Ultrasonographic findings of type IIIa biliary atresia

Abstract

Purpose:To describe the ultrasonographic (US) findings of type IIIa biliary atresia.Methods:We retrospectively reviewed a medical database of patients pathologically confirmed to have biliary atresia, Kasai type IIIa, between January 2002 and May 2013 (n=18). We evaluated US findings including the visible common bile duct (CBD), triangular cord thickness, gallbladder size and shape, and subcapsular flow on color Doppler US; laboratory data; and pathological hepatic fibrosis grades. We divided them into two groups-those with visible (group A) and invisible (group B) CBD on US-and compared all parameters between the two groups.Results:CBD was visible on US in five cases (27.8%; group A) and invisible in 13 cases (72.2%; group B). US was performed at an earlier age in group A than in group B (median, 27 days vs. 60 days; P=0.027) with the maximal age of 51 days. A comparison of the US findings revealed that the triangular cord thickness was smaller (4.1 mm vs. 4.9 mm; P=0.004) and the gallbladder length was larger (20.0 mm vs. 11.7 mm; P=0.021) in group A. The gallbladder shape did not differ between the two groups, and the subcapsular flow was positive in all cases of both groups. There was no significant difference in the laboratory data between the two groups. Upon pathological analysis, group A showed low-grade and group B showed low- to high-grade hepatic fibrosis.Conclusion:When CBD is visible on US in patients diagnosed with type IIIa biliary atresia, other US features could have a false negative status. A subcapsular flow on the color Doppler US would be noted in the type IIIa biliary atresia patients.

Diagnostic Performance of Sonographic Features in Patients With Biliary Atresia: A Systematic Review and Meta‐analysis

“…Searches of the bibliographies of these articles identified no additional eligible studies. Of these 49 articles, 32 were further excluded after reviewing the full text: 13 studies that were not in the field of interest (6 studies that only included minor sonographic features, 4 studies that were associated with surgery, 2 studies that were related to choledochal cysts, and 1 study that included clinical findings of biliary atresia), 11 studies with a partially overlapping patient cohort, 5 studies with insufficient data to construct a diagnostic 2 × 2 table, 1 study with nonconsecutive patients, 1 study that included only infants younger than 90 days, and 1 non‐English article . Finally, 17 eligible studies, which included a total sample size of 1444 patients, were finally included in our meta‐analysis …”

Laparoscopic finding of a hepatic subcapsular spider-like telangiectasis sign in biliary atresia

“…Ultrasonography (US) has been widely used in differentiating BA from other causes of jaundice. Hepatic subcapsular flow (HSF) in color Doppler US was documented as being useful to predict BA[ 8 , 15 , 18 , 26 ] and had the highest performance in discriminating BA from non-BA conditions among several parameters[ 18 ]. However, most of the neonates or infants were uncooperative during color Doppler US examination and other factors, such as the doctor’s experience, machines, and patients’ respiration intensities, also played an important role.…”

Hepatic Subcapsular Flow as a Significant Diagnostic Marker for Biliary Atresia: A Meta-Analysis

“…However, the diagnostic performances of the gallbladder and hepatic arterial diameter are not satisfactory due to the low sensitivity or low specificity [18]. Recent studies have focused on the clinical value of HSF in the early diagnosis of BA [19][20][21]. HSF, which has been confirmed to correlate with mild fibrosis and inflammation of the liver, extends to the hepatic surface in all patients with BA, thus indicating that it could be a novel potential marker [20].…”

“…Recent studies have focused on the clinical value of HSF in the early diagnosis of BA [19][20][21]. HSF, which has been confirmed to correlate with mild fibrosis and inflammation of the liver, extends to the hepatic surface in all patients with BA, thus indicating that it could be a novel potential marker [20]. But its diagnostic accuracy remains inconsistent.…”