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Percutaneous ultrasound-guided cholecystocholangiography with microbubbles combined with liver biopsy for the assessment of suspected biliary atresia

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Abstract

Background

Percutaneous ultrasound (US)-guided cholecystocholangiography is effective in diagnosing biliary atresia for infants with a gallbladder >1.5 cm in length on US. However, whether it is still effective for other types of gallbladders needs further clarification.

Objective

To evaluate the diagnostic performance and safety of percutaneous US-guided cholecystocholangiography combined with liver biopsy in children with suspected biliary atresia and with different types of gallbladders on US.

Materials and methods

Sixty-five infants were referred for percutaneous US-guided cholecystocholangiography with microbubbles and liver biopsy after an equivocal (n=39) or highly suspected (n=26) US diagnosis of biliary atresia. Two radiologists evaluated US and percutaneous US-guided cholecystocholangiography images in consensus. One pathologist independently evaluated liver specimens. We used the unpaired t-test, Mann–Whitney U test and chi-square test to analyze the data.

Results

Of the 65 infants, 59 (90.8%) underwent a successful percutaneous US-guided cholecystocholangiography, with both sensitivity and specificity of 100%. All six infants for whom puncture failed had contracted gallbladders. The sensitivity and specificity of liver biopsy in the diagnosis of biliary atresia were 89.7% (26/29) and 83.3% (30/36), respectively. When percutaneous US-guided cholecystocholangiography and liver biopsy were combined, all infants gained correct diagnosis, and in 35 infants (97.2%, 35/36) biliary atresia could be excluded without intraoperative cholangiography. Twenty-two of 65 infants (33.8%) had fluid collections around the liver related to puncture. None of these complications needed treatment.

Conclusion

Percutaneous US-guided cholecystocholangiography combined with liver biopsy appears safe and effective for excluding or confirming biliary atresia in cholestatic infants with a dilated gallbladder on US.

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Funding

The study was funded by Guangdong Basic and Applied Basic Research Foundation (NO: 2019A1515010549).

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Authors and Affiliations

  1. Department of Medical Ultrasonics, First Affiliated Hospital, Institute for Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, People’s Republic of China

    Luyao Zhou, Shuling Chen, Guotao Wang, Wenying Zhou & Xiaoyan Xie

  2. Department of Pediatric Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

    Juntao Xie, Pengfei Gao & Huadong Chen

Authors
  1. Luyao Zhou
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  2. Juntao Xie
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  3. Pengfei Gao
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  4. Huadong Chen
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  5. Shuling Chen
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  6. Guotao Wang
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  7. Wenying Zhou
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  8. Xiaoyan Xie
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Correspondence to Luyao Zhou.

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Zhou, L., Xie, J., Gao, P. et al. Percutaneous ultrasound-guided cholecystocholangiography with microbubbles combined with liver biopsy for the assessment of suspected biliary atresia. Pediatr Radiol 52, 1075–1085 (2022). https://doi.org/10.1007/s00247-022-05280-3

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  • DOI: https://doi.org/10.1007/s00247-022-05280-3

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