Skip to main content

Use of multi-detector row CT for postoperative follow-up of biliary atresia patients with sequelae



To evaluate the usefulness of multi-detector row computed tomography (MDCT) in the postoperative long-term follow-up of biliary atresia (BA) patients for detection of esophagogastric varices due to portal hypertension and intrahepatic bile duct (IHBD) dilatations. Well-developed esophagogastric varices can cause unexpected life-threatening rupture and contribute to the progression of hepatopulmonary vascular diseases. Dilated IHBDs can trigger cholangitis.


After corrective surgery, 29 BA patients (median age 14 years, range 6 months to 27 years) with suspected long-term sequelae underwent 16-slice MDCT. Esophagogastric varices and IHBD dilatations were evaluated using reconstructed images. Detection rates for esophagogastric varices were compared between MDCT and endoscopic findings. Differences in detection rates for IHBD dilatations between MDCT and ultrasonography (US) were also investigated.


Detection rates for esophageal varices did not differ significantly between MDCT and endoscopy, while three cases positive only on MDCT, including one with hepatopulmonary syndrome, showed conspicuous peri-esophageal varices deep in the esophageal wall. MDCT showed a significantly higher detection rate than endoscopy (p = 0.03) for gastric fundal varices. MDCT with the maximum intensity projection disclosed IHBD dilatations in 17 postoperative BA cases, 15 out of which had past history of cholangitis, while US detected them in 6 cases (p = 0.003). In addition, MDCT was more advantageous for detecting IHBD dilatations, particularly those located in the posterior lobe.


Among postoperative BA patients, compared to endoscopy, MDCT had comparable and superior detection rates for esophageal and gastric fundal varices, respectively. MDCT also precisely demonstrated the location and extent of IHBD dilatations. In long-term follow-up of BA patients, MDCT can help determine follow-up strategies.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. Lai HS, Chen WJ, Chen CC, Hung WT, Chang MH (2006) Long-term prognosis and factors affecting biliary atresia from experience over a 25 year period. Chang Gung Med J 29:234–239

    PubMed  Google Scholar 

  2. Saeki M, Honna T, Nakano M, Kuroda T (1996) Portal hypertension after successful hepatic portoenterostomy in biliary atresia. Nippon Geka Gakkai Zassi 97:648–652

    CAS  Google Scholar 

  3. McKiernan PJ, Baker AJ, Kelly DA (2000) The frequency and the outcome of biliary atresia in the UK and Ireland. Lancet 355:25–29

    CAS  Article  PubMed  Google Scholar 

  4. Lykavieris P, Chardot C, Sokhn M, Gauthier F, Valayer J, Bernard O (2005) Outcome in adulthood of biliary atresia: a study of 63 patients who survived for over 20 years with their native liver. Hepatology 41:366–371

    Article  PubMed  Google Scholar 

  5. Okugawa H, Maruyama H, Kobayashi S, Yoshizumi H, Matsutani S, Yokosuka O (2009) Therapeutic effect of balloon-occluded retrograde transvenous obliteration for gastric varices in relation to haemodynamics in the short gastric vein. Br J Radiol 82:930–935

    CAS  Article  PubMed  Google Scholar 

  6. Hoeper MM, Krowka MJ, Strassburg CP (2004) Portopulmonary hypertension and hepatopulmonary syndrome. Lancet 363:1461–1468

    Article  PubMed  Google Scholar 

  7. Matsuo M, Kanematsu M, Kim T, Hori M, Takamura M, Murakami T, Kondo H, Moriyama N, Nakamura H, Hoshi H (2003) Esophageal varices: diagnosis with gadolinium-enhanced MR imaging of the liver for patients with chronic liver damage. ALR 180:461–466

    Google Scholar 

  8. Willmann JK, Weishaupt D, Bohm T, Pfammatter T, Seifert B, Marincek B, Bauerfeind P (2003) Detection of submucosal gastric fundal varices with multi-detector row CT angiography. Gut 52:886–892

    CAS  Article  PubMed  Google Scholar 

  9. Sato T, Yamazaki K, Toyota J, Karino Y, Ohmura T, Suga T (1999) Evaluation of magnetic resonance angiography in detection of gastric varices. J Gastroenterol 34:321–326

    CAS  Article  PubMed  Google Scholar 

  10. Nio M, Sano N, Ishii T, Sasaki H, Hayashi Y, Ohi R (2004) Cholangitis as a late complication in long-term survivors after surgery for biliary atresia. J Pediatr Surg 39:1797–1799

    Article  PubMed  Google Scholar 

  11. Bu LN, Chen HL, Ni YH, Peng S, Jeng YM, Lai HS, Chang MH (2003) Multiple intrahepatic biliary cysts in children with biliary atresia. J Pediatr Surg 37:1183–1187

    Article  Google Scholar 

  12. Takahashi A, Tsuchida Y, Suzuki N, Kuroiwa M, Ikeda H, Hirato J, Hatakeyama S (1999) Incidence of intrahepatic biliary cysts in biliary atresia after hepatic portoenterostomy and associated histopathologic findings in the liver and porta hepatis at diagnosis. J Pediatr Surg 34:1364–1368

    CAS  Article  PubMed  Google Scholar 

  13. Nio M, Ohi R, Shimaoka S, Iwami D, Sano N (1997) The outcome of surgery for biliary atresia and the current status of long-term survivors. Tohoku J Exp Med 181:235–244

