Diagnostic Performance of Sonographic Features in Patients With Biliary Atresia: A Systematic Review and Meta‐analysis

Yoon, Hyung Ku; Suh, Chong Hyun; Kim, Jeong Rye; Lee, Jin Seong; Jung, Ah Young; Cho, Young Ah

doi:10.1002/jum.14234

Cited by 29 publications

(22 citation statements)

References 56 publications

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“…17 Although radiologic investigations (such as ultrasound, MRI, and hepatobiliary scintigraphy) were reported to be helpful in differentiating BA from other obstructive cholestasis, they are time consuming and costly. [18][19][20][21][22][23] Therefore, an effective biomarker would be extremely valuable for the preoperative diagnosis of BA.…”

Section: What This Study Addsmentioning

confidence: 99%

Serum MMP-7 in the Diagnosis of Biliary Atresia

et al. 2019

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BACKGROUND: The overlapping features of biliary atresia (BA) and other neonatal cholestasis with alternative causes (non-BA) have posed challenges for diagnosis. Matrix metalloproteinase-7 (MMP-7) has been reported to be promising in diagnosing BA. We aimed to validate the diagnostic accuracy of MMP-7 for BA in a large population sample. METHODS: We enrolled 288 patients with neonatal obstructive jaundice from March 2017 to October 2018. Serum MMP-7 levels were measured by using an enzyme-linked immunosorbent assay. Receiver operating characteristic curves were constructed, and decision curve analysis was done. A Pearson correlation coefficient test was conducted to assess the correlation between MMP-7 levels and other characteristics. RESULTS: The median serum MMP-7 levels were 38.89 ng/mL (interquartile range: 22.96-56.46) for the BA group and 4.4 ng/mL (interquartile range: 2.73-6.56) for the non-BA group (P , .001). The area under the receiver operating characteristic curve value was 0.9829 for MMP-7, and the sensitivity, specificity, positive predictive value, and negative predictive value were 95.19%, 93.07%, 97.27%, and 91.43%, respectively, at a cutoff value of 10.37 ng/mL. When MMP-7 was combined with g glutamyl transferase, the diagnostic accuracy was slightly improved without significance when compared with MMP-7 alone and had an area under the curve of 0.9880 (P = .08). Decision curve analysis also showed potential for MMP-7 to be used for clinical applications. A significant correlation was found with fibrosis stage from liver biopsy (R = 0.47; P , .001). CONCLUSIONS: MMP-7 demonstrated good accuracy in diagnosing BA and holds promise for future clinical application. Furthermore, its correlation with liver fibrosis indicated its potential use as a therapeutic target or prognostic biomarker.

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Section: What This Study Addsmentioning

confidence: 99%

Serum MMP-7 in the Diagnosis of Biliary Atresia

et al. 2019

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“…The triangular cord sign, abnormal gallbladder structure, nonvisualization of the common bile duct, hypertrophied hepatic artery, and presence of hepatic subcapsular flow are reported as useful US features for the diagnosis of biliary atresia (4,(11)(12)(13)17,18). According to the principle of parsimony, only two US findings-the triangular cord sign and abnormal gallbladder structure-were selected on the basis of existing studies (4,17). A recent meta-analysis reported a pooled sensitivity of 85% and specificity of 95% of the triangular cord sign (17).…”

Section: Discussionmentioning

confidence: 99%

“…According to the principle of parsimony, only two US findings-the triangular cord sign and abnormal gallbladder structure-were selected on the basis of existing studies (4,17). A recent meta-analysis reported a pooled sensitivity of 85% and specificity of 95% of the triangular cord sign (17). Abnormal gallbladder structure also showed high diagnostic accuracy, with sensitivity ranging from 85% to 96% and specificity ranging from 82% to 95%.…”

Section: Discussionmentioning

confidence: 99%

“…Given the very low risk for biliary atresia in this group, liver biopsy may be deferred; instead, careful follow-up may be recommended until the exact cause of the neonatal cholestasis is identified. Clinical and radiologic findings that are not included in this scoring system but are known to be associated with biliary atresia, such as serum g-glutamyl transferase level (24,25), increased hepatic subcapsular vascularity, nonvisualization of the common bile duct, or hypertrophied hepatic artery at US, may help in the differential diagnosis (4,17,18). Repeat hepatobiliary scintigraphy should be considered if cholestasis persists without a definite cause (23).…”

