nach oben

Erschienen in:

23.08.2016 | Hepatobiliary-Pancreas

The porta hepatis microcyst: an additional sonographic sign for the diagnosis of biliary atresia

verfasst von: Mériam Koob, Danièle Pariente, Dalila Habes, Béatrice Ducot, Catherine Adamsbaum, Stéphanie Franchi-Abella

Erschienen in: European Radiology | Ausgabe 5/2017

Einloggen, um Zugang zu erhalten

Abstract

Objectives

To describe and evaluate an additional sonographic sign in the diagnosis of biliary atresia (BA), the microcyst of the porta hepatis, in comparison with previously described signs.

Methods

Ultrasound performed in 321 infants (mean age 55 days) with cholestasis were retrospectively analyzed. BA was surgically confirmed in 193 patients and excluded in 128. US evaluated gallbladder type (1: normal; 2: consistent with BA; 3: suspicious), triangular cord sign (TCS), microcyst and macrocyst, polysplenia syndrome, portal hypertension, and bile duct dilatation. T test and Pearson χ² test were used to compare US signs between the two groups, followed by univariate regression analysis.

Results

The highest specificity and sensitivity for BA (p < 0.001) were respectively obtained with non-visible gallbladder (100 %-13 %), macrocyst (99 %-10 %), polysplenia (99 %-11 %), microcyst (98 %-20 %), type 2 gallbladder (98 %-34 %), and TCS (97 %-30 %). Combination of signs (macro or microcyst; cyst and no bile duct dilatation; microcyst and/or TCS; type 2 gallbladder and/or cyst) provided better sensitivities (25-49 %) with similar specificities (95-98 %) (p < 0.001).

On univariate analysis, the single US signs most strongly associated with BA were polysplenia (odds ratio, OR 16.3), macrocyst (OR 14.7), TCS (OR 13.4) and microcyst (OR 8).

Conclusions

Porta hepatis microcyst is a reliable US sign for BA diagnosis.

Key Points

• The porta hepatis microcyst is a specific sign of biliary atresia.

• It was found in 31 (16.1 %) of 193 patients with biliary atresia.

• Its specificity was 98 % (p < 0.001).

• High frequency transducer and color Doppler can show the porta hepatis microcyst.

Hartley JL, Davenport M, Kelly DA (2009) Biliary atresia. Lancet 374:1704–1713CrossRefPubMed

Serinet MO, Wildhaber BE, Broue P et al (2009) Impact of age at Kasai operation on its results in late childhood and adolescence: a rational basis for biliary atresia screening. Pediatrics 123:1280–1286CrossRefPubMed

Lee SY, Kim GC, Choe BH et al (2011) Efficacy of US-guided percutaneous cholecystocholangiography for the early exclusion and type determination of biliary atresia. Radiology 261:916–922CrossRefPubMed

Siles P, Aschero A, Gorincour G et al (2014) A prospective pilot study: can the biliary tree be visualized in children younger than 3 months on magnetic resonance cholangiopancreatography? Pediatr Radiol 44:1077–1084CrossRefPubMed

Rastogi A, Krishnani N, Yachha SK, Khanna V, Poddar U, Lal R (2009) Histopathological features and accuracy for diagnosing biliary atresia by prelaparotomy liver biopsy in developing countries. J Gastroenterol Hepatol 24:97–102CrossRefPubMed

Kianifar HR, Tehranian S, Shojaei P et al (2013) Accuracy of hepatobiliary scintigraphy for differentiation of neonatal hepatitis from biliary atresia: systematic review and meta-analysis of the literature. Pediatr Radiol 43:905–919CrossRefPubMed

Choi SO, Park WH, Lee HJ, Woo SK (1996) 'Triangular cord': a sonographic finding applicable in the diagnosis of biliary atresia. J Pediatr Surg 31:363–366CrossRefPubMed

Park WH, Choi SO, Lee HJ, Kim SP, Zeon SK, Lee SL (1997) 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 32:1555–1559CrossRefPubMed

Park WH, Choi SO, Lee HJ (1999) The ultrasonographic 'triangular cord' coupled with gallbladder images in the diagnostic prediction of biliary atresia from infantile intrahepatic cholestasis. J Pediatr Surg 34:1706–1710CrossRefPubMed

10.

Imanieh MH, Dehghani SM, Bagheri MH et al (2010) Triangular cord sign in detection of biliary atresia: is it a valuable sign? Dig Dis Sci 55:172–175CrossRefPubMed

11.

Lee HJ, Lee SM, Park WH, Choi SO (2003) Objective criteria of triangular cord sign in biliary atresia on US scans. Radiology 229:395–400CrossRefPubMed

12.

Roquete ML, Ferreira AR, Fagundes ED, Castro LP, Silva RA, Penna FJ (2008) Accuracy of echogenic periportal enlargement image in ultrasonographic exams and histopathology in differential diagnosis of biliary atresia. J Pediatr (Rio J) 84:331–336

13.

Kim WS, Cheon JE, Youn BJ et al (2007) Hepatic arterial diameter measured with US: adjunct for US diagnosis of biliary atresia. Radiology 245:549–555CrossRefPubMed

14.

Lee MS, Kim MJ, Lee MJ et al (2009) Biliary atresia: color doppler US findings in neonates and infants. Radiology 252:282–289CrossRefPubMed

15.

El-Guindi MA, Sira MM, Sira AM et al (2014) Design and validation of a diagnostic score for biliary atresia. J Hepatol 61:116–123CrossRefPubMed

16.

