Korean Journal of Radiology

  • 제16권6호
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  • Pages.1364-1372
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  • 2015
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  • 1229-6929(pISSN)
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  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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Ultrasonographic Diagnosis of Biliary Atresia Based on a Decision-Making Tree Model

  • Lee, So Mi (Department of Radiology, Seoul National University College of Medicine) ;
  • Cheon, Jung-Eun (Department of Radiology, Seoul National University College of Medicine) ;
  • Choi, Young Hun (Department of Radiology, Seoul National University College of Medicine) ;
  • Kim, Woo Sun (Department of Radiology, Seoul National University College of Medicine) ;
  • Cho, Hyun-Hye (Department of Radiology, Seoul National University College of Medicine) ;
  • Kim, In-One (Department of Radiology, Seoul National University College of Medicine) ;
  • You, Sun Kyoung (Department of Radiology, Seoul National University College of Medicine)
  • 투고 : 2015.01.13
  • 심사 : 2015.09.19
  • 발행 : 2015.11.01
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: To assess the diagnostic value of various ultrasound (US) findings and to make a decision-tree model for US diagnosis of biliary atresia (BA). Materials and Methods: From March 2008 to January 2014, the following US findings were retrospectively evaluated in 100 infants with cholestatic jaundice (BA, n = 46; non-BA, n = 54): length and morphology of the gallbladder, triangular cord thickness, hepatic artery and portal vein diameters, and visualization of the common bile duct. Logistic regression analyses were performed to determine the features that would be useful in predicting BA. Conditional inference tree analysis was used to generate a decision-making tree for classifying patients into the BA or non-BA groups. Results: Multivariate logistic regression analysis showed that abnormal gallbladder morphology and greater triangular cord thickness were significant predictors of BA (p = 0.003 and 0.001; adjusted odds ratio: 345.6 and 65.6, respectively). In the decision-making tree using conditional inference tree analysis, gallbladder morphology and triangular cord thickness (optimal cutoff value of triangular cord thickness, 3.4mm) were also selected as significant discriminators for differential diagnosis of BA, and gallbladder morphology was the first discriminator. The diagnostic performance of the decision-making tree was excellent, with sensitivity of 100% (46/46), specificity of 94.4% (51/54), and overall accuracy of 97% (97/100). Conclusion: Abnormal gallbladder morphology and greater triangular cord thickness (> 3.4mm) were the most useful predictors of BA on US. We suggest that the gallbladder morphology should be evaluated first and that triangular cord thickness should be evaluated subsequently in cases with normal gallbladder morphology.

