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Hepatic subcapsular or capsular flow in biliary atresia: is it useful imaging feature after the Kasai operation?
Suji Lee1, Myung-Joon Kim1,2, Mi-Jung Lee1,2
1Department of Radiology, Severance Hospital, Research Institute of Radiological Science, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea.
Insights
Ultrasonography (US) detection of hepatic subcapsular and capsular flows is meaningful for children post-Kasai operation. Increased liver stiffness and spleen size correlate with these flows, aiding diagnosis and follow-up in biliary atresia.
Area of Science:
- Pediatric Hepatology
- Diagnostic Imaging
- Vascular Ultrasonography
Background:
- The Kasai operation is a critical intervention for biliary atresia.
- Postoperative monitoring of liver health in these children is essential.
- Hepatic subcapsular and capsular flows may indicate underlying liver changes.
Purpose of the Study:
- To evaluate the diagnostic and prognostic implications of hepatic subcapsular and capsular flows using ultrasonography (US) in children following the Kasai operation.
- To correlate these vascular findings with liver stiffness and spleen size.
Main Methods:
- Retrospective analysis of liver US, including color Doppler and microvascular imaging (MVI), in children post-Kasai operation versus a control group.
- Assessment of hepatic subcapsular and capsular flow scores (0-2) using Doppler US and MVI.
- Correlation of flow scores with liver stiffness (TE/SWE) and spleen size.
Main Results:
- Children post-Kasai operation showed significantly higher rates of hepatic subcapsular/capsular flows compared to controls.
- Increased liver stiffness was associated with subcapsular flow on Doppler US (OR 1.225).
- Increased spleen size was associated with higher flow scores on MVI (OR 1.397).
Conclusions:
- Detection of hepatic subcapsular and capsular flows using US is valuable for children after the Kasai operation.
- These US findings can aid in diagnosis and postoperative follow-up of biliary atresia.
- Evaluating these flows may help assess disease progression post-Kasai operation.
Objectives:
To evaluate the implications of hepatic subcapsular and capsular flows using ultrasonography (US) in children after Kasai operation.
Methods:
Children who underwent liver US including color Doppler US and microvascular imaging (MVI) from May 2017 to October 2017 were retrospectively included. Children who underwent the Kasai operation for biliary atresia were included in the Kasai group and children with normal liver were included in the control group. Using US results, the number of intrahepatic biliary cysts and the maximum diameter of the spleen were evaluated in the Kasai group. Liver stiffness values were included when patients in the Kasai group had transient elastography (TE) or shear wave elastography (SWE) results. Hepatic subcapsular and capsular flows on color Doppler US and MVI were compared between the two groups using the following scores: 0, no flow reaching the hepatic capsule; 1, any flow reaching the hepatic capsule; and 2, contiguous hepatic capsular flow. The logistic regression test was used to identify associations between age, intrahepatic biliary cysts, spleen size, SWV, TE results, and flow scores measured on Doppler US and MVI in the Kasai group using the odds ratio (OR) and 95% confidence interval (CI).
Result:
A total of 65 children (mean 7.6 ± 5.3 years), 44 in the Kasai group and 21 in the control group, were included. In the control group, one child had score 1 on MVI and others had score 0 on both Doppler US and MVI. Among the Kasai group, 28 children (63.6%) had score 1, while others had score 0 using Doppler US. Using MVI, 24 children (54.5%) had score 2, 18 children had score 1, and one child had score 0. In the Kasai group, increased liver stiffness on TE was the only factor significantly associated with the presence of subcapsular flow on color Doppler US (OR 1.225, 95% CI 1.020-1.470) and increased spleen size was the only factor significantly associated with increased flow scores on MVI (OR 1.397, 95% CI 1.002-2.724).
Conclusion:
Detection of hepatic subcapsular, capsular flows on US would be meaningful for children after receiving the Kasai operation.
Key Points:
• Hepatic subcapsular or capsular flows can be useful not only for the diagnosis but also for the postoperative follow-up in patients with biliary atresia. • Increased liver stiffness and splenomegaly after the Kasai operation were associated with presence of subcapsular or capsular flow on ultrasonography. • Evaluation of hepatic subcapsular and capsular flows could be needed to assess disease progression after receiving the Kasai operation.
