Peng S S, Li Y W, Chang M H, Ni Y H, Su C T
Department of Medical Imaging, Medical College and Hospital, National Taiwan University, Taipei, Taiwan.
J Formos Med Assoc. 1998 Oct;97(10):698-703.
Distinguishing extrahepatic biliary atresia from other causes of cholestasis in neonates and infants is important because surgical intervention before 2 months of age allows for long-term survival. The purpose of this prospective study was to evaluate the usefulness of magnetic resonance (MR) cholangiography in differentiating biliary atresia from other causes of cholestatic jaundice in neonates and infants. Nine anicteric infants (control group) aged 10 to 224 days (mean +/- SD, 8 +/- 65 days) and 15 neonates and infants with cholestatic jaundice, aged 22 to 142 days (mean +/- SD, 71 +/- 37) underwent MR cholangiography. The final diagnosis of extrabiliary atresia (6 patients) was based on laparotomy findings (4 patients) or autopsy (2 patients), while neonatal hepatitis (9 patients) was diagnosed according to the liver biopsy findings and clinical recovery during follow-up. Percutaneous liver biopsies were performed in all 15 patients. Results showed that the gall bladder and common bile duct (CBD) could be visualized using MR cholangiography in all patients in the control group. Nonvisualization of the CBD (6/6 patients) and demonstration of a small gall bladder (6/6 patients) characterized MR cholangiography findings in patients with biliary atresia. MR cholangiography failed to depict the CBD in one infant with hepatitis. We conclude that demonstration of the CBD by MR cholangiography in neonates and infants with cholestasis can be used to exclude the diagnosis of biliary atresia. In patients with cholestatic jaundice considered for exploratory laparotomy, preoperative MR cholangiography is recommended to avoid unnecessary surgery.
区分新生儿和婴儿肝外胆道闭锁与其他胆汁淤积原因很重要，因为2个月龄前进行手术干预可实现长期存活。这项前瞻性研究的目的是评估磁共振（MR）胆管造影在鉴别新生儿和婴儿胆汁淤积性黄疸的胆道闭锁与其他病因方面的效用。9名无黄疸婴儿（对照组），年龄10至224天（平均±标准差，8±65天），以及15名患有胆汁淤积性黄疸的新生儿和婴儿，年龄22至142天（平均±标准差，71±37）接受了MR胆管造影。肝外胆道闭锁的最终诊断（6例患者）基于剖腹手术结果（4例患者）或尸检（2例患者），而新生儿肝炎（9例患者）根据肝活检结果和随访期间的临床恢复情况进行诊断。所有15例患者均进行了经皮肝活检。结果显示，对照组所有患者使用MR胆管造影均可显示胆囊和胆总管（CBD）。CBD未显影（6/6例患者）以及小胆囊的显示（6/6例患者）是胆道闭锁患者MR胆管造影结果的特征。MR胆管造影未能显示1例肝炎婴儿的CBD。我们得出结论，在患有胆汁淤积的新生儿和婴儿中，MR胆管造影显示CBD可用于排除胆道闭锁的诊断。对于考虑进行剖腹探查术的胆汁淤积性黄疸患者，建议术前进行MR胆管造影以避免不必要的手术。
