Abstract
PurposeTo evaluate the incremental value of a combination of magnetic resonance cholangiopancreatography (MRCP) and ultrasonography (US), compared to US alone, for diagnosing biliary atresia (BA) in neonates and young infants with cholestasis.Materials and MethodsThe institutional review board approved this retrospective study. The US and MRCP studies were both performed on 64 neonates and young infants with BA (n = 41) or without BA (non-BA) (n = 23). Two observers reviewed independently the US alone set and the combined US and MRCP set, and graded them using a five-point scale. Diagnostic performance was compared using pairwise comparison of the receiver operating characteristics (ROC) curve. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value were assessed.ResultsThe diagnostic performance (the area under the ROC curve [Az]) for diagnosing BA improved significantly after additional review of MRCP images; Az improved from 0.688 to 0.901 (P = .015) for observer 1 and from 0.676 to 0.901 (P = .011) for observer 2. The accuracy of MRCP combined with US (observer 1, 95% [61/64]; observer 2 92% [59/64]) and PPV (observer 1, 95% [40/42]; observer 2 91% [40/44]) were significantly higher than those of US alone for both observers (accuracy: observer 1, 73% [47/64], P = 0.003; observer 2, 72% [46/64], P = 0.004; PPV: observer 1, 76% [35/46], P = 0.016; observer 2, 76% [34/45], P = 0.013). Interobserver agreement of confidence levels was good for US alone (ĸ = 0.658, P < .001) and was excellent for the combined set of US and MRCP (ĸ = 0.929, P < .001).ConclusionBetter diagnostic performance was achieved with the combination of US and MRCP than with US alone for the evaluation of BA in neonates and young infants with cholestasis.
Highlights
Diagnosis of biliary atresia (BA) is of great clinical importance because timely surgical intervention can restore bile flow and prevent worsening of liver disease [1]
The accuracy of Magnetic Resonance cholangiopancreatography (MRCP) combined with US and positive predictive value (PPV) were significantly higher than those of US alone for both observers
Better diagnostic performance was achieved with the combination of US and MRCP than with US alone for the evaluation of BA in neonates and young infants with cholestasis
Summary
Diagnosis of biliary atresia (BA) is of great clinical importance because timely surgical intervention can restore bile flow and prevent worsening of liver disease [1]. Avoiding unnecessary laparotomy in patients with other causes of neonatal cholestasis is essential, as this may contribute to morbidity and a considerable proportion of patients may not have BA [2, 3]. Many investigators have endeavored to distinguish BA from non-BA patients without the use of laparotomy. A triangular cord sign, though helpful in the diagnosis, is not always present in every BA patient [4, 8]. Biochemical and histopathologic results may overlap between BA and other causes of neonatal cholestasis [2]. Magnetic Resonance cholangiopancreatography (MRCP) is another useful and non-invasive examination for biliary disease, and offers visualization of the extrahepatic biliary tree, including the confluence of the right and left hepatic ducts. A multidisciplinary approach is required to discriminate BA from non-BA in neonates and young infants
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