Ultrasound, shear-wave elastography, and magnetic resonance imaging in native liver survivor patients with biliary atresia after Kasai portoenterostomy: correlation with medical outcome after treatment

Abstract

Background Biliary atresia (BA) is a rare obliterative cholangiopathy and Kasai portoenterostomy (KP) represents its first-line treatment; clinical and laboratory parameters together with abdominal ultrasound (US) are usually performed during the follow-up. Shear-wave elastography (SWE) is able to evaluate liver parenchyma stiffness; magnetic resonance imaging (MRI) has also been proposed to study these patients. Purpose To correlate US, SWE, and MRI imaging findings with medical outcome in patients with BA who are native liver survivors after KP. Material and Methods We retrospectively enrolled 24 patients. They were divided in two groups based on “ideal” (n = 15) or “non-ideal” (n = 9) medical outcome. US, SWE, and MRI exams were analyzed qualitatively and quantitatively for imaging signs suggestive of chronic liver disease (CLD). Results Significant differences were found in terms of liver surface ( P = 0.007) and morphology ( P = 0.013), portal vein diameter ( P = 0.012) and spleen size ( P = 0.002) by US, liver signal intensity ( P = 0.013), portal vein diameter ( P = 0.010), presence of portosystemic collaterals ( P = 0.042), and spleen size ( P = 0.001) by MRI. The evaluation of portal vein diameter (moderate, κ = 0.44), of portosystemic collaterals (good, κ = 0.78), and spleen size (very good, κ = 0.92) showed the best agreement between US and MRI. A significant ( P = 0.01) difference in liver parenchyma stiffness by SWE was also found between the two groups (cut-off = 9.6 kPa, sensitivity = 55.6%, specificity = 100%, area under the ROC curve = 0.82). Conclusion US, SWE, and MRI findings correlate with the medical outcome in native liver survivor patients with BA treated with KP.

Diagnostic performance and prognostic value of elastography in patients with biliary atresia and after hepatic portoenterostomy: protocol for a systematic review and meta-analysis

“…4 There are accumulating reports of the application of quantitative elastography methods in the diagnosis of BA and prediction of post-HPE outcomes. [5][6][7][8][9][10][11][12] However, these studies vary in the diagnostic performance and prognostic value of elastography, and they have small sample sizes. Thus, we will conduct this systematic review and meta-analysis to synthesise the results and obtain comprehensive evidence on the value of elastography in BA.…”

Machine Learning Evaluation of Biliary Atresia Patients to Predict Long-Term Outcome after the Kasai Procedure

“…For this purpose, clinical evaluation as well as laboratory tests and imaging studies are conventionally used. Imaging exams such as US and/or MR are able to depict liver and spleen anatomic conditions, providing a series of specific imaging parameters to assess the disease course [ 21 ]. Therefore, a wide spectrum of diagnostic parameters (clinical, laboratory, and imaging) is available in this setting, even though it is not well established how to use them and whether a complementary role may be hypothesized.…”

“…Biliary atresia (BA) is a rare cholangiopathy of unknown etiology, which is characterized by inflammatory obliteration of both intrahepatic and extrahepatic bile ducts [ 12 , 13 , 14 , 15 ]; an early diagnosis is needed, and Kasai portoenterostomy (KP) represents the treatment of choice [ 16 , 17 ]. During the post-surgical follow-up, diagnostic evaluation consists of monitoring clinical and laboratory data as well as performing abdominal ultrasound (US) and magnetic resonance imaging (MR) [ 18 , 19 , 20 , 21 , 22 ]. In the literature, a good correlation of qualitative imaging findings using US and/or MR with the medical outcome of BA patients with native liver after KP during follow-up was described, as well as the potential role of US and MR findings in predicting the long-term medical outcome in such patients [ 21 , 22 ].…”

“…During the post-surgical follow-up, diagnostic evaluation consists of monitoring clinical and laboratory data as well as performing abdominal ultrasound (US) and magnetic resonance imaging (MR) [ 18 , 19 , 20 , 21 , 22 ]. In the literature, a good correlation of qualitative imaging findings using US and/or MR with the medical outcome of BA patients with native liver after KP during follow-up was described, as well as the potential role of US and MR findings in predicting the long-term medical outcome in such patients [ 21 , 22 ].…”

Highlights of the development in ultrasound during the last 70 years: A historical review

“…In liver elastography, mainly shear-wave elastography has been applied and has been shown to reduce the number of liver biopsies when elastography findings are in accordance with other clinical findings (201). The most studied field of liver elastography is in chronic viral hepatitis, while the evidence is heavily dependent on the elastography method used for other etiologies (202).…”