  10. 10.
    Tan Kendrick AP, Phua KB, Ooi BC, Tan CE (2003) Biliary atresia: making the diagnosis by the gallbladder ghost triad. Pediatr Radiol 33:311–315CrossRefPubMedGoogle Scholar
  11. 11.
    Kim WS, Cheon JE, Youn BJ et al (2007) Hepatic arterial diameter measured with US: adjunct for US diagnosis of biliary atresia. Radiology 245:549–555CrossRefPubMedGoogle Scholar
  12. 12.
    Megremis SD, Vlachonikolis IG, Tsilimigaki AM (2004) Spleen length in childhood with US: normal values based on age, sex, and somatometric parameters. Radiology 231:129–134CrossRefPubMedGoogle Scholar
  13. 13.
    Humphrey TM, Stringer MD (2007) Biliary atresia: US diagnosis. Radiology 244:845–851CrossRefPubMedGoogle Scholar
  14. 14.
    Zhou LY, Wang W, Shan QY et al (2015) Optimizing the US Diagnosis of Biliary Atresia with a Modified Triangular Cord Thickness and Gallbladder Classification. Radiology 277:181–191CrossRefPubMedGoogle Scholar
  15. 15.
    Zhou L, Shan Q, Tian W, Wang Z, Liang J, Xie X (2016) Ultrasound for the Diagnosis of Biliary Atresia: A Meta-Analysis. AJR Am J Roentgenol 206:W73–W82CrossRefPubMedGoogle Scholar
  16. 16.
    Lee SM, Cheon JE, Choi YH et al (2015) Ultrasonographic Diagnosis of Biliary Atresia Based on a Decision-Making Tree Model. Korean J Radiol 16:1364–1372CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Choi SO, Park WH, Lee HJ, Woo SK (1996) ‘Triangular cord’: a sonographic finding applicable in the diagnosis of biliary atresia. J Pediatr Surg 31:363–366CrossRefPubMedGoogle Scholar
  18. 18.
    Kotb MA, Kotb A, Sheba MF et al (2001) Evaluation of the triangular cord sign in the diagnosis of biliary atresia. Pediatrics 108:416–420CrossRefPubMedGoogle Scholar
  19. 19.
    Kanegawa K, Akasaka Y, Kitamura E et al (2003) Sonographic diagnosis of biliary atresia in pediatric patients using the “triangular cord” sign versus gallbladder length and contraction. AJR Am J Roentgenol 181:1387–1390CrossRefPubMedGoogle Scholar
  20. 20.
    Farrant P, Meire HB, Mieli-Vergani G (2000) Ultrasound features of the gall bladder in infants presenting with conjugated hyperbilirubinaemia. Br J Radiol 73:1154–1158CrossRefPubMedGoogle Scholar
  21. 21.
    Lee MS, Kim MJ, Lee MJ et al (2009) Biliary atresia: color doppler US findings in neonates and infants. Radiology 252:282–289CrossRefPubMedGoogle Scholar
  22. 22.
    El-Guindi MA, Sira MM, Konsowa HA, El-Abd OL, Salem TA (2013) Value of hepatic subcapsular flow by color Doppler ultrasonography in the diagnosis of biliary atresia. J Gastroenterol Hepatol 28:867–872CrossRefPubMedGoogle Scholar
  23. 23.
    Ramesh RL, Murthy GV, Jadhav V, Ravindra S (2015) Hepatic subcapsular flow: An early marker in diagnosing biliary atresia. Indian J Radiol Imaging 25:196–197CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Sook Min Hwang
    • 1
  • Tae Yeon Jeon
    • 1
    Email author
  • So-Young Yoo
    • 1
  • Yon Ho Choe
    • 2
  • Suk-Koo Lee
    • 3
  • Ji Hye Kim
    • 1
  1. 1.Department of RadiologySamsung Medical Centre, Sungkyunkwan University School of MedicineSeoulRepublic of Korea
  2. 2.Department of PaediatricsSamsung Medical Centre, Sungkyunkwan University School of MedicineSeoulKorea
  3. 3.Department of SurgerySamsung Medical Centre, Sungkyunkwan University School of MedicineSeoulKorea

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