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참고문헌

  1. Balistreri WF, Grand R, Hoofnagle JH, Suchy FJ, Ryckman FC, Perlmutter DH, et al. Biliary atresia: current concepts and research directions. Summary of a symposium. Hepatology 1996;23:1682-1692 https://doi.org/10.1002/hep.510230652
  2. Valayer J. Conventional treatment of biliary atresia: long-term results. J Pediatr Surg 1996;31:1546-1551 https://doi.org/10.1016/S0022-3468(96)90174-8
  3. Ikeda S, Sera Y, Ohshiro H, Uchino S, Akizuki M, Kondo Y. Gallbladder contraction in biliary atresia: a pitfall of ultrasound diagnosis. Pediatr Radiol 1998;28:451-453 https://doi.org/10.1007/s002470050380
  4. Park WH, Choi SO, Lee HJ, Kim SP, Zeon SK, Lee SL. 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 https://doi.org/10.1016/S0022-3468(97)90451-6
  5. Nicotra JJ, Kramer SS, Bellah RD, Redd DC. Congenital and acquired biliary disorders in children. Semin Roentgenol 1997;32:215-227 https://doi.org/10.1016/S0037-198X(97)80008-9
  6. Visrutaratna P. Biliary atresia: making the diagnosis by the gallbladder ghost triad. Pediatr Radiol 2003;33:902; author reply 903 https://doi.org/10.1007/s00247-003-1022-6
  7. Lee HJ, Lee SM, Park WH, Choi SO. Objective criteria of triangular cord sign in biliary atresia on US scans. Radiology 2003;229:395-400 https://doi.org/10.1148/radiol.292020472
  8. 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 https://doi.org/10.1007/s005340170005
  9. Choi SO, Park WH, Lee HJ, Woo SK. 'Triangular cord': a sonographic finding applicable in the diagnosis of biliary atresia. J Pediatr Surg 1996;31:363-366 https://doi.org/10.1016/S0022-3468(96)90739-3
  10. Weinberger E, Blumhagen JD, Odell JM. Gallbladder contraction in biliary atresia. AJR Am J Roentgenol 1987;149:401-402 https://doi.org/10.2214/ajr.149.2.401
  11. Azuma T, Nakamura T, Nakahira M, Harumoto K, Nakaoka T, Moriuchi T. Pre-operative ultrasonographic diagnosis of biliary atresia--with reference to the presence or absence of the extrahepatic bile duct. Pediatr Surg Int 2003;19:475-477 https://doi.org/10.1007/s00383-003-0962-0
  12. Kim WS, Cheon JE, Youn BJ, Yoo SY, Kim WY, Kim IO, et al. Hepatic arterial diameter measured with US: adjunct for US diagnosis of biliary atresia. Radiology 2007;245:549-555 https://doi.org/10.1148/radiol.2452061093
  13. Lee MS, Kim MJ, Lee MJ, Yoon CS, Han SJ, Oh JT, et al. Biliary atresia: color doppler US findings in neonates and infants. Radiology 2009;252:282-289 https://doi.org/10.1148/radiol.2522080923
  14. El-Guindi MA, Sira MM, Konsowa HA, El-Abd OL, Salem TA. Value of hepatic subcapsular flow by color Doppler ultrasonography in the diagnosis of biliary atresia. J Gastroenterol Hepatol 2013;28:867-872 https://doi.org/10.1111/jgh.12151
  15. Hothorn T, Hornik K, Zeileis A. Unbiased recursive partitioning: a conditional inference framework. J Comput Graph Stat 2006;15:651-674 https://doi.org/10.1198/106186006X133933
  16. Zhou LY, Wang W, Shan QY, Liu BX, Zheng YL, Xu ZF, et al. Optimizing the US diagnosis of biliary atresia with a modified triangular cord thickness and gallbladder classification. Radiology 2015;277:181-191 https://doi.org/10.1148/radiol.2015142309
  17. Farrant P, Meire HB, Mieli-Vergani G. Ultrasound features of the gall bladder in infants presenting with conjugated hyperbilirubinaemia. Br J Radiol 2000;73:1154-1158 https://doi.org/10.1259/bjr.73.875.11144791
  18. Farrant P, Meire HB, Mieli-Vergani G. Improved diagnosis of extraheptic biliary atresia by high frequency ultrasound of the gall bladder. Br J Radiol 2001;74:952-954 https://doi.org/10.1259/bjr.74.886.740952
  19. Ohi R, Masaki N. The jaundiced infant: biliary atresia and other obstructions. In: O'Neill JA Jr, Rowe MI, Grosfeld JL, Fonkalsrud EW, Coran AG, eds. Pediatric surgery. Philadelphia: Mosby Elsevier, 1998:1465-1481
  20. Burton EM, Babcock DS, Heubi JE, Gelfand MJ. Neonatal jaundice: clinical and ultrasonographic findings. South Med J 1990;83:294-302 https://doi.org/10.1097/00007611-199003000-00010
  21. Kirks DR, Coleman RE, Filston HC, Rosenberg ER, Merten DF. An imaging approach to persistent neonatal jaundice. AJR Am J Roentgenol 1984;142:461-465 https://doi.org/10.2214/ajr.142.3.461
  22. Takamizawa S, Zaima A, Muraji T, Kanegawa K, Akasaka Y, Satoh S, et al. Can biliary atresia be diagnosed by ultrasonography alone? J Pediatr Surg 2007;42:2093-2096 https://doi.org/10.1016/j.jpedsurg.2007.08.032
  23. Park WH, Choi SO, Lee HJ. The ultrasonographic ‘triangular cord’ coupled with gallbladder images in the diagnostic prediction of biliary atresia from infantile intrahepatic cholestasis. J Pediatr Surg 1999;34:1706-1710 https://doi.org/10.1016/S0022-3468(99)90650-4
  24. Lee SY, Kim GC, Choe BH, Ryeom HK, Jang YJ, Kim HJ, et al. Efficacy of US-guided percutaneous cholecystocholangiography for the early exclusion and type determination of biliary atresia. Radiology 2011;261:916-922 https://doi.org/10.1148/radiol.11110665
  25. Kanegawa K, Akasaka Y, Kitamura E, Nishiyama S, Muraji T, Nishijima 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 https://doi.org/10.2214/ajr.181.5.1811387
  26. Tan Kendrick AP, Phua KB, Ooi BC, Subramaniam R, Tan CE, Goh AS. Making the diagnosis of biliary atresia using the triangular cord sign and gallbladder length. Pediatr Radiol 2000;30:69-73 https://doi.org/10.1007/s002470050017
  27. Humphrey TM, Stringer MD. Biliary atresia: US diagnosis. Radiology 2007;244:845-851 https://doi.org/10.1148/radiol.2443061051
  28. Mittal V, Saxena AK, Sodhi KS, Thapa BR, Rao KL, Das A, et al. Role of abdominal sonography in the preoperative diagnosis of extrahepatic biliary atresia in infants younger than 90 days. AJR Am J Roentgenol 2011;196:W438-W445 https://doi.org/10.2214/AJR.10.5180
  29. Han SJ, Kim MJ, Han A, Chung KS, Yoon CS, Kim D, et al. Magnetic resonance cholangiography for the diagnosis of biliary atresia. J Pediatr Surg 2002;37:599-604 https://doi.org/10.1053/jpsu.2002.31617
  30. Norton KI, Glass RB, Kogan D, Lee JS, Emre S, Shneider BL. MR cholangiography in the evaluation of neonatal cholestasis: initial results. Radiology 2002;222:687-691 https://doi.org/10.1148/radiol.2223010969
  31. Liu B, Cai J, Xu Y, Peng X, Zheng H, Huang K, et al. Threedimensional magnetic resonance cholangiopancreatography for the diagnosis of biliary atresia in infants and neonates. PLoS One 2014;9:e88268 https://doi.org/10.1371/journal.pone.0088268

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  3. Early US findings of biliary atresia in infants younger than 30 days vol.28, pp.4, 2015, https://doi.org/10.1007/s00330-017-5092-5
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  10. An Unusual Cause of Cholestasis in an Infant: Biliary Atresia Type IIB vol.31, pp.3, 2021, https://doi.org/10.1055/s-0041-1736165