대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제83권5호
  • /
  • Pages.1003-1013
  • /
  • 2022
  • /
  • 1738-2637(pISSN)
  • /
  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

담도폐쇄증에서 'Triangular Cord' Sign

'Triangular Cord' Sign in Biliary Atresia

  • 이희정 (계명대학교 의과대학 동산병원 영상의학과) ;
  • 이무숙 (계명대학교 의과대학 동산병원 영상의학과) ;
  • 김진영 (계명대학교 의과대학 동산병원 영상의학과)
  • Hee Jung Lee (Department of Radiology, Keimyung University Dongsan Hospital) ;
  • Mu Sook Lee (Department of Radiology, Keimyung University Dongsan Hospital) ;
  • Jin Young Kim (Department of Radiology, Keimyung University Dongsan Hospital)
  • 투고 : 2022.06.03
  • 심사 : 2022.09.11
  • 발행 : 2022.09.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

담도폐쇄증은 원인은 알 수 없으나 간외 담도의 섬유화로 내강이 막히면서 간문부에 '섬유성 담도잔유물'의 형태로 남아있는 질환이다. 'Triangular cord' (이하 TC) sign은 간문부에 남아있는 섬유성 담도잔여물을 초음파 검사에서 나타내는 소견이다. 본 종설에서는 담도폐쇄증의 수술 및 초음파 소견의 비교, TC sign의 정의, 객관적인 진단기준, 진단의 정확도 및 감별진단에 대하여 기술하고자 한다.

Biliary atresia is an unknown etiology of extrahepatic bile duct obstruction with a 'fibrous ductal remnant,' which represents the obliterated ductal remnant in the porta hepatis. The sonographic 'triangular cord' (TC) sign has been reported to indicate a fibrous ductal remnant in the porta hepatis. In this review, we discuss the correlations among surgicopathological and sonographic findings of the porta hepatis and the definition, objective criteria, diagnostic accuracy, and differential diagnosis of the TC sign in biliary atresia.

