Queiroz Thais Costa Nascentes, Pinto-Silva Rogério Auguto, Fagundes Eleonora Druve Tavares, Ferreira Guilherme Domingues, Ferreira Ana Carolina Domingues, Ferreira Alexandre Rodrigues
Universidade Federal de Minas Gerais, Hospital de Clínicas, Belo Horizonte, MG, Brasil.
Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte, MG, Brasil.
Arq Gastroenterol. 2026 Mar 2;63:e25048. doi: 10.1590/S0004-2803.24612025-048. eCollection 2026.
Biliary atresia (BA) is the leading cause of cholestatic jaundice in the first months of life. Liver stiffness measurement by shear wave elastography (2D-SWE) could help discriminate BA from other causes of cholestasis.
To assess the use of abdominal ultrasound with bidimensional shear wave elastography and liver histology to diagnose Biliary Atresia in cholestatic infants. To compare the use of elastography to estimate the stage of liver fibrosis with the histologic classification.
Cholestatic infants younger than three months were divided into BA and non-BA groups (other than neonatal cholestasis). 2D-SWE measured liver stiffness, and fibrosis was measured by Metavir score. Receiver operator characteristic (ROC) curves were developed to assess whether the variables of liver stiffness could be used to identify patients with BA and the best cutoff values.
21 infants with BA and 26 non-BA were included, of which 53,2% were males. The triangular cord was seen in 15/21 (71.4%) of BA and 2/26 (7.7%) non-BA, P<0.0001. The median value of liver stiffness in the first group was 2.7 m/s (IQ 2.1/3.6) and 1.6m/s (IQ 1.2/2) in the second group, P<0.0001. The area under the ROC curve to predict BA was 0.85 (95%CI, 0.74-0.96; P<0.0001). The best cutoff value was 1.99 m/s with sensitivity 81% and specificity 73.1%. Patients with BA classified as F0-2 had mean liver stiffness values by the 2D-SWE of 1.8±0.2m/s, and F3-4, mean values of 3±0.8m/s, P=0.008.
Ultrasound and histology contribute to distinguishing BA from other diagnoses. Liver elastography is a promising tool in the differential diagnosis between BA and other causes of cholestasis, allowing the degree of fibrosis to be estimated at diagnosis.
胆道闭锁（BA）是出生后最初几个月胆汁淤积性黄疸的主要原因。通过剪切波弹性成像（二维剪切波弹性成像，2D-SWE）测量肝脏硬度有助于鉴别BA与其他胆汁淤积原因。
评估腹部超声联合二维剪切波弹性成像及肝脏组织学检查在诊断胆汁淤积性婴儿胆道闭锁中的应用。比较弹性成像用于评估肝纤维化分期与组织学分类的情况。
将3个月以下的胆汁淤积性婴儿分为BA组和非BA组（除新生儿胆汁淤积外）。二维剪切波弹性成像测量肝脏硬度，肝纤维化采用梅塔维（Metavir）评分。绘制受试者操作特征（ROC）曲线，以评估肝脏硬度变量是否可用于识别BA患者及最佳截断值。
纳入21例BA患儿和26例非BA患儿，其中53.2%为男性。三角索在21例BA患儿中的15例（71.4%）可见，在26例非BA患儿中的2例（7.7%）可见，P<0.0001。第一组肝脏硬度的中位数为2.7米/秒（四分位数间距2.1/3.6），第二组为1.6米/秒（四分位数间距1.2/2），P<0.0001。预测BA的ROC曲线下面积为0.85（95%可信区间，0.74 - 0.96；P<0.0001）。最佳截断值为1.99米/秒，敏感性为81%，特异性为73.1%。组织学分类为F0 - 2的BA患者二维剪切波弹性成像测量的肝脏硬度平均值为1.8±0.2米/秒，F3 - 4患者的平均值为3±0.8米/秒，P = 0.008。
超声和组织学有助于鉴别BA与其他诊断。肝脏弹性成像在BA与其他胆汁淤积原因的鉴别诊断中是一种有前景的工具，可在诊断时估计纤维化程度。
