Key imaging features for differentiation of cystic biliary atresia from choledochal cyst including prenatal ultrasonography
Hyun Joo Shin , Haesung Yoon , Seok Joo Han , Kyong Ihn , Hong Koh , Ja-Young Kwon , Mi-Jung Lee
Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Corresponding Author: Mi-Jung Lee ,Tel: 82-2-2228-7400, Fax: 82-2-393-3035, Email: mjl1213@yuhs.ac
Received: April 28, 2020;  Accepted: July 31, 2020.  Published online: July 31, 2020.
ABSTRACT
Purpose:
To compare the radiologic differences between cystic biliary atresia (cBA) and choledochal cyst (CC).
Methods:
Infants (≤ 12 months old) who were diagnosed as cBA or CC type Ia/b from 2005 to 2019 were retrospectively reviewed. The imaging features of preoperative ultrasonography (US) and MRI were compared between the cBA and CC groups. Logistic regression and area under the receiver operating characteristics curve (AUC) analyses were performed to diagnose cBA. The changing patterns of cyst size were also evaluated when the patients had prenatal US exams.
Results:
Ten patients (5.5% of all BA) of cBA (median age 48 days) and 11 infants of CC type Ia/b (Ia:Ib = 10:1, median age 20 days) were included. The triangular cord thickness on US (cutoff 4 mm) showed a 100% sensitivity and 90.9% specificity (AUC 0.964, 95% confidence interval [CI]: 0.779-1.000) and the cyst size on MRI (cutoff 2.2 cm) had 70% sensitivity and 100% specificity (AUC 0.900, 95% CI: 0.690-0.987) for diagnosing cBA. Gallbladder mucosal irregularity on US and invisible distal common bile duct on MRI were only seen in the cBA group (10/10). The prenatal cyst size was more than 1 cm and tended to increase after birth only in the CC group.
Conclusion:
The small cyst size (< 1 cm) on prenatal US, triangular cord thickening (≥ 4 mm) and gallbladder mucosal irregularity on postnatal US, small cyst size (≤ 2.2 cm) and the invisible distal common bile duct on MRI can discriminate cBA from CC type Ia/b.
Keywords: Biliary atresia; Choledochal cyst; Neonatal jaundice; Ultrasonography; Magnetic resonance imaging
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