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Ultrasound Evaluation of Biliary Atresia Based on Gallbladder Classification: Is 4 Hours of Fasting Necessary?
Wenying Zhou1, Dan Chen2, Hong Jiang3
1Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Insights
Fasting time does not impact ultrasound diagnosis of biliary atresia using the gallbladder classification scheme. This scheme aids junior radiologists in identifying biliary atresia and nonbiliary atresia effectively.
Area of Science:
- Pediatric Radiology
- Gastroenterology
- Neonatal Medicine
Background:
- Biliary atresia is a critical neonatal liver disease requiring early diagnosis.
- Ultrasound is a primary imaging modality for evaluating jaundiced infants.
- The gallbladder classification scheme is a tool used in ultrasound to assess gallbladder morphology.
Purpose of the Study:
- To determine if infant fasting duration affects the accuracy of biliary atresia diagnosis via ultrasound using the gallbladder classification scheme.
- To assess the effectiveness of the gallbladder classification scheme for biliary atresia diagnosis by less experienced radiologists.
Main Methods:
- 188 jaundiced infants underwent abdominal sonography.
- Infants were categorized into fasting (≥4 hours) and nonfasting (<4 hours) groups.
- Gallbladders were classified into 4 types; diagnostic accuracy was compared between groups and radiologists of varying experience.
Main Results:
- Diagnostic accuracy for biliary atresia was 86.3% in the fasting group and 93.5% in the nonfasting group (P=.100).
- Junior radiologists achieved 88.7% accuracy, while experienced radiologists achieved 90.4% accuracy (P=.250).
- The inter-radiologist agreement (κ value) was 0.859.
Conclusions:
- Gallbladder morphology assessment using the classification scheme is not significantly influenced by patient fasting status.
- The gallbladder classification scheme demonstrates utility in improving diagnostic performance for both junior and experienced radiologists in identifying biliary atresia.
Objectives:
The aim of this study was to evaluate the influence of fasting time on the ultrasound identification and exclusion of biliary atresia in jaundiced infants through the use of the gallbladder classification scheme and to test the value of the gallbladder classification scheme in the diagnosis of biliary atresia in inexperienced individuals.
Methods:
A total of 188 jaundiced infants were enrolled in this study. All patients received detailed abdominal sonograms. Diagnoses were confirmed via liver biopsy, surgical findings, or follow-up. Infants were grouped into either the fasting group (fasting time ≥ 4 h) or the nonfasting group (fasting time < 4 h). According to the gallbladder classification scheme, the gallbladders were classified into 4 types. The accuracy of diagnosing biliary atresia based on the gallbladder classification scheme was compared between the 2 groups. The gallbladders of 177 infants that were detectable by ultrasonography were used to compare the diagnostic performances between a junior radiologist and an experienced radiologist.
Results:
The accuracies in the diagnosis of biliary atresia with the gallbladder classification scheme were 86.3% (82 of 95 patients) for the fasting group and 93.5% (87 of 93 patients) for the nonfasting group (P = .100). The diagnostic accuracies of biliary atresia were 88.7% (157 of 177 patients) for the junior radiologist and 90.4% (160 of 177 patients) for the experienced radiologist (P = .250). The κ value for the agreement between the 2 radiologists was 0.859.
Conclusions:
The performance of gallbladder diagnoses was not influenced by the fasting time with the use of the gallbladder classification scheme. Additionally, the gallbladder classification scheme may help junior radiologists to more effectively identify biliary atresia and nonbiliary atresia.
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