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Eur Radiol. 2018 Aug;28(8):3422-3431. doi: 10.1007/s00330-018-5327-0. Epub 2018 Feb 23.

MRI-based decision tree model for diagnosis of biliary atresia.

Kim YH1, Kim MJ1,2, Shin HJ1,2, Yoon H1,2, Han SJ2,3, Koh H2,4, Roh YH5, Lee MJ6,7.

Author information

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.
2
Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, 50-1Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
3
Department of Pediatric Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 50-1Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
4
Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, 50-1Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
5
Biostatistics Collaboration Unit, Yonsei University College of Medicine, 50-1Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
6
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. mjl1213@yuhs.ac.
7
Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, 50-1Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea. mjl1213@yuhs.ac.

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.

KEYWORDS:

Biliary atresia; Decision trees; Jaundice; Magnetic resonance imaging; Paediatrics

PMID:
29476221
DOI:
10.1007/s00330-018-5327-0
[Indexed for MEDLINE]

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