Department of Medical Ultrasonics, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, No. 18 Daoshan Road, Gulou District, Fuzhou City, 350001, Fujian Province, People's Republic of China.
Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, the First Affiliated Hospital, Sun Yat-Sen University, No 58, Zhongshan Er Road, Guangzhou, 510080, People's Republic of China.
Eur Radiol. 2019 Dec;29(12):6699-6707. doi: 10.1007/s00330-019-06339-w. Epub 2019 Jul 11.
To prospectively assess whether the detection of hepatic hilar lymph nodes (LNs) contributes to the diagnosis of biliary atresia (BA).
A total of 80 jaundiced infants were enrolled in this study and had abdominal ultrasound (US). The hepatic hilar LNs, the gallbladder classification, and the triangular cord (TC) thickness of all infants were evaluated. The area under the receiver operating characteristic curve (AUROC) analysis, t tests, and chi-squared tests were used to compare US signs between infants with BA and those without BA.
BA was found in 45 patients and excluded in 35 patients. The length of the hepatic hilar LNs in infants with BA (median with interquartile range, 11 mm (8, 13.5)) was significantly greater than that in infants without BA (0 mm (0, 0)) (p < 0.001). The AUROCs of the enlarged hepatic hilar LNs, gallbladder classification, and TC thickness were 0.867, 0.894, and 0.832, respectively. The accuracy of LNs (87.5%) in the diagnosis of BA was close to that of the gallbladder classification scheme (88.8%) (p = 0.049) and was higher than that of the TC thickness (82.5%) (p = 0.031). The enlarged LNs had the highest sensitivity (93.3%) in distinguishing BA from non-BA.
The presence of enlarged hepatic hilar LNs is an additional highly sensitive sign for the noninvasive diagnosis of BA. Through the combination of enlarged LNs, gallbladder classification, and TC thickness, most BA could be identified.
• An enlarged hepatic hilar LN is an additional US sign for the noninvasive diagnosis of biliary atresia. • Combining enlarged hepatic hilar LNs, gallbladder classification, and TC thickness, BA could be diagnosed in most infants.
前瞻性评估肝门部淋巴结（LNs）的检出是否有助于胆道闭锁（BA）的诊断。
本研究共纳入 80 例黄疸婴儿，均行腹部超声（US）检查。评估所有婴儿的肝门部 LNs、胆囊分类和三角韧带（TC）厚度。采用受试者工作特征曲线（ROC）下面积（AUROC）分析、t 检验和卡方检验比较 BA 患儿与非 BA 患儿的 US 征象。
45 例患儿确诊为 BA，35 例患儿排除 BA。BA 患儿肝门部 LNs 长度（中位数[四分位距]，11mm[8，13.5]）明显长于非 BA 患儿（0mm[0，0]）（p<0.001）。肝门部 LNs 增大、胆囊分类和 TC 厚度的 AUROC 分别为 0.867、0.894 和 0.832。LNs 对 BA 的诊断准确率（87.5%）接近胆囊分类方案（88.8%）（p=0.049），高于 TC 厚度（82.5%）（p=0.031）。肿大 LNs 对鉴别 BA 与非 BA 的敏感性最高（93.3%）。
肝门部 LNs 增大是 BA 无创诊断的另一个高度敏感的征象。通过联合肿大 LNs、胆囊分类和 TC 厚度，可识别大多数 BA。
• 肝门部 LNs 增大是胆道闭锁无创诊断的另一个超声征象。
• 联合肿大 LNs、胆囊分类和 TC 厚度，可诊断大多数 BA。
