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MRI-based decision tree model for diagnosis of biliary atresia

  • Paediatric
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate MRI findings and to generate a decision tree model for diagnosis of biliary atresia (BA) in infants with jaundice.

Methods

We retrospectively reviewed features of MRI and ultrasonography (US) performed in infants with jaundice between January 2009 and June 2016 under approval of the institutional review board, including the maximum diameter of periportal signal change on MRI (MR triangular cord thickness, MR-TCT) or US (US-TCT), visibility of common bile duct (CBD) and abnormality of gallbladder (GB). Hepatic subcapsular flow was reviewed on Doppler US. We performed conditional inference tree analysis using MRI findings to generate a decision tree model.

Results

A total of 208 infants were included, 112 in the BA group and 96 in the non-BA group. Mean age at the time of MRI was 58.7 ± 36.6 days. Visibility of CBD, abnormality of GB and MR-TCT were good discriminators for the diagnosis of BA and the MRI-based decision tree using these findings with MR-TCT cut-off 5.1 mm showed 97.3 % sensitivity, 94.8 % specificity and 96.2 % accuracy.

Conclusions

MRI-based decision tree model reliably differentiates BA in infants with jaundice. MRI can be an objective imaging modality for the diagnosis of BA.

Key Points

• MRI-based decision tree model reliably differentiates biliary atresia in neonatal cholestasis.

• Common bile duct, gallbladder and periportal signal changes are the discriminators.

• MRI has comparable performance to ultrasonography for diagnosis of biliary atresia.

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Abbreviations

3D:

Three-dimensional

AUC:

Area under the curve

BA:

Biliary atresia

CBD:

Common bile duct

CI:

Confidence interval

GB:

Gallbladder

HA:

Hepatic artery

MR-TCT:

MR triangular cord thickness

MRCP:

MR cholangiopancreatography

NPV:

Negative predictive value

OR:

Odds ratio

PPV:

Positive predictive value

PV:

Portal vein

ROC:

Receiver-operating characteristic

US:

Ultrasonography

US-TCT:

US triangular cord thickness

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiological Science, Severance Children’s Hospital, Yonsei University College of Medicine, 50-1Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea

    Yong Hee Kim, Myung-Joon Kim, Hyun Joo Shin, Haesung Yoon & Mi-Jung Lee

  2. Severance Pediatric Liver Disease Research Group, Severance Children’s Hospital, Yonsei University College of Medicine, 50-1Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea

    Myung-Joon Kim, Hyun Joo Shin, Haesung Yoon, Seok Joo Han, Hong Koh & Mi-Jung Lee

  3. Department of Pediatric Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, 50-1Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea

    Seok Joo Han

  4. Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, 50-1Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea

    Hong Koh

  5. Biostatistics Collaboration Unit, Yonsei University College of Medicine, 50-1Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea

    Yun Ho Roh

Authors
  1. Yong Hee Kim
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  2. Myung-Joon Kim
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  8. Mi-Jung Lee
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Corresponding author

Correspondence to Mi-Jung Lee.

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Guarantor

The scientific guarantor of this publication is Eun Kyung Kim.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

As an author and an expert in statistics, Yun Ho Roh contributed statistical analyses of this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board for this retrospective study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• case-control

• performed at one institution

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Kim, Y.H., Kim, MJ., Shin, H.J. et al. MRI-based decision tree model for diagnosis of biliary atresia. Eur Radiol 28, 3422–3431 (2018). https://doi.org/10.1007/s00330-018-5327-0

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  • DOI: https://doi.org/10.1007/s00330-018-5327-0

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