Yang Qianhui, Zhang Yanran, Meng Yu, Liu Shaowen, Zhan Jianghua
Clinical School of Pediatrics, Tianjin Medical University, Tianjin, 300070, China.
Department of General Surgery, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin University, 238 Longyan Road, Beichen District, Tianjin, 300134, China.
Pediatr Surg Int. 2025 Aug 18;41(1):251. doi: 10.1007/s00383-025-06118-3.
Previous meta-analyses have evaluated the diagnostic performance of various ultrasound (US) features in differentiating biliary atresia (BA) from infantile cholestasis, but none have specifically addressed the accuracy of these features in differentiating cystic biliary atresia (CBA) from infants with jaundice and porta hepatis cysts. We searched PubMed, Embase, Web of Science, Cochrane, China National Knowledge Infrastructure, China Biology Medicine, Wanfang, and VIP databases for articles that evaluated the US features of BA. We pooled effect estimates and constructed summary receiver operating characteristic curves, along with meta-regression and subgroup analysis. The summary sensitivity and specificity for TCS in differentiating BA from infantile cholestasis and CBA from infants with jaundice and porta hepatis cysts were 49.6% (95% CI 48.2%-51.0%) and 70.3% (95% CI 62.7%-77.2%), respectively, and 95.5% (95% CI 94.9%-96.1%) and 99.6% (95% CI 98.0%-100.0%) for the latter. For porta hepatis cysts, sensitivity and specificity were 17.1% (95% CI 13.7%-21.1%) and 84.2% (95% CI 72.1%-92.5%) in differentiating BA, and 99.0% (95% CI 97.4%-99.7%) and 91.3% (95% CI 82.8%-96.4%) for cyst size (length) in distinguishing CBA. For US-guided PTCC, sensitivity and specificity were 100.0% (95% CI 94.9%-100.0%) and 90.6% (95% CI 84.1%-95.0%) for differentiating BA from infantile cholestasis. TCS remains the relatively higher accurate and widely accepted conventional US feature for differentiating BA from infantile cholestasis and CBA from infants with jaundice and porta hepatis cysts. Porta hepatis cysts have the highest specificity for diagnosing BA, with size (length) aiding in distinguishing CBA. The undetected proportions of gallbladder abnormalities-related features were quite variable. Other US features, such as HSF, CBD, and liver stiffness, can support BA diagnosis. While US-guided PTCC is effective in certain cases, its clinical application is limited by technical complexity and patient requirements. Furthermore, artificial intelligence, especially deep learning, holds promising potential for improving the accuracy of BA diagnosis.
以往的荟萃分析评估了各种超声（US）特征在鉴别胆道闭锁（BA）与婴儿胆汁淤积方面的诊断性能，但均未专门探讨这些特征在鉴别囊性胆道闭锁（CBA）与患有黄疸和肝门部囊肿的婴儿方面的准确性。我们检索了PubMed、Embase、Web of Science、Cochrane、中国知网、中国生物医学文献数据库、万方数据库和维普数据库，以查找评估BA超声特征的文章。我们汇总效应估计值并构建汇总的受试者工作特征曲线，同时进行meta回归和亚组分析。TCS在鉴别BA与婴儿胆汁淤积以及CBA与患有黄疸和肝门部囊肿的婴儿方面的汇总敏感性和特异性分别为49.6%（95%CI 48.2%-51.0%）和70.3%（95%CI 62.7%-77.2%），而对于后者分别为95.5%（95%CI 94.9%-96.1%）和99.6%（95%CI 98.0%-100.0%）。对于肝门部囊肿，在鉴别BA时敏感性和特异性分别为17.1%（95%CI 13.7%-21.1%）和84.2%（95%CI 72.1%-92.5%），而在区分CBA时囊肿大小（长度）的敏感性和特异性分别为99.0%（95%CI 97.4%-99.7%）和91.3%（95%CI 82.8%-96.4%）。对于超声引导下经皮经肝胆道造影（PTCC），在鉴别BA与婴儿胆汁淤积时敏感性和特异性分别为100.0%（95%CI 94.9%-100.0%）和90.6%（CI 84.1%-95.0%）。TCS仍然是鉴别BA与婴儿胆汁淤积以及CBA与患有黄疸和肝门部囊肿的婴儿相对更准确且被广泛接受的传统超声特征。肝门部囊肿在诊断BA方面具有最高的特异性，囊肿大小（长度）有助于区分CBA。胆囊异常相关特征的未检测比例差异很大。其他超声特征，如肝实质血流（HSF）、胆总管（CBD）和肝脏硬度，可支持BA的诊断。虽然超声引导下PTCC在某些情况下有效，但其临床应用受到技术复杂性和患者需求的限制。此外，人工智能，尤其是深度学习，在提高BA诊断准确性方面具有广阔的潜力。
