Value of color Doppler ultrasonography in the differential diagnosis of cystic biliary atresia and choledochal cyst in infants

Abstract

Objective To explore the value of color Doppler ultrasonography (CDU) in the differential diagnosis of cystic biliary atresia (CBA) and choledochal cyst (CC) in infants. Methods A total of 54 infants diagnosed with hepatic portal cystic lesion in the First Affiliated Hospital of Sun Yat-sen University from January 2012 to July 2014 who were going to receive surgical treatment were included in this prospective study. Of the 54 cases, 35 were baby boys and 19 were baby girls with a mean of (63±19) d old. According to the results of pathological examination, the patients were divided into the CBA group and the CC group. All guardians of the infants signed the informed consent and the local ethical committee approval had been received. Preoperative TB level and DB level were recorded. CDU was used to observe the incidence of hepatic portal fibrous mass, intrahepatic bile duct dilation and biliary sludge sedimentation in the cyst. In addition, the length diameter and width diameter of gallbladder and the inner diameter of hepatic artery were measured. The observed parameters of two groups were compared by χ2 test or t test. Results The incidence of hepatic portal fibrous mass in CBA group was 96% (25/26), which was significantly higher than 0 (0/28) in CC group (P<0.05). The incidence of intrahepatic bile duct dilation and biliary sludge sedimentation in the cyst in CBA group were both 0 (0/26), which were significantly lower than 75% (21/28) and 54% (15/28) in CC group (P<0.05). The width diameter of gallbladder in CBA group was (5±1) mm, which was significantly less than (8±2) mm in CC group (t=-38.68, P<0.05). The inner diameter of hepatic artery in CBA group was (2.4±0.4) mm, which was significantly greater than (1.8±0.3) mm in CC group (t=28.40, P<0.05). Conclusions The hepatic portal fibrous mass, intrahepatic bile duct dilation, biliary sludge sedimentation in the cyst, width diameter of gallbladder and inner diameter of hepatic artery are effective indexes for CDU to differentiate CBA and CC, thus, CDU may be used in the preoperative differential diagnosis. Key words: Ultrasonography; Biliary atresia; Choledochal cyst; Jaundice, neonatal