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Key imaging features for differentiating cystic biliary atresia from choledochal cyst: prenatal ultrasonography and postnatal ultrasonography and MRI

Ultrasonography 2021년 40권 2호 p.301 ~ 311
신현주, 윤혜성, 한석주, 인경, 고홍, 권자영, 이미정,
소속 상세정보
신현주 ( Shin Hyun-Joo ) - Yonsei University College of Medicine Severance Hospital Department of Radiology
윤혜성 ( Yoon Hae-Sung ) - Yonsei University College of Medicine Severance Hospital Department of Radiology
한석주 ( Han Seok-Joo ) - Yonsei University College of Medicine Department of Surgery
인경 ( Ihn Kyong ) - Yonsei University College of Medicine Department of Surgery
고홍 ( Koh Hong ) - Yonsei University College of Medicine Department of Pediatrics
권자영 ( Kwon Ja-Young ) - Yonsei University College of Medicine Department of Obstetrics and Gynecology
이미정 ( Lee Mi-Jung ) - Yonsei University College of Medicine Severance Hospital Department of Radiology

Abstract


Purpose: This study compared clinical and radiologic differences between cystic biliary atresia (cBA) and choledochal cyst (CC) type Ia/b.

Methods: Infants (≤12 months old) who were diagnosed with cBA or CC type Ia/b from 2005 to 2019 were retrospectively reviewed. Imaging features on preoperative ultrasonography (US) and magnetic resonance imaging (MRI) were compared between the cBA and CC groups. Logistic regression and area under the receiver operating characteristic curve (AUC) analyses were performed for the diagnosis of cBA. Changes in cyst size were also evaluated when prenatal US exams were available.

Results: Ten patients (5.5% of biliary atresia cases) with cBA (median age, 48 days) and 11 infants with CC type Ia/b (Ia:Ib=10:1; median age, 20 days) were included. Triangular cord thickness on US (cutoff, 4 mm) showed 100% sensitivity and 90.9% specificity (AUC, 0.964; 95% confidence interval [CI], 0.779 to 1.000) and cyst size on MRI (cutoff, 2.2 cm) had 70% sensitivity and 100% specificity (AUC, 0.900; 95% CI, 0.690 to 0.987) for diagnosing cBA. Gallbladder mucosal irregularity on US and an invisible distal common bile duct on MRI were only seen in the cBA group (10 of 10). Only the CC group showed prenatal cysts exceeding 1 cm with postnatal enlargement.

Conclusion: Small cyst size (<1 cm) on prenatal US, triangular cord thickening (≥4 mm) and gallbladder mucosal irregularity on postnatal US, and small cyst size (≤2.2 cm) and an invisible distal common bile duct on MRI can discriminate cBA from CC type Ia/b in infancy.

키워드

Biliary atresia; Choledochal cyst; Neonatal jaundice; Ultrasonography; Magnetic resonance imaging

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