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Preoperative imaging findings to predict 2-year native liver survival after the Kasai procedure in patients with biliary atresia

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objectives

To investigate the feasibility of using preoperative imaging indices to predict 2-year native liver survival after the Kasai procedure in patients with biliary atresia (BA).

Materials and methods

The retrospective review included 190 BA patients who underwent the Kasai procedure between 2000 and 2020, with preoperative US and/or MRI, excluding cases with less than 2-year follow-up period. Multivariable logistic regression analysis was performed to identify imaging indices to predict 2-year native liver survival. Kasai failure was defined as the need for liver transplantation or death within 2 years of the Kasai procedure.

Results

Of the 90 patients included, all had preoperative US, and 61 also had MRI. Kasai failure occurred in 52% (47/90). Preoperative US identified gallbladder length (OR 0.40, 95% CI 0.17–0.95, p = 0.039; cutoff 1.6 cm, AUC 67.66) and biliary cysts (OR 24.64, 95% CI 1.97–308.08, p = 0.013) as significant Kasai failure predictors, with a combined accuracy of 73% (60/82). For patients having both preoperative US and MRI, significant predictors were hepatic artery diameter (OR 6.75, 95% CI 1.31–34.88, p = 0.023; cutoff 2 mm, AUC 73.83) and biliary cysts (OR 23.89, 95% CI 1.43–398.82, p = 0.027) on US, and gallbladder length (OR 0.25, 95% CI 0.08–0.76, p = 0.014; cutoff 1.2 cm, AUC 74.72) and spleen size (OR 2.53, 95% CI 1.02–6.29, p = 0.045; cutoff 6.9 cm, AUC 73.72) on MRI, with a combined accuracy of 85% (52/61).

Conclusion

Preoperative US and/or MRI enhance the 2-year native liver survival prediction in BA patients after the Kasai procedure.

Clinical relevance statement

BA patients with hepatic artery diameter > 2 mm (US), gallbladder length < 1.6 cm (US) or < 1.2 cm (MRI), spleen size > 6.9 cm (MRI), and absence of biliary cysts (US/MRI) have a decreased likelihood of 2-year native liver survival.

Key Points

• Preoperative US and/or MRI can predict the probability of achieving 2-year native liver survival following the Kasai procedure.

• Combining US and MRI improved the accuracy to 85% for predicting 2-year native liver survival in BA patients.

• The hepatic artery diameter > 2 mm (US), gallbladder length < 1.6 cm (US) or < 1.2 cm (MRI), spleen size > 6.9 cm (MRI), and no biliary cysts (US/MRI) are significant predictors of Kasai failure in patients with biliary atresia.

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Abbreviations

3D:

Three-dimensional

AST:

Aspartate aminotransferase

BA:

Biliary atresia

CI:

Confidence intervals

HA:

Hepatic artery

ICC:

Interclass correlation coefficients

LT:

Liver transplant

OR:

Odds ratios

PV:

Portal vein

TC:

Triangular cord

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Funding

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

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Authors and Affiliations

  1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea

    Harim Kim, So-Young Yoo, Ji Hye Kim & Tae Yeon Jeon

  2. Biomedical Statistics Center and Research Institute for Future Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea

    Min-Ji Kim

  3. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea

    Sanghoon Lee

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  1. Harim Kim
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  2. So-Young Yoo
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Correspondence to Tae Yeon Jeon.

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Guarantor

The scientific guarantor of this publication is the corresponding author 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

Min-Ji Kim, a statistical analyst, participated as co-author of this manuscript and performed statistical analysis for this manuscript.

Informed consent

This study was approved by the Institutional Review Board of Samsung Medical Center (IRB No. 2022-05-151-001) with a waiver of informed consent.

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Institutional Review Board approval was obtained.

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This study subjects or cohorts have not been previously reported.

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  • Retrospective

  • Observational

  • Performed at one institution

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Kim, H., Yoo, SY., Kim, J.H. et al. Preoperative imaging findings to predict 2-year native liver survival after the Kasai procedure in patients with biliary atresia. Eur Radiol 34, 1493–1501 (2024). https://doi.org/10.1007/s00330-023-10055-x

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  • DOI: https://doi.org/10.1007/s00330-023-10055-x

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