Caponcelli E, Knisely AS, Davenport M (2008) Cystic biliary atresia: an etiologic and prognostic subgroup. J Pediatr Surg 43:1619–1624CrossRefPubMed

17.

Suzuki T, Hashimoto T, Hussein MH, Hara F, Hibi M, Kato T (2013) Biliary atresia type I cyst and choledochal cyst [corrected]: can we differentiate or not? J Hepatobiliary Pancreat Sci 20:465–470CrossRefPubMed

18.

Zhou LY, Guan BY, Li L et al (2012) Objective differential characteristics of cystic biliary atresia and choledochal cysts in neonates and young infants: sonographic findings. J Ultrasound Med 31:833–841CrossRefPubMed

19.

Kim MJ, Park YN, Han SJ et al (2000) 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 215:395–401CrossRefPubMed

20.

Shin NY, Kim MJ, Lee MJ et al (2014) Transient elastography and sonography for prediction of liver fibrosis in infants with biliary atresia. J Ultrasound Med 33:853–864CrossRefPubMed

21.

Tainaka T, Kaneko K, Nakamura S, Ono Y, Sumida W, Ando H (2008) Histological assessment of bile lake formation after hepatic portoenterostomy for biliary atresia. Pediatr Surg Int 24:265–269CrossRefPubMed

22.

Lal R, Prasad DK, Krishna P et al (2007) Biliary atresia with a "cyst at porta": management and outcome as per the cholangiographic anatomy. Pediatr Surg Int 23:773–778CrossRefPubMed

23.

Gezer HO, Oguzkurt P, Temiz A, Ince E, Ezer SS, Hicsonmez A (2015) Choledochal cysts in children: Intrahepatic ductal dilatation does not indicate true intrahepatic biliary duct disease. Turk J Gastroenterol. doi:10.5152/tjg.2015.150211 PubMed

24.

Ohi R, Ibrahim M (1992) Biliary atresia. Semin Pediatr Surg 1:115–124PubMed

25.

Tan CE, Driver M, Howard ER, Moscoso GJ (1994) Extrahepatic biliary atresia: a first-trimester event? Clues from light microscopy and immunohistochemistry. J Pediatr Surg 29:808–814CrossRefPubMed

26.

Da Ines D, Essamet W, Montoriol PF (2011) Peribiliary cysts. Hepatology 54:2271–2272PubMed

27.

Mittal V, Saxena AK, Sodhi KS et al (2011) Role of abdominal sonography in the preoperative diagnosis of extrahepatic biliary atresia in infants younger than 90 days. AJR Am J Roentgenol 196:W438–W445CrossRefPubMed

28.

Humphrey TM, Stringer MD (2007) Biliary atresia: US diagnosis. Radiology 244:845–851CrossRefPubMed

29.

Tan Kendrick AP, Phua KB, Ooi BC, Subramaniam R, Tan CE, Goh AS (2000) Making the diagnosis of biliary atresia using the triangular cord sign and gallbladder length. Pediatr Radiol 30:69–73CrossRefPubMed

30.

Jiang LP, Chen YC, Ding L et al (2013) The diagnostic value of high-frequency ultrasonography in biliary atresia. Hepatobiliary Pancreat Dis Int 12:415–422CrossRefPubMed

31.

Takamizawa S, Zaima A, Muraji T et al (2007) Can biliary atresia be diagnosed by ultrasonography alone? J Pediatr Surg 42:2093–2096CrossRefPubMed

32.

Li SX, Zhang Y, Sun M et al (2008) Ultrasonic diagnosis of biliary atresia: a retrospective analysis of 20 patients. World J Gastroenterol 14:3579–3582CrossRefPubMedPubMedCentral

33.

Saxena AK, Mittal V, Sodhi KS (2012) Triangular cord sign in biliary atresia: does it have prognostic and medicolegal significance? Radiology 263:621, author reply 621-622CrossRefPubMed

34.

Zhou LY, Wang W, Shan QY et al (2015) Optimizing the US diagnosis of biliary atresia with a modified triangular cord thickness and gallbladder classification. Radiology. doi:10.1148/radiol.2015142309:142309

35.

Sun Y, Zheng S, Qian Q (2011) Ultrasonographic evaluation in the differential diagnosis of biliary atresia and infantile hepatitis syndrome. Pediatr Surg Int 27:675–679CrossRefPubMed

36.

Aziz S, Wild Y, Rosenthal P, Goldstein RB (2011) Pseudo gallbladder sign in biliary atresia--an imaging pitfall. Pediatr Radiol 41:620–626, quiz 681-622CrossRefPubMedPubMedCentral

37.

Matar M, Ayoubi JM, Picone O (2014) Prenatal diagnosis of gallbladder abnormalities: a review. J Gynecol Obstet Biol Reprod (Paris) 43:581–586CrossRef

38.

Peng SS, Jeng YM, Hsu WM, Yang JC, Ho MC (2015) Hepatic ADC map as an adjunct to conventional abdominal MRI to evaluate hepatic fibrotic and clinical cirrhotic severity in biliary atresia patients. Eur Radiol 25:2992–3002CrossRefPubMed

Titel: The porta hepatis microcyst: an additional sonographic sign for the diagnosis of biliary atresia
verfasst von: Mériam Koob
Danièle Pariente
Dalila Habes
Béatrice Ducot
Catherine Adamsbaum
Stéphanie Franchi-Abella
Publikationsdatum: 23.08.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 5/2017
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-016-4546-5

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

The porta hepatis microcyst: an additional sonographic sign for the diagnosis of biliary atresia