Arsena Hermis, Kenny Tedja Audric, Gunarti Hesti, Leksono Tiara Putri, Kuncoro Afina Azka Latifanisa, Amaragati Adisrasti Rejeki, Makhmudi Akhmad, Gunadi Gunadi
Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia.
Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia.
Turk Arch Pediatr. 2024 Sep 2;59(5):449-453. doi: 10.5152/TurkArchPediatr.2024.24084.
Biliary atresia (BA) is an obstructive cholangiopathy that involves the intrahepatic and extrahepatic bile ducts. Ultrasound (US) can aid in evaluation of the biliary system and be efficiently used in daily practice. However, most studies on US for diagnosing BA have been conducted in developed countries. Therefore, we have aimed to evaluate the diagnostic accuracy of US in BA in infants with cholestasis from a developing country. This retrospective study used data collected from our hospital medical records. The US findings were compared with the gold standard intraoperative or cholangiography findings. Thirty-five BA patients (19 males and 16 females) and 36 controls (20 males and 16 females) were included in the study. Most of the patients (85.7%) were ≤ 6 months old. The absence of a gallbladder demonstrated 71.42% sensitivity (Sn), 91.67% specificity (Sp), 89.29% positive predictive value (PPV), 76.74% negative predictive value (NPV), 8.57 positive likelihood ratio (LR+), and 0.31 negative likelihood ratio (LR-) for diagnosing BA. The triangular cord sign demonstrated 14.28% Sn, 100% Sp, 100% PPV, 76.74% NPV, ∞ LR+, and 0.86 LR- for diagnosing BA. The combination of gallbladder absence and a positive triangular cord sign demonstrated 82.85% Sn, 91.67% Sp, 90.63% PPV, 84.61% NPV, 9.95 LR+, and 0.19 LR- for diagnosing BA. The diagnostic accuracy of US in BA is high, indicating that it can be the imaging tool of choice in infants with cholestasis. Ultrasound is safe and can be easily used in daily practice without the risk of radiation exposure.
胆道闭锁（BA）是一种累及肝内和肝外胆管的阻塞性胆管病。超声（US）有助于评估胆道系统，且能在日常实践中有效应用。然而，大多数关于超声诊断BA的研究是在发达国家进行的。因此，我们旨在评估超声对来自发展中国家的胆汁淤积婴儿BA的诊断准确性。这项回顾性研究使用了从我院病历中收集的数据。将超声检查结果与术中或胆管造影的金标准结果进行比较。35例BA患者（19例男性和16例女性）和36例对照（20例男性和16例女性）纳入研究。大多数患者（85.7%）年龄≤6个月。胆囊缺如诊断BA的敏感性（Sn）为71.42%、特异性（Sp）为91.67%、阳性预测值（PPV）为89.29%、阴性预测值（NPV）为76.74%、阳性似然比（LR+）为8.57、阴性似然比（LR-）为0.31。三角索征诊断BA的Sn为14.28%、Sp为100%、PPV为100%、NPV为76.74%、LR+为∞、LR-为0.86。胆囊缺如与三角索征阳性相结合诊断BA的Sn为82.85%、Sp为91.67%、PPV为90.63%、NPV为84.61%、LR+为9.95、LR-为0.19。超声对BA的诊断准确性较高，表明它可以成为胆汁淤积婴儿的首选成像工具。超声安全，且在日常实践中易于使用，无辐射暴露风险。
