Department of Radiology, Severance Hospital, Research Institute of Radiological Science, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea.
Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea.
Eur Radiol. 2020 Jun;30(6):3161-3167. doi: 10.1007/s00330-020-06656-5. Epub 2020 Feb 11.
To evaluate the implications of hepatic subcapsular and capsular flows using ultrasonography (US) in children after Kasai operation.
Children who underwent liver US including color Doppler US and microvascular imaging (MVI) from May 2017 to October 2017 were retrospectively included. Children who underwent the Kasai operation for biliary atresia were included in the Kasai group and children with normal liver were included in the control group. Using US results, the number of intrahepatic biliary cysts and the maximum diameter of the spleen were evaluated in the Kasai group. Liver stiffness values were included when patients in the Kasai group had transient elastography (TE) or shear wave elastography (SWE) results. Hepatic subcapsular and capsular flows on color Doppler US and MVI were compared between the two groups using the following scores: 0, no flow reaching the hepatic capsule; 1, any flow reaching the hepatic capsule; and 2, contiguous hepatic capsular flow. The logistic regression test was used to identify associations between age, intrahepatic biliary cysts, spleen size, SWV, TE results, and flow scores measured on Doppler US and MVI in the Kasai group using the odds ratio (OR) and 95% confidence interval (CI).
A total of 65 children (mean 7.6 ± 5.3 years), 44 in the Kasai group and 21 in the control group, were included. In the control group, one child had score 1 on MVI and others had score 0 on both Doppler US and MVI. Among the Kasai group, 28 children (63.6%) had score 1, while others had score 0 using Doppler US. Using MVI, 24 children (54.5%) had score 2, 18 children had score 1, and one child had score 0. In the Kasai group, increased liver stiffness on TE was the only factor significantly associated with the presence of subcapsular flow on color Doppler US (OR 1.225, 95% CI 1.020-1.470) and increased spleen size was the only factor significantly associated with increased flow scores on MVI (OR 1.397, 95% CI 1.002-2.724).
Detection of hepatic subcapsular, capsular flows on US would be meaningful for children after receiving the Kasai operation.
• Hepatic subcapsular or capsular flows can be useful not only for the diagnosis but also for the postoperative follow-up in patients with biliary atresia. • Increased liver stiffness and splenomegaly after the Kasai operation were associated with presence of subcapsular or capsular flow on ultrasonography. • Evaluation of hepatic subcapsular and capsular flows could be needed to assess disease progression after receiving the Kasai operation.
使用超声（US）评估Kasai 手术后儿童肝包膜下和包膜下血流的意义。
回顾性纳入 2017 年 5 月至 2017 年 10 月期间行肝脏 US 检查（包括彩色多普勒 US 和微血管成像（MVI））的儿童。Kasai 手术治疗胆道闭锁的儿童纳入 Kasai 组，肝脏正常的儿童纳入对照组。使用 US 结果评估 Kasai 组的肝内胆管囊肿数量和脾脏最大直径。当 Kasai 组的患者有瞬时弹性成像（TE）或剪切波弹性成像（SWE）结果时，纳入肝硬度值。使用以下评分比较两组之间彩色多普勒 US 和 MVI 上的肝包膜下和包膜下血流：0 分，无血流到达肝包膜；1 分，任何血流到达肝包膜；2 分，连续肝包膜血流。使用比值比（OR）和 95%置信区间（CI），使用 logistic 回归检验识别年龄、肝内胆管囊肿、脾脏大小、SWV、TE 结果和 MVI 上的多普勒 US 测量的血流评分之间的关联。
共纳入 65 名儿童（平均 7.6±5.3 岁），44 名在 Kasai 组，21 名在对照组。对照组中，1 名儿童在 MVI 上得分为 1，其余儿童在多普勒 US 和 MVI 上均得分为 0。在 Kasai 组中，28 名儿童（63.6%）的多普勒 US 评分为 1，其余儿童的评分为 0。使用 MVI，24 名儿童（54.5%）得分为 2，18 名儿童得分为 1，1 名儿童得分为 0。在 Kasai 组中，TE 上的肝硬度增加是与彩色多普勒 US 上包膜下血流存在相关的唯一因素（OR 1.225，95%CI 1.020-1.470），脾脏增大是与 MVI 上血流评分增加相关的唯一因素（OR 1.397，95%CI 1.002-2.724）。
Kasai 手术后，超声检测肝包膜下和包膜下血流对儿童具有重要意义。
• 肝包膜下或包膜下血流不仅对诊断有意义，而且对胆道闭锁患者的术后随访也有意义。
• Kasai 手术后肝硬度增加和脾肿大与超声检查中包膜下或包膜下血流的存在相关。
• 需要评估肝包膜下和包膜下血流，以评估接受 Kasai 手术后疾病的进展情况。
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