Assessment of Diffusion Tensor Imaging Parameters of Hepatic Parenchyma for Differentiation of Biliary Atresia from Alagille Syndrome

Abstract

Objective: To assess diffusion tensor imaging (DTI) parameters of the hepatic parenchyma for the differentiation of biliary atresia (BA) from Alagille syndrome (ALGS). Materials and Methods: This study included 32 infants with BA and 12 infants with ALGS groups who had undergone DTI. Fractional anisotropy (FA) and mean diffusivity (MD) of the liver were calculated twice by two separate readers and hepatic tissue was biopsied. Statistical analyses were performed to determine the mean values of the two groups. The optimum cutoff values for DTI differentiation of BA and ALGS were calculated by receiver operating characteristic (ROC) analysis. Results: The mean hepatic MD of BA (1.56 ± 0.20 and 1.63 ± 0.2 x 10-3 mm 2 /s) was significantly lower than that of ALGS (1.84 ± 0.04 and 1.79 ± 0.03 x 10-3 mm 2 /s) for both readers (r = 0.8, p = 0.001). Hepatic MD values of 1.77 and 1.79 x 10-3 mm 2 /s as a threshold for differentiating BA from ALGS showed accuracies of 82 and 79% and area under the curves (AUCs) of 0.90 and 0.91 for both readers, respectively. The mean hepatic FA of BA (0.34 ± 0.04 and 0.36 ± 0.04) was significantly higher (p = 0.01, 0.02) than that of ALGS (0.30 ± 0.06 and 0.31 ± 0.05) for both readers (r = 0.80, p = 0.001). FA values of 0.30 and 0.28 as a threshold for differentiating BA from ALGS showed accuracies of 75% and 82% and AUCs of 0.69 and 0.68 for both readers, respectively. Conclusion: Hepatic DTI parameters are promising quantitative imaging parameters for the detection of hepatic parenchymal changes in BA and ALGS and may be an additional noninvasive imaging tool for the differentiation of BA from ALGS.

Early distinction of Alagille syndrome and biliary atresia in infants: A Comparative Study

“…However, contrary to our ndings, several studies [13,22] have suggested that GGT levels are higher in ALGS patients than in BA patients. We hypothesize that this discrepancy might be related to the younger age of ALGS patients in our study, and the degree of early GGT increase may not be signi cant.…”

Development and Assessment of Screening Nomogram for Biliary Atresia Based on Hepatobiliary Ultrasonographic Features

“…A study reported by Abdel Razek et al investigated the DTI parameters of the hepatic parenchyma to distinguish BA and Alagille syndrome (ALGS). The DTI parameters such as fractional anisotropy (FA) and mean diffusivity (MD) of the liver showed higher diagnostic performance in BA early diagnosis, which indicates that DTI could be the extra non-invasive imaging tool for BA from ALGS (24). However, the cost of the ultrasound examination is much lower than that of MRI or DTI.…”