Restricted accessResearch articleFirst published online 2020-10
Ultrasound,shear-wave elastography,and magnetic resonance imaging in native liver survivor patients with biliary atresia after Kasai portoenterostomy: correlation with medical outcome after treatment
Biliary atresia (BA) is a rare obliterative cholangiopathy and Kasai portoenterostomy (KP) represents its first-line treatment; clinical and laboratory parameters together with abdominal ultrasound (US) are usually performed during the follow-up. Shear-wave elastography (SWE) is able to evaluate liver parenchyma stiffness; magnetic resonance imaging (MRI) has also been proposed to study these patients.
Purpose
To correlate US, SWE, and MRI imaging findings with medical outcome in patients with BA who are native liver survivors after KP.
Material and Methods
We retrospectively enrolled 24 patients. They were divided in two groups based on “ideal” (n = 15) or “non-ideal” (n = 9) medical outcome. US, SWE, and MRI exams were analyzed qualitatively and quantitatively for imaging signs suggestive of chronic liver disease (CLD).
Results
Significant differences were found in terms of liver surface (P = 0.007) and morphology (P = 0.013), portal vein diameter (P = 0.012) and spleen size (P = 0.002) by US, liver signal intensity (P = 0.013), portal vein diameter (P = 0.010), presence of portosystemic collaterals (P = 0.042), and spleen size (P = 0.001) by MRI. The evaluation of portal vein diameter (moderate, κ = 0.44), of portosystemic collaterals (good, κ = 0.78), and spleen size (very good, κ = 0.92) showed the best agreement between US and MRI. A significant (P = 0.01) difference in liver parenchyma stiffness by SWE was also found between the two groups (cut-off = 9.6 kPa, sensitivity = 55.6%, specificity = 100%, area under the ROC curve = 0.82).
Conclusion
US, SWE, and MRI findings correlate with the medical outcome in native liver survivor patients with BA treated with KP.
BaumannUUreB.Biliary atresia. Clin Res Hepatol Gastroenterol2012;
36:257–259.
6.
NioMWadaMSasakiH, et al.
Risk factors affecting late-presenting liver failure in adult patients with biliary atresia. J Pediatr Surg2012;
47:2179–2183.
7.
LeeWSOngSYFooHW, et al.
Chronic liver disease is universal in children with biliary atresia living with native liver. World J Gastroenterol2017;
23:7776–7784.
8.
HadzićNDavenportMTizzardS, et al.
Long-term survival following Kasai portoenterostomy: is chronic liver disease inevitable?J Pediatr Gastroenterol Nutr2003;
37:430–433.
9.
ParkCJArmeniaSJKeungCH, et al.
Surgical modifications of the Kasai hepatoportoenterostomy minimize invasiveness without compromising short- and medium-term outcomes. J Pediatr Surg2019;
54:537–542.
10.
LiYXiangBWuY, et al.
Medium-term outcome of laparoscopic Kasai portoenterostomy for biliary atresia with 49 cases. J Pediatr Gastroenterol Nutr2018;
66:857–860.
11.
JeonTYYooS-YKimJH, et al.
Serial ultrasound findings associated with early liver transplantation after Kasai portoenterostomy in biliary atresia. Clin Radiol2013;
68:588–594.
12.
JancelewiczTBarmherzigRChungCT-S, et al.
A screening algorithm for the efficient exclusion of biliary atresia in infants with cholestatic jaundice. J Pediatr Surg2015;
50:363–370.
13.
SeraiSDTroutATSirlinCB.Elastography to assess the stage of liver fibrosis in children: Concepts, opportunities, and challenges. Clin Liver Dis2017;
9:5–10.
14.
TangACloutierGSzeverenyiNM, et al.
Ultrasound elastography and MR elastography for assessing liver fibrosis: part 2, diagnostic performance, confounders, and future directions. AJR Am J Roentgenol2015;
205:33–40.
15.
ChenSLiaoBZhongZ, et al.
Supersonic shearwave elastography in the assessment of liver fibrosis for postoperative patients with biliary atresia. Sci Rep2016;
6:1–9.
16.
TakahashiAHatakeyamaSSuzukiN, et al.
MRI findings in the liver in biliary atresia patients after the Kasai operation.Tohoku J Exp Med1997;
181:193–202.
17.
AvniFESegersVDe MaertelaerV, et al.
The evaluation by magnetic resonance imaging of hepatic periportal fibrosis in infants with neonatal cholestasis: Preliminary report. J Pediatr Surg2002;
37:1128–1133.
18.
TakahashiAHatakeyamaSIKuroiwaM, et al.
Time-course changes in the liver of biliary atresia patients on magnetic resonance imaging. Pediatr Int2009;
51:66–70.
19.
NgVLHaberBHMageeJC, et al.
Medical status of 219 children with biliary atresia surviving long-term with their native livers: results from a North American multicenter consortium. J Pediatr2014;
165:539–546.e2.
