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A quantitative image analysis using MRI for diagnosis of biliary atresia

  • Dao Chen Lin
    Affiliations
    Department of Radiology, Taipei Veterans General Hospital, Taipei City 11217, Taiwan, ROC

    Division of Endocrine and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei City 11217, Taiwan, ROC

    School of Medicine, National Yang-Ming University, Taipei City 11221, Taiwan, ROC
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  • Kun Yu Wu
    Affiliations
    Department of Medical Imaging, Chi Mei Medical Center, Tainan City 71004, Taiwan, ROC
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  • Fang Ju Sun
    Affiliations
    Mackay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan, ROC

    Department of Medical Research, MacKay Memorial Hospital, Tamsui Branch, New Taipei City 25160, Taiwan, ROC
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  • Chun Chao Huang
    Affiliations
    Mackay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan, ROC

    Department of Radiology, MacKay Memorial Hospital, Taipei City 10449, Taiwan, ROC

    Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan, ROC
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  • Tung Hsin Wu
    Affiliations
    Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei City 11221, Taiwan, ROC
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  • Shin Lin Shih
    Affiliations
    Department of Radiology, MacKay Memorial Hospital, Taipei City 10449, Taiwan, ROC

    Department of Radiology, Taipei Medical University, Taipei City 11031, Taiwan, ROC
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  • Pei Shan Tsai
    Correspondence
    Corresponding author at: Department of Radiology, MacKay Memorial Hospital, No. 92, Sec. 2, Chung-Shan N. Rd., Taipei City 10449, Taiwan, ROC.
    Affiliations
    Mackay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan, ROC

    Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan, ROC

    Department of Radiology, MacKay Memorial Hospital, Taipei City 10449, Taiwan, ROC
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      Highlights

      • MRI image can give more information for diagnosis of biliary atresia when other image findings are inconclusive.
      • Enlarged T2-weighted high signal at porta hepatis can distinguish biliary atresia from neonatal hepatitis.
      • A quantitative measurement in the MRI image may be helpful for diagnosis of biliary atresia.

      Abstract

      Purpose

      Biliary atresia is a life-threatening disease that needs early diagnosis and management. Recently, MRI images have been used for the diagnosis of biliary atresia with improved accuracy of diagnosis when other imaging modalities such as ultrasonography are equivocal. This study aimed to evaluate the juxta-hilar extrahepatic biliary tree using MRI images to determine a quantitative value for diagnosing biliary atresia.

      Materials and methods

      This retrospective study was approved by the Ethical Committee at Mackey Memorial Hospital (IRB Number: 15MMHIS149e). Between January 2010 and December 2015, twenty-five patients with surgically confirmed biliary atresia were enrolled (age 18–65 days). Another 25 patients with clinically or surgically diagnosed idiopathic neonatal hepatitis (age 6–64 days) and 20 patients with non-hepatobiliary disease (age 6–65 days) were considered control group and normal subjects, respectively. The diameter of the enlarged, T2-hyperintense structure was measured using MRI images by two radiologists both blinded. The cut-off value for a biliary atresia diagnosis was obtained by area under the curve analysis.

      Results

      The diameter of the T2-hyperintense structure at porta hepatis in biliary atresia (4.79 ± 1.14 mm) is larger than in idiopathic neonatal hepatitis (1.72 ± 0.42 mm) or in non-hepatobiliary disease (1.72 ± 0.35 mm) (p < 0.05). The optimum cut-off value for diagnosing biliary atresia was 3.1 mm with 98% sensitivity and 98% specificity.

      Conclusion

      The value of the enlarged, T2-hyperintense structure measured on MRI images was significantly increased in biliary atresia and may be useful in diagnosing biliary atresia.

      Keywords

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