Ye Fengying, Ling Wen, Wu Qiumei, Ma Hong, Huang Zhen, Fang Yifan, Lyu Guorong, Weng Zongjie
Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
Department of Pathology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
Insights Imaging. 2024 Jun 20;15(1):154. doi: 10.1186/s13244-024-01735-3.
To evaluate the usefulness of porta hepatis lymph nodes (PHLNs) on ultrasonography (US) scans in diagnosing biliary atresia (BA) and predicting the outcomes after Kasai portoenterostomy (KPE) surgery.
A total of 668 patients from one hospital were enrolled in the study (542 non-BA and 126 BA). The independent and combined diagnostic efficacy of PHLNs, triangular cord (TC) thickness, and gallbladder morphology were assessed by drawing the receiver operating characteristic (ROC) curves and counting the area under the ROC curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The US features, histopathological findings of PHLNs, and serum total bilirubin (TBIL) levels 3 months post-KPE were correlated.
The AUC, sensitivity, specificity, PPV, and NPV of PHLNs with hyperechogenicity and a maximum length larger than 8.4 mm were 0.898, 81.8%, 97.8%, 89.6%, and 95.8%, respectively. The combination of PHLNs, TC thickness, and gallbladder morphology achieved the best overall diagnostic efficacy among all indicators with an AUC of 0.927 and a sensitivity of 99.2%. The germinal center number and bile particle number of PHLNs were positively correlated with pathological size and US echogenicity intensity of PHLNs, respectively (r = 0.591, 0.377, p = 0.001, 0.004). The pathological size of PHLNs in BA patients was negatively correlated with jaundice clearance status 3 months after KPE surgery (r = -0.385, p = 0.047).
PHLNs with hyperechogenicity and a maximum length > 8.4 mm are useful US indicators for BA diagnosis. Additionally, the enlargement of PHLNs might play a role in predicting outcomes of KPE surgery.
The article proposed for the first time that PHLNs with hyperechogenicity and a maximum length > 8.4 mm are a useful US indicator for diagnosing BA.
PHLNs may be helpful in diagnosing BA and predicting outcomes after surgery. Enlarged hyperechoic PHLNs are a useful diagnostic indicator for BA, and play a role in predicting surgical outcomes. These findings can assist clinicians in more accurately diagnosing BA, enabling more timely treatments.
评估肝门淋巴结（PHLNs）超声（US）扫描在诊断胆道闭锁（BA）及预测Kasai肝门空肠吻合术（KPE）术后结局中的作用。
本研究纳入了一家医院的668例患者（542例非BA患者和126例BA患者）。通过绘制受试者操作特征（ROC）曲线并计算ROC曲线下面积（AUC）、灵敏度、特异度、阳性预测值（PPV）和阴性预测值（NPV），评估PHLNs、三角索（TC）厚度和胆囊形态的独立及联合诊断效能。对PHLNs的超声特征、组织病理学结果与KPE术后3个月的血清总胆红素（TBIL）水平进行相关性分析。
高回声且最大长度大于8.4 mm的PHLNs的AUC、灵敏度、特异度、PPV和NPV分别为0.898、81.8%、97.8%、89.6%和95.8%。在所有指标中，PHLNs、TC厚度和胆囊形态的联合诊断效能最佳，AUC为0.927，灵敏度为99.2%。PHLNs的生发中心数量和胆汁颗粒数量分别与PHLNs的病理大小和超声回声强度呈正相关（r = 0.591，0.377；p = 0.001，0.004）。BA患者中PHLNs的病理大小与KPE术后3个月的黄疸清除状态呈负相关（r = -0.385，p = 0.047）。
高回声且最大长度>8.4 mm的PHLNs是诊断BA的有用超声指标。此外，PHLNs增大可能在预测KPE手术结局中起作用。
本文首次提出高回声且最大长度>8.4 mm的PHLNs是诊断BA的有用超声指标。
PHLNs可能有助于诊断BA并预测术后结局。增大的高回声PHLNs是诊断BA的有用指标，并在预测手术结局中起作用。这些发现可帮助临床医生更准确地诊断BA，从而实现更及时的治疗。
