Biliary atresia: making the diagnosis by the gallbladder ghost triad

Area of Science:

• Pediatric Radiology
• Gastroenterology
• Neonatal Imaging

Background:

• Extrahepatic biliary atresia (BA) is a critical neonatal liver disease requiring early diagnosis.
• Sonography is a key imaging modality for evaluating cholestatic jaundice in infants.
• Accurate diagnostic criteria are essential for timely intervention.

Purpose of the Study:

• To define the sonographic "gallbladder ghost triad".
• To assess the diagnostic accuracy of the gallbladder ghost triad for extrahepatic biliary atresia (BA).

Main Methods:

• Sonographic examination of 217 infants (aged 2-12 weeks) with cholestatic jaundice.
• Defined the gallbladder ghost triad: gallbladder length <1.9 cm, indistinct mucosal lining, and irregular contour.
• Correlated sonographic findings with surgical and histological BA diagnoses.

Main Results:

• The gallbladder ghost triad was present in 30 of 31 infants with BA (97% sensitivity).
• No false-positive cases of the triad were observed.
• Gallbladder wall thickening was absent in BA but present in 46/186 non-BA infants.

Conclusions:

• The gallbladder ghost triad is a highly specific and sensitive sonographic marker for extrahepatic biliary atresia.
• Close follow-up is recommended for indeterminate cases to ensure accurate diagnosis and treatment.