Analysis value of gallbladder length-to-width ratio for diagnosis of biliary atresia at different ages

Abstract

Objective To investigate the value of gallbladder length-to-width ratio(LTWR) by ultrasound for differentiating biliary atresia (BA) from other causes of hepatic cholestasis at different ages. Methods From January 2016 to June 2022, the data of 114 patients with BA and 69 patients with non-BA who underwent abdominal ultrasound and surgical exploration in the Affiliated Hospital of Zunyi Medical University were analyzed retrospectively.The demographic data, liver function, histopathology results, maximum length and maximum width of gallbladder and gallbladder LTWR measured by ultrasound were recorded. Results There were statistically significant differences between BA group and non-BA group in maximum length and width of gallbladder and gallbladder LTWR (P < 0.001). In all age groups (I: ≤30 days; II: 31–60 days; III: 61–90 days; IV: 91–120 days; V: ≥121 days), in which group III (61–90 days) had the highest area under the curve (AUC) of 0.831, and group V (≥ 121 days) had the lowest AUC of 0.548. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of gallbladder LTWR with a cut-off at 3.60 for BA in group III (61–90 days) were 84.4%, 69.2%, 87.1% ,64.3% and 80.0%, respectively. Conclusion Ultrasonography LTWR of gallbladder has certain value in the diagnosis of BA patients of all ages. The possibility of BA should be considered if the gallbladder LTWR > 3.16 as measured by ultrasound in infants with direct bilirubin increase.If the gallbladder LTWR > 3.60 at 61–90 days infants, early surgical exploration should be recommended. Level of evidence:Level IV