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Triangular cord sign and ultrasound features of the gall bladder in infants with biliary atresia
Pannee Visrutaratna1, Lumduan Wongsawasdi, Pailin Lerttumnongtum
1Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. pvisruta@mail.med.cmu.ac.th
Insights
The ultrasonographic triangular cord sign combined with abnormal gallbladder length is highly accurate for diagnosing biliary atresia in infants with cholestatic jaundice. This combined approach offers superior reliability compared to using the triangular cord sign alone or assessing gallbladder wall irregularity.
Area of Science:
- Pediatric Radiology
- Hepatobiliary Imaging
- Neonatal Jaundice Diagnostics
Background:
- Biliary atresia is a critical neonatal condition causing cholestatic jaundice.
- Accurate and timely diagnosis is essential for effective treatment and improved outcomes.
- Current diagnostic methods, including ultrasound markers, require ongoing reassessment.
Purpose of the Study:
- To evaluate the diagnostic accuracy of the triangular cord sign (TCS) for biliary atresia.
- To assess the combined accuracy of TCS with abnormal gallbladder length (AGBL).
- To compare the reliability of TCS, TCS + AGBL, and irregular gallbladder wall (IGBW) in diagnosing biliary atresia.
Main Methods:
- Retrospective review of 46 infant ultrasonograms with cholestatic jaundice.
- Analysis of TCS, gallbladder length, and gallbladder wall features.
- Independent assessment of ultrasonograms without clinical data.
Main Results:
- The TCS showed 95.7% sensitivity and 73.9% specificity for biliary atresia.
- Combining TCS with AGBL yielded 95.7% sensitivity, specificity, accuracy, and positive predictive value.
- IGBW was less reliable, particularly in infants with bile-containing gallbladders.
Conclusions:
- The ultrasonographic triangular cord sign coupled with abnormal gallbladder length is a highly reliable indicator for diagnosing biliary atresia.
- This combined ultrasonographic finding surpasses the diagnostic utility of the triangular cord sign alone or gallbladder wall irregularity.
- The findings are particularly relevant for centers managing advanced-stage cholestatic jaundice in infants.
Abstract:
The aim of this study was to reassess the accuracy of the triangular cord sign, the triangular cord sign coupled with abnormal gall-bladder length, and an irregular gall-bladder wall in the diagnosis of biliary atresia. The ultrasonograms of 46 infants with cholestatic jaundice were reviewed for the triangular cord sign, gall-bladder length and gall-bladder wall without knowledge of the clinical data. Of the 23 infants with biliary atresia, 22 had the triangular cord sign whereas 17 infants with other causes of cholestatic jaundice did not have the triangular cord sign. The sensitivity, specificity, accuracy and positive predictive value of the triangular cord sign in the diagnosis of biliary atresia were 95.7, 73.9, 84.8 and 78.6%, respectively. The sensitivity, specificity, accuracy and positive predictive value of the triangular cord sign coupled with abnormal gall-bladder length in the diagnosis of biliary atresia were all 95.7%. Gall-bladder wall irregularity was seen in seven of 14 infants (50%) with biliary atresia whose gall bladders contained bile on ultrasound and in two of 22 infants (9.1%) without biliary atresia whose gall bladders contained bile on ultrasound. At the medical centre where this study was performed and where infants present with cholestatic jaundice at an advanced stage, the ultrasonographic triangular cord sign coupled with abnormal gall-bladder length is more reliable than the ultrasonographic triangular cord sign alone or gall-bladder wall irregularity in the diagnosis of biliary atresia.
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