Abstract
Background Early detection of biliary atresia (BA) has a vital role in prevention of liver cirrhosis in these patients. There are some evidences that triangular cord (TC) sign, i.e., triangular structure located cranial to the portal vein bifurcation on ultrasonographic examination, is suggestive of BA in suspected cases. The aim of this study is to evaluate and compare the sensitivity, specificity, and accuracy of TC sign with other methods of diagnosis such as hepatobiliary scan. Methods Fifty-eight infants referred to pediatric gastroenterology ward with diagnosis of infantile cholestasis from March 2004 to March 2008 were evaluated to find the cause of cholestasis. Diagnosis was made by means of history, clinical examination, hepatobiliary scan, and liver biopsy. Ultrasonographic examination was focused on presence of TC sign in patients. If the diagnosis was in favor of BA, patient was sent for direct cholangiography as a gold-standard test for confirmation of the diagnosis. The sensitivity, specificity, and accuracy of the tests were compared with golden standard. Results Among 58 infants with infantile cholestasis, BA was diagnosed and confirmed in 10 infants (17.2%). Hepatobiliary scintigraphy had 80% sensitivity, 72.9% specificity, and 74.1% accuracy. TC sign had 70% sensitivity, 95.8% specificity, and 91.3% accuracy. Conclusion TC sign is more accurate than hepatobiliary scan and has acceptable sensitivity and specificity for diagnosis of BA.
Similar content being viewed by others
References
Choi SO, Pare WH, Lee HJ, Woo S. Triangular cord: a sonographic finding applicable in the diagnosis of biliary atresia. J Pediatr Surg. 1996;31:363–366. doi:10.1016/S0022-3468(96)90739-3.
A-Kader HH, Balistreri WF. Neonatal hepatobiliary disease. Semin Gastrointest Dis. 1994;5:1–15.
Kotb MA, Kotb A, Sheba MF, et al. Evaluation of the triangular cord sign in the diagnosis of biliary atresia. Pediatrics. 2001;108:416–420. doi:10.1542/peds.108.2.416.
Kanegawa K, Yoshinobu A, Kitamura E, et al. Sonographic diagnosis of biliary atresia in pediatric patients using the “Triangular cord” sign versus gallbladder length and contraction. AJR Am J Roentgenol. 2003;181:1387–1390.
Dehghani SM, Haghighat M, Imanieh MH, Geramizadeh B. Comparison of different diagnostic methods in infants with cholestasis world. J Gastroenterol. 2006;12(36):5893–5896.
Park WH, Choi SO, Lee HJ, Kim SP, Zeon SK, Lee SK. A new diagnostic approach to Biliary atresia with emphasis on the ultrasonographic triangular cord sign: comparison of ultrasonography, hepatobiliary scintigraphy, and liver needle biopsy in the evaluation of infantile cholestasis. J Pediatr Surg. 1997;32:1555–1559. doi:10.1016/S0022-3468(97)90451-6.
Park WH, Choi SO, Lee HJ. The ultrasonographic “triangular cord” coupled with gallbladder images in diagnostic prediction of biliary atresia from infantile intrahepatic cholestasis. J Pediatr Surg. 1999;34(11):1706–1710. doi:10.1016/S0022-3468(99)90650-4.
Park WH, Choi SO, Lee HJ. Technical innovation for noninvasive and early diagnosis of biliary atresia: the ultrasonographic “triangular cord” sign. J Hepatobiliary Pancreat Surg. 2001;8:337–341. doi:10.1007/s005340170005.
Takamizawa S, Zaimaa A, Muraji T, et al. Can biliary atresia be diagnosed by ultrasonography alone? J Pediatr Surg. 2007;42(12):2093–2096. doi:10.1016/j.jpedsurg.2007.08.032.
Wongsawasdi L, Ukarapol N, Visrutaratna P, Singhavejsakul J, Kattipattanapong V. Diagnostic evaluation of infantile cholestasis. J Med Assoc Thai. 2008;91(3):345–349.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Imanieh, M.H., Dehghani, S.M., Bagheri, M.H. et al. Triangular Cord Sign in Detection of Biliary Atresia: Is It a Valuable Sign?. Dig Dis Sci 55, 172–175 (2010). https://doi.org/10.1007/s10620-009-0718-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-009-0718-3