Kim Woo Sun, Cheon Jung-Eun, Youn Byung Jae, Yoo So-Young, Kim Wha Young, Kim In-One, Yeon Kyung Mo, Seo Jeong Kee, Park Kwi-Won
Department of Radiology, Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Chongno-Gu, Seoul, Korea.
Radiology. 2007 Nov;245(2):549-55. doi: 10.1148/radiol.2452061093. Epub 2007 Sep 21.
To prospectively evaluate the accuracy of hepatic artery diameter and hepatic artery diameter-to-portal vein diameter ratio for ultrasonographic (US) diagnosis of biliary atresia, with cholangiographic or clinical information as reference standard.
Institutional review board approval and informed consent were obtained. US was performed in 68 neonates and infants with cholestatic jaundice (mean age, 61 days; male-to-female ratio, 38:30). Biliary atresia (n = 38) was confirmed with cholangiography, and hepatitis (n = 30) was diagnosed with clinical (n = 24) or cholangiographic (n = 6) findings. Diameter of the right hepatic artery was measured with US. Right hepatic artery diameter-to-right portal vein diameter ratio was measured to determine relative enlargement of the hepatic artery. As a control group, 17 neonates and infants (mean age, 67 days; male-to-female ratio, 12:5) without jaundice underwent US of the porta hepatis. Statistical analysis was performed to compare US parameters among three groups with one-way analysis of variance. Optimal cutoff values of the hepatic artery diameter and hepatic artery diameter-to-portal vein diameter ratio for biliary atresia diagnosis were obtained with receiver operating characteristic analysis.
The diameter of the right hepatic artery in biliary atresia group (1.9 mm +/- 0.4 [standard deviation]) was significantly larger than that in the hepatitis (1.4 mm +/- 0.3) and control (1.2 mm +/- 0.2) groups (P < .001). Hepatic artery diameter-to-portal vein diameter ratio in the biliary atresia group (0.52 +/- 0.12) was larger than that in hepatitis (0.40 +/- 0.07) and in control (0.40 +/- 0.10) groups (P < .001). Optimum cutoff values for diagnosis of biliary atresia were 1.5 mm (sensitivity, 92%; specificity, 87%; accuracy, 89%) for hepatic artery diameter and 0.45 for hepatic artery diameter-to-portal vein diameter ratio (sensitivity, 76%; specificity, 79%; accuracy, 78%).
Measurement of hepatic artery diameter can be helpful in the US diagnosis of biliary atresia.
以胆管造影或临床信息作为参考标准，前瞻性评估肝动脉直径及肝动脉直径与门静脉直径之比在超声（US）诊断胆道闭锁中的准确性。
获得机构审查委员会批准并取得知情同意。对68例胆汁淤积性黄疸的新生儿及婴儿（平均年龄61天；男女比例为38:30）进行超声检查。38例经胆管造影确诊为胆道闭锁，30例根据临床（24例）或胆管造影（6例）结果诊断为肝炎。用超声测量右肝动脉直径。测量右肝动脉直径与右门静脉直径之比以确定肝动脉的相对增粗情况。作为对照组，对17例无黄疸的新生儿及婴儿（平均年龄67天；男女比例为12:5）进行肝门部超声检查。采用单因素方差分析对三组的超声参数进行统计学分析。通过受试者操作特征分析得出诊断胆道闭锁的肝动脉直径及肝动脉直径与门静脉直径之比的最佳截断值。
胆道闭锁组右肝动脉直径（1.9 mm±0.4[标准差]）显著大于肝炎组（1.4 mm±0.3）和对照组（1.2 mm±0.2）（P<.001）。胆道闭锁组肝动脉直径与门静脉直径之比（0.52±0.12）大于肝炎组（0.40±0.07）和对照组（0.40±0.10）（P<.001）。诊断胆道闭锁的最佳截断值为肝动脉直径1.5 mm（敏感性92%；特异性87%；准确性89%），肝动脉直径与门静脉直径之比为0.45（敏感性76%；特异性79%；准确性78%）。
测量肝动脉直径有助于超声诊断胆道闭锁。
