From the Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Y.Z., W.W., Q.Y.S., B.X.L., Y.L.Z., Z.F.X., M.X., F.S.P., X.Y.X.), and Department of Hepatobiliary Surgery (M.D.L.), First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou 510080, People's Republic of China.
Radiology. 2015 Oct;277(1):181-91. doi: 10.1148/radiol.2015142309. Epub 2015 May 6.
Purpose To evaluate the diagnostic performance of ultrasonography (US) in the identification and exclusion of biliary atresia with a modified triangular cord thickness metric together with a gallbladder classification scheme, as well as hepatic artery (HA) diameter and liver and spleen size, in a large sample of jaundiced infants. Materials and Methods The ethics committee approved this study, and written informed parental consent was obtained. In 273 infants with conjugated hyperbilirubinemia (total bilirubin level ≥ 31.2 μmol/L, with direct bilirubin level > indirect bilirubin level), detailed abdominal US was performed to exclude biliary atresia. Biliary atresia was found in 129 infants and ruled out in 144. A modified triangular cord thickness was measured at the anterior branch of the right portal vein, and a gallbladder classification scheme was identified that incorporated the appearance of the gallbladder and a gallbladder length-to-width ratio of up to 5.2 when the lumen was visualized, as well as HA diameter and liver and spleen size. Reference standard diagnosis was based on results of one or more of the following: surgery, liver biopsy, cholangiography, and clinical follow-up. Area under the receiver operating characteristic curve (AUC) analysis, binary logistic regression analysis, Fisher exact test, and unpaired t test were performed. Results Triangular cord thickness, HA diameter, ratio of gallbladder length to gallbladder width, liver size, and spleen size exhibited statistically significant differences (all P < .05) between the group with biliary atresia and the group without. AUCs of triangular cord thickness, ratio of gallbladder length to width, and HA diameter were 0.952, 0.844, and 0.838, respectively. Logistic regression analysis demonstrated that these three US parameters were significantly associated (all P < .05) with biliary atresia. The combination of triangular cord thickness and gallbladder classification could yield comparable AUCs (0.915 vs 0.933, P = .400) and a higher sensitivity (96.9% vs 92.2%), compared with triangular cord thickness alone. Conclusion By using the combination of modified triangular cord thickness and gallbladder classification scheme, most infants with biliary atresia could be identified. (©) RSNA, 2015.
目的 评估改良的三角索带厚度测量法联合胆囊分级方案，以及肝动脉（HA）直径和肝脾大小在大量黄疸婴儿中用于识别和排除先天性胆道闭锁（biliary atresia，BA）的诊断性能。
材料与方法 本研究经伦理委员会批准，所有患儿家长均签署了书面知情同意书。对 273 例结合胆红素升高（总胆红素水平≥31.2 μmol/L，直接胆红素水平>间接胆红素水平）的婴儿行详细腹部超声检查，以排除 BA。129 例婴儿确诊为 BA，144 例排除。在右门静脉前支测量改良的三角索带厚度，采用胆囊分级方案，当观察到胆囊管腔时，胆囊分级方案中包含胆囊的外观和胆囊长径与宽径比值（最大为 5.2），以及 HA 直径和肝脾大小。参考标准诊断基于以下一种或多种方法：手术、肝活检、胆管造影和临床随访。采用受试者工作特征曲线下面积（area under the receiver operating characteristic curve，AUC）分析、二元逻辑回归分析、Fisher 确切检验和独立样本 t 检验。
结果 三角索带厚度、HA 直径、胆囊长径与胆囊宽径比值、肝脾大小在 BA 组与非 BA 组间差异均有统计学意义（均 P <.05）。三角索带厚度、胆囊长径与胆囊宽径比值、HA 直径的 AUC 分别为 0.952、0.844、0.838。Logistic 回归分析显示，这 3 项 US 参数与 BA 显著相关（均 P <.05）。与单独使用三角索带厚度相比，联合三角索带厚度和胆囊分级方案的 AUC 相当（0.915 比 0.933，P =.400），且敏感性更高（96.9%比 92.2%）。
结论 采用改良的三角索带厚度和胆囊分级方案，大多数 BA 患儿可被识别。