키워드

참고문헌

  1. Landing BH. Considerations of the pathogenesis of neonatal hepatitis, biliary atresia and choledochal cyst-- the concept of infantile obstructive cholangiopathy. Prog Pediatr Surg 1974;6:113-139 
  2. Kasai M, Suzuki H, Ohashi E, Ohi R, Chiba T, Okamoto A. Technique and results of operative management of biliary atresia. World J Surg 1978;1:571-579 
  3. Gubernick JA, Rosenberg HK, Ilaslan H, Kessler A. US approach to jaundice in infants and children. Radiographics 2000;20:173-195 
  4. 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 
  5. Napolitano M, Franchi-Abella S, Damasio MB, Augdal TA, Avni FE, Bruno C, et al. Practical approach to imaging diagnosis of biliary atresia, part 1: prenatal ultrasound and magnetic resonance imaging, and postnatal ultrasound. Pediatr Radiol 2021;51:314-331 
  6. Brahee DD, Lampl BS. Neonatal diagnosis of biliary atresia: a practical review and update. Pediatr Radiol 2022;52:685-692 
  7. 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 
  8. Kasai M, Kimura S, Asakura Y, Suzuki H, Taira Y, Ohashi E. Surgical treatment of biliary atresia. J Pediatr Surg 1968;3:665-675 
  9. Ohi R, Ibrahim M. Biliary atresia. Semin Pediatr Surg 1992;1:115-124 
  10. Lee HJ, Lee SM, Park WH, Choi SO. Objective criteria of triangular cord sign in biliary atresia on US scans. Radiology 2002;229:395-400 
  11. Karrer FM, Price MR, Bensard DD, Sokol RJ, Narkewicz MR, Smith DJ, et al. Long-term results with the Kasai operation for biliary atresia. Arch Surg 1996;131:493-496 
  12. Wildhaber BE, Coran AG, Drongowski RA, Hirschl RB, Geiger JD, Lelli JL, et al. The Kasai portoenterostomy for biliary atresia: a review of a 27-year experience with 81 patients. J Pediatr Surg 2003;38:1480-1485 
  13. Hung PY, Chen CC, Chen WJ, Lai HS, Hsu WM, Lee PH, et al. Long-term prognosis of patients with biliary atresia: a 25 year summary. J Pediatr Gastroenterol Nutr 2006;42:190-195 
  14. Altman RP, Lilly JR, Greenfeld J, Weinberg A, van Leeuwen K, Flanigan L. A multivariable risk factor analysis of the portoenterostomy (Kasai) procedure for biliary atresia: twenty-five years of experience from two centers. Ann Surg 1997;226:348-353; discussion 353-355 
  15. Emblem R, Stake G, Monclair T. Progress in the treatment of biliary atresia: a plea for surgical intervention within the first two months of life in infants with persistent cholestasis. Acta Paediatr 1993;82:971-974 
  16. Davenport M, Caponcelli E, Livesey E, Hadzic N, Howard E. Surgical outcome in biliary atresia: etiology affects the influence of age at surgery. Ann Surg 2008;247:694-698 
  17. Serinet MO, Wildhaber BE, Broue P, Lachaux A, Sarles J, Jacquemin E, et al. Impact of age at Kasai operation on its results in late childhood and adolescence: a rational basis for biliary atresia screening. Pediatrics 2009;123:1280-1286 
  18. Hwang SM, Jeon TY, Yoo SY, Choe YH, Lee SK, Kim JH. Early US findings of biliary atresia in infants younger than 30 days. Eur Radiol 2018;28:1771-1777 
  19. Kim MJ, Park YN, Han SJ, Yoon CS, Yoo HS, Hwang EH, et al. Biliary atresia in neonates and infants: triangular area of high signal intensity in the porta hepatis at T2-weighted MR cholangiography with US and histopathologic correlation. Radiology 2000;215:395-401 
  20. Kim YH, Kim MJ, Shin HJ, Yoon H, Han SJ, Koh H, et al. MRI-based decision tree model for diagnosis of biliary atresia. Eur Radiol 2018;28:3422-3431 
  21. Hernanz-Schulman M, Ambrosino MM, Freeman PC, Quinn CB. Common bile duct in children: sonographic dimensions. Radiology 1995;195:193-195 
  22. Carroll BA, Oppenheimer DA, Muller HH. High-frequency real-time ultrasound of the neonatal biliary system. Radiology 1982;145:437-440 
  23. Berland LL, Lawson TL, Foley WD. Porta hepatis: sonographic discrimination of bile ducts from arteries with pulsed Doppler with new anatomic criteria. AJR Am J Roentgenol 1982;138:883-840 
  24. Lee SM, Cheon JE, Choi YH, Kim WS, Cho HH, Kim IO, et al. Ultrasonographic diagnosis of biliary atresia based on a decision-making tree model. Korean J Radiol 2015;16:1364-1372 
  25. 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 
  26. 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 
  27. Nemati M, Rafeey M, Shakeri AB. Ultrasound findings in biliary atresia: the role of triangular cord sign. Pak J Biol Sci 2009;12:95-97 
  28. 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 
  29. 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 
  30. Visrutaratna P, Wongsawasdi L, Lerttumnongtum P, Singhavejsakul J, Kattipattanapong V, Ukarapol N. Triangular cord sign and ultrasound features of the gall bladder in infants with biliary atresia. Australas Radiol 2003;47:252-256 
  31. Humphrey TM, Stringer MD. Biliary atresia: US diagnosis. Radiology 2008;244:845-851 
  32. 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 
  33. Kotb MA, Kotb A, Sheba MF, El Koofy NM, El-Karaksy HM, Abdel-Kahlik MK, et al. Evaluation of the triangular cord sign in the diagnosis of biliary atresia. Pediatrics 2001;108:416-420 
  34. Imanieh MH, Dehghani SM, Bagheri MH, Emad V, Haghighat M, Zahmatkeshan M, et al. Triangular cord sign in detection of biliary atresia: is it a valuable sign? Dig Dis Sci 2010;55:172-175 
  35. 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 
  36. 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 
  37. 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 
  38. Kim WS, Kim IO, Yeon KM, Park KW, Seo JK, Kim CJ. Choledochal cyst with or without biliary atresia in neonates and young infants: US differentiation. Radiology 1998;209:465-469