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confidence: 99%

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Risk Estimation for Biliary Atresia in Patients with Neonatal Cholestasis: Development and Validation of a Risk Score

Kim¹,

Hwang²,

Yoon³

et al. 2018

Radiology

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Purpose To develop and validate a scoring system based on clinical and imaging features to predict the risk for biliary atresia in patients with neonatal cholestasis. Materials and Methods Patients with neonatal cholestasis who underwent both ultrasonography (US) and hepatobiliary scintigraphy (n = 480) were retrospectively identified from two tertiary referral hospitals from January 2000 to February 2017. Patients from one hospital were classified as the derivation cohort (n = 371), and those from the other hospital were classified as the validation cohort (n = 109). Clinical and imaging features associated with biliary atresia were assessed. Histopathologic or intraoperative cholangiographic findings served as the reference standard for biliary atresia. A prediction model was developed by using logistic regression and was then transformed into a scoring system. The scoring system was internally and externally validated. Results Among the 371 patients in the derivation cohort, 97 (26.15%) had biliary atresia. A scoring system was constructed with the following variables: full-term birth, presence of the triangular cord sign at US, abnormal gallbladder morphology at US, and failure of radioisotope excretion to the small bowel at hepatobiliary scintigraphy. The maximum possible score with this system is 7 points. This system enabled differentiation of biliary atresia in the derivation cohort (C statistic, 0.981; 95% confidence interval [CI]: 0.970, 0.992) and the validation cohort (C statistic, 0.995; 95% CI: 0.987, 1.000). The risk score also showed good calibration in both the derivation and the validation cohorts (P = .328 and P = .281, respectively). Conclusion A simple scoring system combining clinical and imaging features can help accurately estimate the risk for biliary atresia in patients with neonatal cholestasis.

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“…Ultrasonography, a noninvasive, cost-efficient, and simple primary method, can clearly show the structure of porta hepatis (sonographic triangular cord sign, gallbladder, hepatic arterial diameter, and ultrasonic hepatic subcapsular flow (HSF)); thus, it may potentially be the preferred method for the early diagnosis of BA and exclusion of BA [17]. However, the diagnostic performances of the gallbladder and hepatic arterial diameter are not satisfactory due to the low sensitivity or low specificity [18]. Recent studies have focused on the clinical value of HSF in the early diagnosis of BA [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Hepatic Subcapsular Flow as a Significant Diagnostic Marker for Biliary Atresia: A Meta-Analysis

Sun

Pan

et al. 2020

Disease Markers

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Aim. Increasing evidence indicates that hepatic subcapsular flow (HSF) can serve as a noninvasive ultrasonographic marker for the early diagnosis of biliary atresia (BA). However, results regarding its diagnostic accuracy are inconsistent and inconclusive. We conducted this meta-analysis with an aim to systematically evaluate the diagnostic value of HSF in predicting BA. Methods. A comprehensive literature search of four databases was conducted to identify the eligible studies. All analyses were performed using STATA 12.0. Results. Nine studies from eight articles containing 368 patients and 469 controls were included in our meta-analysis. Briefly, the values for pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) were 0.95 (95% CI 0.88-0.98), 0.92 (95% CI 0.85-0.96), 11.6 (95% CI 6.3-21.5), 0.06 (95% CI 0.02-0.14), 201 (95% CI 59-689), and 0.98 (95% CI 0.96-0.99), respectively. Additionally, metaregression along with subgroup analysis based on various covariates revealed the potential sources of heterogeneity and the detailed diagnostic value in each subgroup. Conclusion. Our meta-analysis showed that HSF assay could provide high accuracy in predicting BA patients and non-BA individuals. However, further studies with better design and larger sample size are required to support the results of the present study.

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Diagnostic Performance of Sonographic Features in Patients With Biliary Atresia: A Systematic Review and Meta‐analysis

Abstract: The triangular cord sign and other sonographic features, including abnormal GB morphologic characteristics, nonvisualization of the common bile duct, and the presence of hepatic subcapsular flow, had high diagnostic performance for the diagnosis of biliary atresia.

Cited by 29 publications

References 56 publications

Serum MMP-7 in the Diagnosis of Biliary Atresia

Serum MMP-7 in the Diagnosis of Biliary Atresia

Risk Estimation for Biliary Atresia in Patients with Neonatal Cholestasis: Development and Validation of a Risk Score

Hepatic Subcapsular Flow as a Significant Diagnostic Marker for Biliary Atresia: A Meta-Analysis

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