Skip to main content
SpringerLink
Log in

A prospective pilot study: Can the biliary tree be visualized in children younger than 3 months on Magnetic Resonance Cholangiopancreatography?

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

Magnetic resonance cholangiopancreatography (MRCP) could aid in the diagnosis of biliary atresia, a hepatic pathology with thin, irregular or interrupted biliary ducts. There is little published evidence of MRCP appearances in normal neonates and young infants.

Objective

To assess the use of MR cholangiopancreatography in visualizing the biliary tree in neonates and infants younger than 3 months with no hepatobiliary disorder, and to assess this visibility in relationship to the child’s age, weight, and sedation and fasting states.

Materials and methods

Between December 2008 and October 2010 our department performed MRI of the brain, orbits and face on 16 full-term neonates and infants. Each child was younger than 3 months (90 days) and without any hepatobiliary disorders. The children were scanned with a respiratory-gated 0.54 × 0.51 × 0.4-mm3 3-D MRCP sequence. We used a reading grid to assess subjectively the visibility of the extrahepatic bile ducts along with extrahepatic bile duct confluence. The visibility of the extrahepatic bile duct confluence was assessed against age, weight, and sedation and fasting states.

Results

The extrahepatic bile duct confluence was seen in 10 children out of 16 (62.5%). In the neonate sub-group (corrected age younger than 30 days), the MRCP was technically workable and the extrahepatic bile duct confluence was seen in four cases out of eight (50%). This visualization was up to 75% in the subgroup older than 30 days. However, statistically there was no significant difference in visibility of the extrahepatic bile duct confluence in relationship to age, weight or MRCP performance conditions (feeding, fasting or sedation).

Conclusion

The complete normal biliary system (extrahepatic bile duct confluence included) is not consistently visualized in infants younger than 3 months old on non-enhanced MRCP. Thus the use of MRCP to exclude a diagnosis of biliary atresia is compromised at optimal time of surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Hartley JL, Davenport M, Kelly DA (2009) Biliary atresia. Lancet 374:1704–1713

    Article  PubMed  Google Scholar 

  2. Benchimol EI, Walsh CM, Ling SC (2009) Early diagnosis of neonatal cholestatic jaundice: test at 2 weeks. Can Fam Physician 55:1184–1192

    PubMed Central  PubMed  Google Scholar 

  3. Moyer V, Freese DK, Whitington PF et al (2004) Guideline for the evaluation of cholestatic jaundice in infants: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 39:115–128

    Article  PubMed  Google Scholar 

  4. Petersen C, Davenport M (2013) Aetiology of biliary atresia: what is actually known? Orphanet J Rare Dis 8:128

    Article  PubMed Central  PubMed  Google Scholar 

  5. Lykavieris P, Chardot C, Sokhn M et al (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 

  6. Serinet M-O, Wildhaber BE, Broué 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 123:1280–1286

    Article  PubMed  Google Scholar 

  7. Chan YL, Yeung CK, Lam WW et al (1998) Magnetic resonance cholangiography – feasibility and application in the paediatric population. Pediatr Radiol 28:307–311

    Article  CAS  PubMed  Google Scholar 

  8. Guibaud L, Lachaud A, Touraine R et al (1998) MR cholangiography in neonates and infants: feasibility and preliminary applications. AJR Am J Roentgenol 170:27–31

    Article  CAS  PubMed  Google Scholar 

  9. Jaw TS, Kuo YT, Liu GC et al (1999) MR cholangiography in the evaluation of neonatal cholestasis. Radiology 212:249–256

    Article  CAS  PubMed  Google Scholar 

  10. Peng SS, Li YW, Chang MH et al (1998) Magnetic resonance cholangiography for evaluation of cholestatic jaundice in neonates and infants. J Formos Med Assoc 97:698–703

    CAS  PubMed  Google Scholar 

  11. Miyazaki T, Yamashita Y, Tang Y et al (1998) Single-shot MR cholangiopancreatography of neonates, infants, and young children. AJR Am J Roentgenol 170:33–37

    Article  CAS  PubMed  Google Scholar 

  12. Norton KI, Glass RB, Kogan D et al (2002) MR cholangiography in the evaluation of neonatal cholestasis: initial results. Radiology 222:687–691

    Article  PubMed  Google Scholar 

  13. Metreweli C, So NMC, Chu WCW et al (2004) Magnetic resonance cholangiography in children. Br J Radiol 77:1059–1064

    Article  CAS  PubMed  Google Scholar 

  14. Sodickson A, Mortele KJ, Barish MA et al (2006) Three-dimensional fast-recovery fast spin-echo MRCP: comparison with two-dimensional single-shot fast spin-echo techniques. Radiology 238:549–559

    Article  PubMed  Google Scholar 

  15. Morita S, Ueno E, Masukawa A et al (2009) Comparison of SPACE and 3D TSE MRCP at 1.5 T focusing on difference in echo spacing. Magn Reson Med Sci 8:101–105