    CAS  Article  PubMed  Google Scholar 

  14. Mitsunaga T, Yoshida H, Kouchi K, Hishiki T, Saito T, Yamada S, Sato Y, Terui K, Nakata M, Takenouchi A, Ohnuma N (2006) Pediatric gastroesophageal varices: treatment strategy and long-term results. J Pediatr Surg 41:1980–1983

    Google Scholar 

  15. Nio M, Hayashi Y, Sano N, Ishii T, Sasaki H, Ohi R (2003) Long-term efficacy of partial splenic embolization in children. J Pediatr Surg 38:1760–1762

    Article  PubMed  Google Scholar 

  16. Ferrara C, Valeri G, Salvolini L, Giovagnoni A (2002) Magnetic resonance cholangiopancreatography in primary sclerosing cholangitis in children. Pediatr Radiol 32:413–417

    Article  PubMed  Google Scholar 

  17. Chavhan GB, Roberts E, Moineddin R, Babyn PS, Manson DE (2008) Primary sclerosing cholangitis in children: utility of magnetic resonance cholangiopancreatography. Pediatr Radiol 38:868–873

    Article  PubMed  Google Scholar 

  18. The Japan Society for Portal Hypertension and Esophago-Gastric Varices (1996) The general rules for study of portal hypertension. Kinbara, Tokyo, pp 58–63

  19. Couinaud C (1957) Le Foie: Etudes anatomiques et chirurgicales. Paris, France: Masson

  20. Irisawa A, Obara K, Bhutani MS, Saito S, Shishido H, Shibukawa G, Takagi T, Yamamoto G, Seino O, Shishido F, Kasukawa R, Sato Y (2003) Role of para-esophageal collateral veins in patients with portal hypertension based on the results endoscopic ultrasonography and liver scintigraphy analysis. J Gastroenterol Hepatol 18:309–314

    Article  PubMed  Google Scholar 

  21. Watanabe M, Hori T, Kaneko M, Komuro H, Hirai M, Inoue S, Urita Y, Hoshino N (2007) Intrahepatic biliary cysts in children with biliary atresia who have had a Kasai operation. J Pediatr Surg 42:1185–1189

    Article  PubMed  Google Scholar 

  22. Liu H, Cao H, Wu ZY (2005) Magnetic resonance angiography in the management of patients with portal hypertension. Hepatobiliary Pancreat Dis Int 4:239–243

    PubMed  Google Scholar 

  23. Ono N, Toyonaga A, Nishimura H, Hayabuchi N, Tanikawa K (1997) Evaluation of magnetic resonance angiography on portosystemic collaterals in cirrhotic patients. Am J Gastroenterol 92:1515–1519

    CAS  PubMed  Google Scholar 

  24. Textor HJ, Flacke S, Pauleit D, Keller E, Neubrand M, Terjung B, Gieseke J, Scheurlen C, Sauerbruch T, Schild HH (2002) Three-dimensional magnetic resonance cholangiopancreatography with respiratory triggering in the diagnosis of primary sclerosing cholangitis: comparison with endoscopic retrograde cholangiography. Endoscopy 34:984–990

    CAS  Article  PubMed  Google Scholar 

  25. Kuroiwa M, Suzuki N, Hatakeyama S, Takahashi A, Ikeda H, Sakai M, Tsuchida Y (2001) Magnetic resonance angiography of portal collateral pathways after hepatic portoenterostomy in biliary atresia: comparison with endoscopic findings. J Pediatr Surg 36:1012–1016

    CAS  Article  PubMed  Google Scholar 

  26. Takahashi T, Kobayashi H, Kuwatsuru R, Lane GJ, Yamataka A (2007) Magnetic resonance angiography versus endoscopy for the assessment of gastroesophageal varices in biliary atresia. Pediatr Surg Int 23:931–934

    Article  PubMed  Google Scholar 

  27. Yu CY, Concejero AM, Huang TL, Chen TY, Tsang LL, Wang CC, Wang SH, Chen CL, Cheng YF (2008) Preoperative vascular evaluation in living donor liver transplantation for biliary atresia. Transpl Proc 40:2478–2480

    Article  Google Scholar 

  28. Suzuki M, Shimizu T, Kudo T, Suzuki R, Ohtsuka Y, Yamashiro Y, Shimotakahara A, Yamataka A (2006) Usefulness of nonbreath-hold 1-shot magnetic resonance cholangiopancreatography for the evaluation of choledochal cyst in children. J Pediatr Gastroenterol Nutr 42:539–544

    Article  PubMed  Google Scholar 

  29. Nakayama Y, Awai K, Funama Y, Hatemura M, Imuta M, Nakaura T, Ryu D, Morishita S, Sultana S, Sato N, Yamashita Y (2005) Abdominal CT with low tube voltage: preliminary observations about radiation dose, contrast enhancement, image quality, and noise. Radiology 237:945–951

    Article  PubMed  Google Scholar 

Download references


The authors did not receive any grants or financial support.

Conflict of interest

The authors declare no conflicts of interest.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Takeshi Saito.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Saito, T., Hishiki, T., Terui, K. et al. Use of multi-detector row CT for postoperative follow-up of biliary atresia patients with sequelae. Pediatr Surg Int 27, 309–314 (2011).

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Biliary atresia
  • Cholangitis
  • Esophageal varix
  • Gastric fundal varix
  • Multi-detector row CT
  • Portal hypertension