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Novel Scoring Systems and Age-Based Hepatic Shear Wave Stiffness Cut-Offs for Improving Sonographic Diagnosis of
Praveen Kesav Ramaswamy1, Manisha Jana2, Raju Sharma1
1Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
Insights
A new grey scale scoring system enhances the accuracy and reproducibility of diagnosing biliary atresia (BA) via ultrasound. Hepatic shear wave elastography (SWE) plays a minor role in this diagnosis.
Area of Science:
- Pediatric Radiology
- Hepatobiliary Imaging
- Diagnostic Ultrasound
Background:
- Biliary atresia (BA) diagnosis relies on ultrasound, but objectivity and reproducibility are challenges.
- Conventional sonography has limitations in accurately diagnosing BA, leading to potential misdiagnosis.
Purpose of the Study:
- To develop objective scoring systems for sonographic evaluation of BA.
- To assess the utility of hepatic shear wave elastography (SWE) as an adjunct diagnostic tool for BA.
Main Methods:
- A prospective observational cohort study included 64 infants with cholestatic jaundice.
- Sonography and SWE were performed; novel scoring systems integrated sonographic parameters and hepatic stiffness.
- Statistical analysis was conducted using SPSS software.
Main Results:
- The grey scale scoring system achieved 96.9% diagnostic accuracy for BA.
- Gallbladder wall irregularity and fasting gallbladder length were key individual sonographic indicators.
- Hepatic SWE showed significant differences between BA and non-BA infants but with reduced accuracy (93.8%).
Conclusions:
- The developed grey scale scoring system improves sonographic diagnosis of BA, enhancing accuracy and reproducibility without increased cost or time.
- Hepatic SWE offers a limited adjunctive role in the sonographic diagnosis of biliary atresia.
Objectives:
To make sonographic evaluation for biliary atresia (BA) more objective and reproducible using scoring systems, and evaluate hepatic shear wave elastography (SWE) as an adjunct in sonographic diagnosis of BA.
Methods:
Sixty-four infants with cholestatic jaundice were enrolled between June 2016 and March 2018 in this prospective observational cohort study. Sonography and SWE was performed with SuperSonic Aixplorer system. Novel scoring systems were developed incorporating established sonographic parameters and hepatic stiffness values and analysed using SPSS software.
Results:
Of the 18 patients confirmed as BA, 3 were misdiagnosed on conventional sonography (16.7%) as non-BA. Gall bladder (GB) wall irregularity and fasting GB length were the most accurate (93.8%) and most specific (97.8%) individual parameters, respectively. A significant difference was noted in the triangular cord (TC) thickness of BA and non-BA infants (p <0.001), with a high specificity of 95.6% for a 4 mm cut-off value for a positive TC sign. Comparison of hepatic SWE stiffness among age-matched groups of BA and non-BA showed significant differences (≤60 d: p = 0.003; >60 d: p <0.001) but with a reduced accuracy (93.8%). Diagnostic accuracy of greyscale scoring system (96.9%), greyscale + elastography scoring system in ≤60 d (94.4%) and >60 d (97.8%) were better than that of conventional sonographic diagnosis (93.8%).
Conclusions:
Grey scale scoring system improves the accuracy of sonographic diagnosis of BA without any additional cost or time penalty along with making it universally reproducible. SWE has only an adjunctive role, if any, in the sonographic diagnosis of BA.
