| Objective:The infants suffering jaundice were explored with high-frequency ultrasonography (US) to evaluate its differential diagnostic value in biliary atresia(BA) .Methods:After 4 hours fasting, 43 infants with neonatal jaundice were scanned with general and high-frequency US respectively. The data of hepatic, gallbladder, bile duct, right hepatic Artery (RHA), portal vein(PV) and triangular cord (TC) sign were observed and measured, and then a primary BA diagnosis was given. At the same time, the other data were collected, which included the laboratory reports, the imaging results such as MRI or CT, the findings during operation and the pathological reports after operation or liver puncture biopsy.Results:The results of the liver puncture biopsy and pathological reports after operation were regarded as gold standard to diagnose BA.17 out of 18 BA patients were diagnosed by the high-frequency US, and no non-BA was misdiagnosed. The positive TC sign, hypertrophy RHA and abnormal gallbladder (absent or small gallbladder, lack of smooth wall or with irregular contour) emphasized their importance in diagnosis of BA. The TC sign had 88.9% sensitivity, 100% specificity, and 95.3% accuracy in detection of BA. If we regarded RHA>0.16cm as the best cut-off value, it showed 94% sensitivity, 84% specificity, 88.4% accuracy. The sensitivity, specificity, and accuracy for diagnosis BA of abnormal gallbladder were 94%, 100%, 97.7% respectively. By combining the three features for diagnosis BA, it displayed with a sensitivity 94%,a specificity 100% and a accuracy 97.7%.Conclusions:High-frequency US is useful to show the features of hepatic portal limpidly and significantly. These features increase the accuracy to diagnose BA, which is up to 97.7%(42/43). Objective:To evaluate the early diagnostic value and what we should considerate in Biliary Atresia(BA) diagnosis by ultrasonography(US), by reviewing the ultrasonographic reports of BA patients who have been undergone surgery.Methods:The ultrasonographic results of 37 BA patients between January 2008 and November 2009, as well as 15 BA patients during December 2009 to December 2010, were collected and analyzed retrospectively. In the first stage, all infants were undergone convention ultrasonography (CUS), and the reports with BA diagnosis or ultrasonic features indicated BA were included the study if the infant had been undergone CUS several times. In the second stage, High-frequency ultrasonography(HUS) was used and the BA diagnosis were made after some given characteristic features were observed, for example, the TC sign, hypertrophy of hepatic artery and abnormal gallbladder(GB). The differences of BA diagnosis were analyzed between the two stages.Results:All BA infants were confirmed surgically and histologically. The results of CUS groups were showed as following: only 2 cases was given a tendentious diagnosis of BA(5.4%); 24 abnormal GBs(64.9%), which including 20 cases without GB(54.1%)shown, 2 GBs with abnormal wall or contour(5.4%), and 2 small GBs(5.4%);but the other 10 cases showed with normal GBs(27%); 2 cases of positive TC sign(5.4%); no hypertrophy hepatic artery was mentioned.The results of the second group were: 14 out of 15 cases were given a tendentious diagnosis of BA(93.8%); 15 abnormal GBs(93.3%) which including 1 case without shown GB(6.3%),14 GBs with abnormal wall or contou(r93.3%) , and 1 small GB(6.7%);1 normal GB(6.7%) ; 13 cases with positive TC sign(86.7%); 14 cases with hypertrophy hepatic artery(93.3%). The difference to diagnosis of BA between the first state(5.4%) and the second stage (93.3%)was significantly (P<0.001). If the patients with TC sign and abnormal GB were regarded as BA, the diagnosis rate is 67.6%(25/37) in CUS group, which was still statistically different with 93.3%(14/15) in HUS group(P<0.05). There were statistically significant differences in displaying the characteristic signs of the BA between the two stages: positive TC sign( P<0.001 ) , visualization rate of gallbladder(P<0.005), abnormal gallbladder(P<0.05), and hypertrophy of hepatic artery(P<0.001).Conclusion:In contrast with CUS, HUS is more useful to show the features of hepatic portal and gallbladder, which therefore increases the accuracy to diagnose BA early significantly. Meanwhile, the knowledge to a disease is the key point of making an accurate diagnosis. |
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