Diagnostic Performance of Transient Elastography in Biliary Atresia Among Infants With Cholestasis
Yin-Ann Boo1, Mei-Hwei Chang1,2, Yung-Ming Jeng3
1Department of PediatricsNational Taiwan University HospitalTaipeiTaiwan.
Insights
Transient elastography (TE) accurately diagnoses biliary atresia (BA) in infants with cholestasis. This liver stiffness measurement (LSM) aids early detection, improving outcomes for this challenging infant liver disease.
Area of Science:
- Pediatric Hepatology
- Diagnostic Imaging
- Gastroenterology
Background:
- Biliary atresia (BA) is a critical infant liver disease requiring early diagnosis for effective treatment.
- Timely hepatoportoenterostomy is crucial for managing BA, underscoring the need for accurate diagnostic tools.
Purpose of the Study:
- To evaluate the age-specific diagnostic performance of transient elastography (TE) for biliary atresia (BA) in infants presenting with cholestasis.
- To assess the correlation between liver stiffness measurement (LSM) and liver fibrosis in infants with cholestasis.
Main Methods:
- A prospective follow-up study involving 61 infants with cholestasis (5-121 days old), including 15 with BA.
- Transient elastography (TE) was used to measure liver stiffness (LSM), with a cutoff of 7.7 kPa evaluated.
- Picrosirius red staining quantified collagen fibers to assess liver fibrosis.
Main Results:
- TE demonstrated high diagnostic power for BA across all four age groups (≤30, 31-60, 61-90, 91-180 days).
- Positive predictive values reached 100% in infants ≤90 days, with diagnostic accuracies ranging from 92.9% to 100%.
- Liver stiffness measurement (LSM) showed a significant positive correlation with the percentage of collagen fibers (P=0.03), indicating fibrosis.
Conclusions:
- Transient elastography (TE) is accurate for differentiating biliary atresia (BA) from other causes of cholestasis in infants up to 90 days old.
- The study confirms TE's utility in diagnosing BA, supporting its role in early infant liver disease management.
- Liver stiffness measurement (LSM) by TE correlates with histological evidence of liver fibrosis in cholestatic infants.
Abstract:
Biliary atresia (BA) is a challenging liver disease in infancy. Early diagnosis of BA is important for timely hepatoportoenterostomy. We evaluated the age-specific diagnostic performance of transient elastography (TE) with a liver stiffness measurement (LSM) greater than 7.7 kPa in BA among infants with cholestasis. A total of 61 infants with cholestasis (5-121 days of age) were enrolled in this prospective follow-up study; 15 infants were BA. Four age groups were defined (≤30, 31-60, 61-90, and 91-180 days). Picrosirius red staining was performed to quantify the percentage of collagen fibers in liver specimens. The utility of an LSM greater than 7.7 kPa for diagnosis of BA among infants with cholestasis was compared among age groups. In all four groups, TE showed high diagnostic power for BA using the criterion of an LSM greater than 7.7 kPa. Positive predictive values were 100%, 100%, and 100% in the groups aged 30 days or younger, 31 to 60 days, and 61 to 90 days, respectively. Respective negative predictive values were 90.9%, 94.7%, and 100%, and respective diagnostic accuracies were 92.9%, 95.2%, and 100%. The positive predictive value, negative predictive value, and diagnostic accuracy were 100%, 100%, and 100%, respectively, for LSM greater than 8.8 kPa in the group aged 91 to 180 days. The LSM was positively correlated with the percentage of collagen fibers stained by picrosirius red (P = 0.03). Conclusion: In this prospective follow-up study, TE had good diagnostic accuracy for differentiation of BA from non-BA cholestasis in infants with cholestasis who were 90 days of age or younger. The LSM was significantly positive correlated with the liver fibrosis status stained by picrosirius red in infants with cholestasis.