20.
DillmanJRHeiderABilhartzJL, et al.
Ultrasound shear wave speed measurements correlate with liver fibrosis in children. Pediatr Radiol2015;
45:1480–1488.
21.
LurieYWebbMCytter-KuintR, et al.
Non-invasive diagnosis of liver fibrosis and cirrhosis. World J Gastroenterol2015;
21:11567–11583.
22.
KonuşOLOzdemirAAkkayaA, et al.
Normal liver, spleen, and kidney dimensions in neonates, infants, and children: evaluation with sonography. AJRAm J Roentgenol1998;
171:1693–1698.
23.
MulabecirovicAMjelleABGiljaOH, et al.
Repeatability of shear wave elastography in liver fibrosis phantoms-Evaluation of five different systems. PLoS One2018;
13:e0189671.
24.
AhnSJLeeJMChangW, et al.
Prospective validation of intra- and interobserver reproducibility of a new point shear wave elastographic technique for assessing liver stiffness in patients with chronic liver disease. Korean J Radiol2017;
18:926–935.
25.
SoyupakSGunesliASeydaoğluG, et al.
Portal venous diameter in children: Normal limits according to age, weight and height. Eur J Radiol2010;
75:245–247.
26.
NievelsteinRAJRobbenSGFBlickmanJG.Hepatobiliary and pancreatic imaging in children-techniques and an overview of non-neoplastic disease entities. Pediatr Radiol2011;
41:55–75.
27.
MengYLiangYLiuM.The value of MRI in the diagnosis of primary biliary cirrhosis and assessment of liver fibrosis. PLoS One2015;
10:e0120110.
28.
HuberAEbnerLHeverhagenJT, et al.
State-of-the-art imaging of liver fibrosis and cirrhosis: A comprehensive review of current applications and future perspectives. Eur J Radiol Open2015;
2:90–100.
29.
BrennanPSilmanA.Statistical methods for assessing observer variability in clinical measures.BMJ1992;
304:1491–1494.
30.
PengSSFJengYMHsuWM, et al.
Hepatic ADC map as an adjunct to conventional abdominal MRI to evaluate hepatic fibrotic and clinical cirrhotic severity in biliary atresia patients. Eur Radiol2015;
25:2992–3002.
31.
MoYHJawFSHoMC, et al.
Hepatic ADC value correlates with cirrhotic severity of patients with biliary atresia. Eur J Radiol2011;
80:e253–e257.
32.
YangJCRickmanLSBosserSK.The clinical diagnosis of splenomegaly.West J Med1991;
155:47–52.
33.
KhannaRSarinSK.Non-cirrhotic portal hypertension – Diagnosis and management. J Hepatol2014;
60:421–441.
34.
DitchfieldMRGibsonRNDonlanJD, et al.
Duplex Doppler ultrasound signs of portal hypertension: relative diagnostic value of examination of paraumbilical vein, portal vein and spleen. Australas Radiol1992;
36:102–105.
35.
HwangSMJeonTYYooS-Y, et al.
Early US findings of biliary atresia in infants younger than 30 days. Eur Radiol2018;
28:1771–1777.
36.
Srinivasa BabuAWellsMLTeytelboymOM, et al.
Elastography in chronic liver disease: modalities, techniques, limitations, and future directions. RadioGraphics2016;
36:1987–2006.
37.
VenkateshSKYinMEhmanRL.Magnetic resonance elastography of liver: Technique, analysis, and clinical applications. J Magn Reson Imaging2013;
37:544–555.
38.
GovenderPJonasMMAlomariAI, et al.
Sonography-guided percutaneous liver biopsies in children. AJR Am J Roentgenol2013;
201:645–650.
39.
LeungVYFShenJWongVWS, et al.
Quantitative elastography of liver fibrosis and spleen stiffness in chronic hepatitis B carriers: Comparison of shear-wave elastography and transient elastography with liver biopsy correlation. Radiology2013;
269:910–918.
40.
ZhengJGuoHZengJ, et al.
Two-dimensional shear-wave elastography and conventional us: The optimal evaluation of liver fibrosis and cirrhosis. Radiology2015;
275:290–300.
41.
FerraioliGTinelliCDal BelloB, et al.
Accuracy of real-time shear wave elastography for assessing liver fibrosis in chronic hepatitis C: A pilot study. Hepatology2012;
56:2125–2133.
42.
HahnSMKimSParkKI, et al.
Clinical benefit of liver stiffness measurement at 3 months after Kasai hepatoportoenterostomy to predict the liver related events in biliary atresia. PLoS One2013;
8:e80652.
43.
HanquinetSCourvoisierDSRougemontAL, et al.
Acoustic radiation force impulse sonography in assessing children with biliary atresia for liver transplantation. Pediatr Radiol2016;
46:1011–1016.
