Upton Ashley M, Hernandez Jose A, Shneider Benjamin L, Rabbani Tebyan A, Devaraj Sridevi, Patel Kalyani R, Vasudevan Sanjeev A, Vogel Adam M, Harpavat Sanjiv
Department of Radiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
J Pediatr Gastroenterol Nutr. 2025 Aug;81(2):204-211. doi: 10.1002/jpn3.70081. Epub 2025 Jun 2.
Ultrasound exams are commonly used to evaluate infants for biliary atresia. However, ultrasound findings may be inconclusive, and more invasive diagnostic testing is often required. We hypothesized that another ultrasound finding-absence of the extrahepatic bile duct at the liver hilum (the "duct at the hilum")-could be useful.
Ultrasound exams were reviewed from infants undergoing evaluation for biliary atresia at Texas Children's Hospital during two periods. First, exams performed before 2021 were reviewed to develop a systematic approach to visualize the duct at the hilum. Second, exams performed during a subsequent 26-month period were reviewed to assess the approach's diagnostic performance.
A four-step approach to visualize the duct at the hilum was developed, based on location, position, length, and absence of blood flow specifications. The approach was then performed on 64 infants with a median age of 25 days (range: 0-170 days) and a median weight of 3.2 kg (range: 1.0-6.3 kg). The approach identified all 12 patients with biliary atresia and excluded 49 out of 52 infants without biliary atresia, for a sensitivity of 1.00 (95% confidence interval [CI]: 0.70-1.00) and specificity of 0.94 (95% CI: 0.83-0.99). The approach could be performed in feeding infants and often in <5 min.
We present a systematic approach to visualize the duct at the hilum, which does not require fasting and may efficiently exclude infants who do not have biliary atresia. Future, multisite studies are needed to determine how the approach performs in larger populations and in different healthcare settings.
超声检查常用于评估婴儿是否患有胆道闭锁。然而，超声检查结果可能不明确，通常需要更具侵入性的诊断测试。我们推测，另一种超声检查结果——肝门处肝外胆管缺如（“肝门处胆管”）——可能会有所帮助。
回顾了德克萨斯儿童医院两个时期接受胆道闭锁评估的婴儿的超声检查。首先，回顾2021年之前进行的检查，以制定一种系统的方法来观察肝门处胆管。其次，回顾随后26个月期间进行的检查，以评估该方法的诊断性能。
基于位置、方位、长度和无血流特征，开发了一种观察肝门处胆管的四步法。然后，对64名婴儿进行了该方法检查，这些婴儿的中位年龄为25天（范围：0 - 170天），中位体重为3.2千克（范围：1.0 - 6.3千克）。该方法识别出了所有12例胆道闭锁患者，并排除了52例非胆道闭锁婴儿中的49例，灵敏度为1.00（95%置信区间[CI]：0.70 - 1.00），特异度为0.94（95%CI：0.83 - 0.99）。该方法可在喂奶的婴儿中进行，且通常在5分钟内完成。
我们提出了一种观察肝门处胆管缺如的系统方法，该方法无需禁食，可能有效地排除非胆道闭锁的婴儿。未来，需要进行多中心研究，以确定该方法在更大规模人群和不同医疗环境中的表现。
