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Selective enlargement of left lateral segment liver volume as a potential diagnostic predictor for biliary atresia
Kenji Santo1, Yuichi Takama1, Yuki Hirose1
1Department of Pediatric Surgery, Osaka City General Hospital, 2-13-22, Miyakojimahondori, Miyakojima-ku, Osaka, 534-0021, Japan.
Insights
The left lateral segment (LLS) ratio can help diagnose biliary atresia (BA) early. This ratio, along with GGT levels, shows high specificity for identifying BA in infants.
Area of Science:
- Hepatology
- Pediatric Surgery
- Medical Imaging
Background:
- Biliary atresia (BA) is a severe neonatal liver disease.
- Early diagnosis is crucial for effective treatment and improved outcomes.
- Morphological liver differences may serve as early diagnostic indicators.
Purpose of the Study:
- To identify an early diagnostic indicator for biliary atresia (BA).
- To investigate morphological left-right differences in BA livers.
- To evaluate the utility of the left lateral segment (LLS) ratio in diagnosing BA.
Main Methods:
- Retrospective analysis of 25 infants with suspected BA (15 BA, 10 non-BA).
- Liver CT volumetry using a 3D image analysis system.
- Comparison of patient characteristics, blood data, and LLS ratio between groups.
Main Results:
- Gamma-glutamyl transpeptidase (GGT) levels were significantly higher in the BA group (p < 0.001).
- The LLS ratio was significantly higher in the BA group (0.321 vs. 0.243, p = 0.01).
- The GGT × LLS ratio demonstrated high sensitivity (86.7%) and specificity (100%) for BA diagnosis.
Conclusions:
- The LLS ratio is a highly specific early diagnostic predictor for biliary atresia.
- Enlargement of the left lateral segment may be linked to the etiology of BA.
- Combined GGT and LLS ratio analysis offers a promising diagnostic approach for BA.
Purpose:
To determine an early diagnostic indicator of biliary atresia (BA), we focused on morphological left-right differences of BA livers.
Methods:
Of 74 infants with suspected BA at our hospital in the last 12 years, 25 met the conditions for investigation: 15 infants with BA (BA group) and 10 with other pathologies (non-BA group). CT volumetry of the liver in each patient was performed using a 3D image analysis system. Patient characteristics, blood data, and proportion of the left lateral segment to the total liver volume (LLS ratio) were compared between the two groups.
Results:
Among the patient characteristics and liver function tests, only γ-glutamyl transpeptidase (GGT) were significantly higher in the BA group (p < 0.001). The LLS ratio was 0.321 (0.227-0.382) in the BA group and 0.243 (0.193-0.289) in the non-BA group (p = 0.01). The summary cut-off, area under the curve, sensitivity, and specificity were 0.322, 0.813, 53.3, and 100% for the LLS ratio and 94.26, 0.95, 86.7, and 100% for the GGT × LLS ratio, respectively.
Conclusions:
The LLS ratio is highly specific and may be an early diagnostic predictor of BA. Moreover, this segmental LLS enlargement may be associated with the etiology of BA.
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