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Key postnatal magnetic resonance characteristics for differentiating cystic biliary atresia from choledochal cyst

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To analyze the ability of magnetic resonance (MR) to identify cystic biliary atresia (CBA) and choledochal cyst (CC).

Methods

Infants (≤ 1 year old) who were diagnosed with CBA or CC type I/IV from January 2010 to July 2023 were retrospectively reviewed. Imaging characteristics on MR were compared between the CBA and CC groups. Binary logistic regression and the area under the receiver operating characteristic curve (AUC) were analyzed for the identification of CBA.

Results

Sixty-three patients with CBA (median age, 30 days) and 172 patients with CC (median age, 60 days) were included. Gallbladder (GB) wall thickness (cutoff, 1.2 mm) showed 98.4% sensitivity and 100% specificity (AUC, 0.998). MR-triangular cord thickness (MR-TCT) (cutoff, 4.1 mm) showed 100% sensitivity and 95.9% specificity (AUC, 0.986). The bile duct loop visualization showed 96.8% sensitivity and 100% specificity (AUC, 0.984). Proximal bile duct (PBD) diameter (cutoff, 1.3 mm) showed 92.1% sensitivity and 95.3% specificity (AUC, 0.977). Cyst wall thickness (cutoff, 1 mm) showed 77.8% sensitivity and 95.3% specificity (AUC, 0.942). The combination of GB wall thickness > 1.2 mm and MR-TCT > 4.1 mm, GB wall thickness > 1.2 mm and loop visualization, GB wall thickness > 1.2 mm, and cyst wall thickness > 1 mm showed 100% sensitivity and 100% specificity (AUC, 1.000).

Conclusions

Imaging characteristics on MR might be used to identify CBA and CC, and the combination of GB wall thickness and MR-TCT, or loop visualization, or cyst wall thickness, has a perfect diagnostic value.

Clinical relevance statement

Early and accurate differentiation of CBA and CC is essential, but current methods rely on inherently subjective ultrasound. Biliary features on MRI allow for an objective, accurate diagnosis.

Key Points

  • Cystic biliary atresia and choledochal cysts have similar clinical presentations, but require different treatments at different ages.

  • Examined MR features eliminate ultrasound related subjectivity and diagnose cystic biliary atresia with nearly perfect accuracy.

  • Early and accurate differentiation between these entities allows for timely life-saving intervention.

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Abbreviations

AUC:

Area under the ROC curve

BA:

Biliary atresia

CBA:

Cystic biliary atresia

CC:

Choledochal cyst

GB:

Gallbladder

MPR:

Multiplanar reconstruction

MR:

Magnetic resonance

MRCP:

Magnetic resonance cholangiopancreatography

ROC:

Receiver operating characteristic

TC:

Triangular cord

TCT:

Triangular cord thickness

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Funding

This study has received funding from the project of Guangzhou Municipal Science and Technology Bureau (Grant No. 2024A03J1008).

Author information

Authors and Affiliations

  1. Department of Radiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, 510623, China

    Fan He & Hongsheng Liu

  2. Department of Neonatal Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, 510623, China

    Xisi Guan

  3. Department of Medical Ultrasonics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, 510623, China

    Boyang Yang

Authors
  1. Fan He
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  3. Boyang Yang
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  4. Hongsheng Liu
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Corresponding authors

Correspondence to Boyang Yang or Hongsheng Liu.

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Guarantor

The scientific guarantor of this publication is Dr Hongsheng Liu.

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

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

The study subjects or cohorts have not been reported.

Methodology

  • Retrospective

  • Diagnostic study

  • Performed at one institution

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He, F., Guan, X., Yang, B. et al. Key postnatal magnetic resonance characteristics for differentiating cystic biliary atresia from choledochal cyst. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10753-0

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  • DOI: https://doi.org/10.1007/s00330-024-10753-0

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