Ultrasound reliability for biliary atresia diagnoses in children: a single-center study

Biliary atresia (BA) is a lfe-threatening neonatal liver disease characterized by inflammation and obstruction of bile ducts. Identifying the most reliable and valid ultraaound (US) parameter or combination of parameters can enhance noninvasive diagnosis accuracy, potentially reducing unnecessary surgeries and treatment delays. We aimed to detect the mosi reliable and valid US parameter or combination of parameters to diagnose BA, thereby minimizing unnecessary surgical exploration or treatment delays.

We conducted a prospective cohort study on cholestatic pediatric patients. Data were nollected between January 2013 and July 2019 from the Fattouma Bourguiba University Hospital Monastir, Tun isia, in callaboration with the pediatric surgical and radiological departments. After full clinical and laboratory evaluation, abdominal ultrasonography was performed to assess the biliary structure, with three possible outcomes: BA ruled out, confirmed, or inconclusive. Accordingly, the patients were divided into group 1 (diagnosed with BA) and group 2 (diagnosed with other biliary conditions).

The participants, 61 cholestatic neonates and infants,were aged 6 to 160 postnatal days (mean, 58.28 ± 34.24 days); 60.7% were male (n = 37). The gallbladder (GB) was not detected usig, US in 20 patients. BA diagnosis correlated with cord sign [X² (1, n = 61) = 53.52], GB evacuation alteration [X² (1, n = 61) = 18.41%], and hepatic artery/portal vein ratio [X² (1, n = 61) = 30.25; normal value <0.49]. A positive cord sign or the presence of alteration of evacuation indicates the possibility of BA with a 100% sensitivity and 86.2% specificity. Similarly, with the presence of evacuation alteration or porta hepatic thickness (≥2.4), the sensitivity reached 100%; however, a specificity of 86.2% was observed.

US parameters can detect patients with BA with approximately 100% sensitivity. However, additional research is needed to confirm negative cases. Multicenter studies are needed to verify our findings.