    PubMed  Google Scholar 

  16. Humphrey TM, Stringer MD (2007) Biliary atresia: US diagnosis. Radiology 244:845–851

    Article  PubMed  Google Scholar 

  17. Kim MJ, Park YN, Han SJ et al (2000) Biliary atresia in neonates and infants: triangular area of high signal intensity in the porta hepatis at T2-weighted MR cholangiography with US and histopathologic correlation. Radiology 215:395–401

    Article  CAS  PubMed  Google Scholar 

  18. Edwards AD, Arthurs OJ (2011) Paediatric MRI under sedation: is it necessary? What is the evidence for the alternatives? Pediatr Radiol 41:1353–1364

    Article  PubMed  Google Scholar 

  19. Arthurs OJ, Edwards A, Austin T et al (2012) The challenges of neonatal magnetic resonance imaging. Pediatr Radiol 42:1183–1194

    Article  PubMed  Google Scholar 

  20. Bracken J, Heaslip I, Ryan S (2012) Chloral hydrate sedation in radiology: retrospective audit of reduced dose. Pediatr Radiol 42:349–354

    Article  PubMed  Google Scholar 

  21. Park WH, Choi SO, Lee HJ (1999) The ultrasonographic ‘triangular cord’ coupled with gallbladder images in the diagnostic prediction of biliary atresia from infantile intrahepatic cholestasis. J Pediatr Surg 34:1706–1710

    Article  CAS  PubMed  Google Scholar 

  22. Lee H-J, Lee S-M, Park W-H et al (2003) Objective criteria of triangular cord sign in biliary atresia on US scans. Radiology 229:395–400

    Article  PubMed  Google Scholar 

  23. Yang J-G, Ma D-Q, Peng Y et al (2009) Comparison of different diagnostic methods for differentiating biliary atresia from idiopathic neonatal hepatitis. Clin Imaging 33:439–446

    Article  PubMed  Google Scholar 

  24. Esmaili J, Izadyar S, Karegar I et al (2007) Biliary atresia in infants with prolonged cholestatic jaundice: diagnostic accuracy of hepatobiliary scintigraphy. Abdom Imaging 32:243–247

    Article  PubMed  Google Scholar 

  25. Sevilla A, Howman-Giles R, Saleh H et al (2007) Hepatobiliary scintigraphy with SPECT in infancy. Clin Nucl Med 32:16–23

    Article  PubMed  Google Scholar 

  26. Nwomeh BC, Caniano DA, Hogan M (2007) Definitive exclusion of biliary atresia in infants with cholestatic jaundice: the role of percutaneous cholecysto-cholangiography. Pediatr Surg Int 23:845–849

    Article  PubMed  Google Scholar 

  27. Meyers RL, Book LS, O’Gorman MA et al (2004) Percutaneous cholecysto-cholangiography in the diagnosis of obstructive jaundice in infants. J Pediatr Surg 39:16–18

    Article  PubMed  Google Scholar 

  28. Ohnuma N, Takahashi T, Tanabe M et al (1997) The role of ERCP in biliary atresia. Gastrointest Endosc 45:365–370

    Article  CAS  PubMed  Google Scholar 

  29. Ohnuma N, Takahashi H, Tanabe M et al (1997) Endoscopic retrograde cholangiopancreatography (ERCP) in biliary tract disease of infants less than one year old. Tohoku J Exp Med 181:67–74

    Article  CAS  PubMed  Google Scholar 

  30. Poddar U, Thapa BR, Bhasin DK et al (2001) Endoscopic retrograde cholangiopancreatography in the management of pancreaticobiliary disorders in children. J Gastroenterol Hepatol 16:927–931

    Article  CAS  PubMed  Google Scholar 

  31. Petersen C, Meier PN, Schneider A, et al. (2009) Endoscopic retrograde cholangiopancreaticography prior to explorative laparotomy avoids unnecessary surgery in patients suspected for biliary atresia. J Hepatol 51:1055–1060

    Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Radiology, La Timone Children’s Hospital, 264 rue Saint Pierre, 13005, Marseille, France

    Pascale Siles

  2. Department of Pediatric Radiology, La Timone Children’s Hospital, Marseille, France

    Audrey Aschero, Guillaume Gorincour, Brigitte Bourliere-Najean & Philippe Petit

  3. Department of Pediatrics, La Timone Children’s Hospital, Marseille, France

    Bertrand Roquelaure

  4. Department of Pediatric Surgery, La Timone Children’s Hospital, Marseille, France

    Arnauld Delarue

Authors
  1. Pascale Siles
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Audrey Aschero
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guillaume Gorincour
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brigitte Bourliere-Najean
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bertrand Roquelaure
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Arnauld Delarue
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Philippe Petit
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pascale Siles.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Siles, P., Aschero, A., Gorincour, G. et al. A prospective pilot study: Can the biliary tree be visualized in children younger than 3 months on Magnetic Resonance Cholangiopancreatography?. Pediatr Radiol 44, 1077–1084 (2014). https://doi.org/10.1007/s00247-014-2953-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-014-2953-9

Keywords

Search

Navigation