Sonographic diagnosis of biliary atresia in pediatric patients using the "triangular cord" sign versus gallbladder
Kimio Kanegawa1, Yoshinobu Akasaka, Eri Kitamura
1Department of Radiology, Kobe Children's Hospital, 1-1-1 Takakuradai Suma-ku, Kobe 654-0081, Japan.
Insights
The triangular cord sign is a highly accurate ultrasound marker for diagnosing biliary atresia in infants. This sign is more reliable than gallbladder length or contraction for identifying this serious liver condition.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Hepatology
Background:
- Biliary atresia is a severe neonatal liver disease requiring early diagnosis.
- Accurate diagnostic tools are crucial for timely intervention and improved outcomes.
- Current diagnostic methods for biliary atresia have limitations.
Purpose of the Study:
- To evaluate the diagnostic utility of the "triangular cord" sign in pediatric patients with suspected biliary atresia.
- To compare the effectiveness of the triangular cord sign against gallbladder length and contraction in diagnosing biliary atresia.
Main Methods:
- A retrospective review of 55 infants with cholestatic jaundice who underwent sonography.
- Focused sonographic assessment of the triangular cord sign, gallbladder length, and gallbladder contraction.
- Diagnosis confirmed by clinical follow-up and resolution of symptoms for non-biliary atresia cases.
Main Results:
- The triangular cord sign demonstrated 95% diagnostic accuracy, 93% sensitivity, and 96% specificity for biliary atresia.
- Gallbladder length and contraction showed lower diagnostic accuracy (71% and 77% respectively).
- The triangular cord sign was present in 27/29 infants with biliary atresia.
Conclusions:
- The triangular cord sign is a superior sonographic marker for diagnosing biliary atresia compared to gallbladder measurements.
- This finding can aid in the early and accurate diagnosis of biliary atresia in infants.
- Ultrasound visualization of the triangular cord sign offers a valuable non-invasive diagnostic approach.
Objective:
A retrospective review was performed to evaluate the importance of the "triangular cord" sign in comparison with gallbladder length and contraction for the diagnosis of biliary atresia in pediatric patients.
Materials And Methods:
Fifty-five fasting infants with cholestatic jaundice were examined on sonography. The examinations focused on the visualization of the triangular cord sign and assessment of gallbladder length and contraction. The diagnosis of neonatal hepatitis or of other causes of infantile cholestasis was made if symptom resolution occurred during follow-up.
Results:
A triangular cord sign was found in 27 of 29 infants with biliary atresia and in one of 26 infants with neonatal hepatitis or other causes of infantile cholestasis. The diagnostic accuracy was 95%, sensitivity was 93%, and specificity was 96%. The gallbladder was thought to be abnormal if it was less than 1.5 cm long, was not detectable, or was detectable but had no lumen. The gallbladder was abnormal in 21 of 29 infants with biliary atresia, whereas it was abnormal in eight of 26 infants with neonatal hepatitis or other causes of infantile cholestasis. The diagnostic accuracy was 71%, sensitivity was 72%, and specificity was 69%. The gallbladder was detectable on sonography in 13 infants with biliary atresia and 26 infants with neonatal hepatitis or other causes of infantile cholestasis. Gallbladder contraction was not confirmed in 11 of 13 infants with biliary atresia and seven of 26 infants with neonatal hepatitis or other causes of infantile cholestasis. The diagnostic accuracy was 77%, sensitivity was 85%, and specificity was 73%.
Conclusion:
The triangular cord sign was a more useful sonographic finding for diagnosing biliary atresia than gallbladder length and contraction.
