Diffusion Tensor Imaging for Evaluating Biliary Atresia in Infants and Neonates

Abstract

BackgroundPreliminary studies have shown that diffusion tensor imaging (DTI) is helpful in evaluating liver disorders. However, there is no published literature on the use of DTI in the diagnosis of biliary atresia (BA). This study aimed to investigate the diagnostic value of the liver average apparent diffusion coefficient (ADC) and fractional anisotropy (FA) measured using DTI for BA in neonates and infants.MethodsFifty-nine patients with infant jaundice were included in this study. DTI was performed with b factors of 0 and 1000 s/mm2. Liver fibrosis in the BA group was determined and graded (F0, F1, F2, F3, F4) based on the pathological findings. Statistical analyses were performed to determine the diagnostic accuracy of DTI for BA.ResultsThe ADC value was significantly lower in the BA group [(1.262±0.127)×10−3 mm2/s] than in the non-BA group [(1.430±0.149)×10−3 mm2/s, (P<0.001)]. The area under the receiver operating characteristic curve was 0.805±0.058 (P<0.001) for ADC. With a cut-off value of 1.317×10−3 mm2/s, ADC achieved a sensitivity of 75% and a specificity of 81.5% for the differential diagnosis of BA and non-BA. In the BA group, the ADC value was significantly correlated with fibrotic stage. Further analysis showed that the ADC value of stage F0 was significantly higher than that of stages F1, F2, F3 and F4, whereas there were no significant differences among stages F1, F2, F3 and F4.ConclusionHepatic ADC measured with DTI can be used as an adjunct to other noninvasive imaging methods in the differential diagnosis of BA and non-BA. ADC was helpful in detecting liver fibrosis but not in differentiating the fibrotic grades.

Diffusion-Weighted Imaging for Differentiation of Biliary Atresia and Grading of Hepatic Fibrosis in Infants with Cholestasis

“…Moreover, they showed the difference between BA patients and normal healthy subjects, but not with non-BA cholestasis patients. A recent study in 59 neonates and infants demonstrated the utility of diffusion tensor imaging in neonatal cholestasis for the differentiation of BA from non-BA ( 17 ). When using the b-values of 0 and 1000 s/mm 2 , the ADC cutoff value of 1.317 × 10 −3 mm 2 /s showed 78% sensitivity and 81.5% specificity for diagnosing BA ( 17 ).…”

“…In previous studies, ADC values and clinical scores for assessing hepatic fibrosis showed a significant correlation in patients with BA ( 15 16 ). However, only a few report the use of DWI in the diagnosis of BA and, in particular, on the relationship between the histologically diagnosed degree of hepatic fibrosis and DWI in pediatric patients ( 17 ).…”

Clinical utility of mono-exponential model diffusion weighted imaging using two b-values compared to the bi- or stretched exponential model for the diagnosis of biliary atresia in infant liver MRI

“…Peng et al mentioned that ADC values could also be used to predict the degree of liver fibrosis in postoperative patients [12]. In 2016, Liu et al first utilized diffusion tensor imaging (DTI) to differentiate BA from non-BA and demonstrated that fractional anisotropy from DTI showed no significant differences between the two groups, while ADC values with 0 and 1000 s/mm 2 had significantly lower values in BA patients [13]. The diagnostic performance of ADC value was demonstrated by an AUC value of 0.805 with a cutoff value of 1.317 ×10 −3 mm 2 /s with a sensitivity of 75% and specificity of 82% [13].…”

“…In 2016, Liu et al first utilized diffusion tensor imaging (DTI) to differentiate BA from non-BA and demonstrated that fractional anisotropy from DTI showed no significant differences between the two groups, while ADC values with 0 and 1000 s/mm 2 had significantly lower values in BA patients [13]. The diagnostic performance of ADC value was demonstrated by an AUC value of 0.805 with a cutoff value of 1.317 ×10 −3 mm 2 /s with a sensitivity of 75% and specificity of 82% [13]. To our knowledge, our study is the first attempt to utilize MEM, BEM, and SEM DWI to differentiate BA from non-BA.…”

“…In previous studies, the apparent diffusion coefficient (ADC) values from MEM were significantly lower in the liver of BA patients compared to patients with neonatal hepatitis [11–13]. A previous study demonstrated that ADC could be a new imaging parameter for assessing liver fibrosis in BA patients [12].…”