Practical approach for the diagnosis of biliary atresia on imaging, part 2: magnetic resonance cholecystopancreatography, hepatobiliary scintigraphy, percutaneous cholecysto-cholangiography, endoscopic retrograde cholangiopancreatography, percutaneous liver biopsy, risk scores and decisional flowchart
Napolitano, Marcello; Franchi-Abella, Stéphanie; Damasio, Beatrice Maria; Augdal, Thomas Angell; Avni, Fred Efraim; Bruno, Costanza; Darge, Kassa; Ključevšek, Damjana; Littooij, Annemieke Simone; Lobo, Luisa; Mentzel, Hans-Joachim; Riccabona, Michael; Stafrace, Samuel; Toso, Seema; Woźniak, Magdalena Maria; Di Leo, Giovanni; Sardanelli, Francesco; Ording Müller, Lil-Sofie; Petit, Philippe
(2021) Pediatric radiology, volume 51, issue 8, pp. 1545 - 1554
(Article)
Abstract
We aim to present a practical approach to imaging in suspected biliary atresia, an inflammatory cholangiopathy of infancy resulting in progressive fibrosis and obliteration of extrahepatic and intrahepatic bile ducts. Left untreated or with failure of the Kasai procedure, biliary atresia progresses to biliary cirrhosis, end-stage liver failure and death
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within the first years of life. Differentiating biliary atresia from other nonsurgical causes of neonatal cholestasis is difficult as there is no single method for diagnosing biliary atresia and clinical, laboratory and imaging features of this disease overlap with those of other causes of neonatal cholestasis. In this second part, we discuss the roles of magnetic resonance (MR) cholecystopancreatography, hepatobiliary scintigraphy, percutaneous biopsy and percutaneous cholecysto-cholangiography. Among imaging techniques, ultrasound (US) signs have a high specificity, although a normal US examination does not rule out biliary atresia. Other imaging techniques with direct opacification of the biliary tree combined with percutaneous liver biopsy have roles in equivocal cases. MR cholecystopancreatography and hepatobiliary scintigraphy are not useful for the diagnosis of biliary atresia. We propose a decisional flowchart for biliary atresia diagnosis based on US signs, including elastography, percutaneous cholecysto-cholangiography or endoscopic retrograde cholangiopancreatography and liver biopsy.
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Keywords: Biliary Atresia/diagnostic imaging, Biopsy, Cholangiography, Cholangiopancreatography, Endoscopic Retrograde, Cholestasis, Humans, Infant, Liver/diagnostic imaging, Magnetic Resonance Spectroscopy, Radionuclide Imaging, Risk Factors, Software Design, Biliary atresia, Endoscopic retrograde cholangiopancreatography, Liver, Percutaneous liver biopsy, Infants, Percutaneous cholecysto-cholangiography, Bile duct, Magnetic resonance imaging, Hepatobiliary scintigraphy, Radiology Nuclear Medicine and imaging, Pediatrics, Perinatology, and Child Health, Journal Article
ISSN: 0301-0449
Publisher: Springer Verlag
Note: Publisher Copyright: © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
(Peer reviewed)