Does Supersonic Shear Wave Elastography Help Differentiate Biliary Atresia from Other Causes of Cholestatic Hepatitis in Infants Less than 90 Days Old? Compared with Grey-Scale US.

Xingxing Duan,Wengang Liu,Jie Zhang,Ya Peng,Liu Yang

doi:10.1155/2019/9036362

Abstract

Purpose To investigate the diagnostic performance of shear wave elastography (SWE) for measuring liver stiffness to identify and differentiate biliary atresia (BA) from cholestatic hepatitis in infants younger than 90 days. Methods A total of 138 infants younger than 90 days with cholestatic hepatitis were examined by SWE. The infants were subclassified into BA and nonbiliary atresia (non-BA) groups. Receiver operating characteristic (ROC) analysis was used to determine the sensitivity and specificity of hepatic Young's modulus measurements, the ultrasonic findings in the differential diagnosis of suspected BA, and the cut-off value to diagnose BA. Results In all infants with cholestatic hepatitis, the cut-off value of hepatic Young's modulus to differentiate the BA group from the non-BA group was 12.35 kPa and the area under the ROC curve (AUC) was 0.937, with a sensitivity of 84.3% and a specificity of 89.7%; nevertheless the AUC of the abnormal gallbladder (AbGB) was 0.940, with a sensitivity of 96.1% and a specificity of 92.0%. In the parallel test, triangular cord (TC) sign combined with AbGB had the best diagnostic performance and the AUC was 0.960, with a sensitivity of 100% and a specificity of 92.0%. In the serial test, SWE combined with AbGB achieved the best diagnostic performance; the AUC was 0.902, the sensitivity and specificity were 80.4% and 100%, respectively. Conclusions SWE could not only help differentiate BA from cholestatic hepatic diseases but also increase the diagnostic specificity when combined with grey-scale ultrasound in the serial test.

Highlights

Biliary atresia (BA) is a pediatric hepatic disease of unknown etiology that is characterized by biliary obliteration and progressive liver fibrosis [1]
Among the 138 infants suspected of having cholestatic hepatitis, 51 were diagnosed as having BA via surgery and pathological findings
The remaining 87 infants had a condition other than BA diagnosed by surgery or liver biopsy and/or blood biochemistry examination and clinical assessment and for this reason they were assigned into the non-BA group

Summary

Introduction

Biliary atresia (BA) is a pediatric hepatic disease of unknown etiology that is characterized by biliary obliteration and progressive liver fibrosis [1]. The similarity in clinical presentation and blood biochemistry results between patients with BA and those with infantile hepatitis syndrome represents a great challenge to clinicians in establishing a final diagnosis [4]. The treatment of the two diseases is very different, with BA requiring surgery and infantile hepatitis often cured with only a medical treatment [5, 6]; e.g., reduced glutathione protects the liver, ursodeoxycholic acid promotes bilirubin excretion, and bifendate reduces aminotransferase. A prompt diagnosis is essential for a correct treatment decision [12]

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Results

Conclusion