Evaluation of the Triangular Cord Sign in the Diagnosis of Biliary Atresia

Kotb, Magd A.; Kotb, Ahmed M.; Sheba, Maha F.; Koofy, Nehal M El; El‐Karaksy, Hanaa; Abdel-Kahlik, Mohamed K.; Abdalla, Ahmed; El-Regal, Mohammed Ez; Warda, Rady; Mostafa, Hosam; Karjoo, Manoochehr; A-Kader, H. Hesham

doi:10.1542/peds.108.2.416

Cited by 74 publications

(37 citation statements)

References 19 publications

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“…A small or absent gallbladder on hepatic US suggests BA, but the relatively low sensitivity of US indicates that it cannot be used to exclude this diagnosis. Recent studies have concluded that the triangular cord sign, which is identified at the porta hepatis and likely represents the fibrosis at the portal plate, was 73–100% sensitive and 98–100% specific for the diagnosis of BA [16]–[18]. If no such characteristic US sign is visualized, hepatobiliary scintigraphy or MRCP is the next step.…”

Section: Discussionmentioning

confidence: 99%

Three-Dimensional Magnetic Resonance Cholangiopancreatography for the Diagnosis of Biliary Atresia in Infants and Neonates

Liu

Cai

et al. 2014

PLoS ONE

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Background and ObjectiveMagnetic resonance cholangiopancreatography (MRCP) is widely accepted for visualization of the biliary system. However, the sensitivity and specificity of MRCP for the diagnosis of biliary atresia (BA) are still not fully elucidated. This study aimed to investigate the diagnostic value of three-dimensional MRCP (3D-MRCP) for BA in a large cohort of cholestatic infants and neonates.MethodsOne hundred ninety patients with infant jaundice underwent 3D-MRCP and one or more of the following: (1) intraoperative cholangiography, (2) laparoscopic exploration and pathological examination, or/and (3) clinical therapy. Statistical analyses were performed to determine the diagnostic accuracy of 3D-MRCP for BA.ResultsOur study demonstrated that 158 of 190 patients were interpreted as having BA by 3D-MRCP; of those, 103 patients were confirmed as having BA, whereas 55 patients did not have BA. Of the 32 patients interpreted as non-BA cases by 3D-MRCP, one patient was misdiagnosed. The diagnostic accuracy for 3D-MRCP was 70.53% (134 of 190), the sensitivity was 99.04% (103 of 104), the specificity was 36.05% (31 of 86), the negative predictive value was 96.88% (31 of 32), the positive predictive value was 65.19% (103 of 158), the positive likelihood ratio was 2.7473, the negative likelihood ratio was 0.0267, and the Youden index was 0.3509.ConclusionsThe sensitivity of 3D-MRCP in diagnosing BA was excellent, but the specificity was not as high as described in previous reports. 3D-MRCP can be an effective screening method but should be combined with other modalities to identify BA and distinguish it from other causes of infant jaundice.

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Section: Discussionmentioning

confidence: 99%

Three-Dimensional Magnetic Resonance Cholangiopancreatography for the Diagnosis of Biliary Atresia in Infants and Neonates

Liu

Cai

et al. 2014

PLoS ONE

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“…Lin et al 33 demonstrated a sensitivity, specificity and accuracy of abdominal ultrasound for biliary atresia of 86.7%, 77.1% and 79.4%, respectively, and similar data were reported by Park et al, 10 with values of 85%, 100% and 95%, respectively. Kotb et al 34 found 25/65 cholestatic infants aged 32 -161 days identified with the triangular cord sign had extrahepatic biliary atresia and suggested that its presence on ultrasound should promote an intraoperative cholangiogram, reserving liver biopsy for cases that do not show the triangular cord sign. After abdominal ultrasonography of 55 infants with cholestatic jaundice, which focused on the triangular cord sign, Kanegawa et al 35 reported that the diagnostic accuracy for biliary atresia was 95%, the sensitivity was 93% and the specificity was 96%.…”

Section: Diagnosis Of Infantile Cholestasismentioning

confidence: 99%

Predictive Value of Assessment of Different Modalities in the Diagnosis of Infantile Cholestasis

et al. 2010

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This study investigated the relative accuracy and roles of abdominal ultrasonography, hepatobiliary scintigraphy and liver biopsy in the diagnosis of infantile cholestasis. A total of 50 infants (27 females) aged 1 - 12 months were classified into those with intrahepatic causes of cholestasis (n = 22) and those with extrahepatic causes (n = 28). Cholestasis is caused by a wide range of conditions and diagnosis requires meticulous history taking, thorough clinical examination and many laboratory tests. The most common cause of intrahepatic cholestasis was found to be idiopathic neonatal hepatitis (54.5%), followed by infectious hepatitis (9.1%), metabolic liver diseases (9.1%), intrahepatic biliary atresia (9.1%) and Alagille syndrome (4.5%). The most common cause of extrahepatic cholestasis was extrahepatic biliary atresia (96.4%). The incidence of choledochal cyst was low (3.6%). The cornerstone of the diagnosis of infantile cholestasis was found to be liver biopsy, which was associated with a high degree of accuracy.

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“…It is a triangular structure, composed of fibrous tissue located cranial to the portal vein bifurcation. Although some studies reported 100% accuracy of TC sign in detection of BA [3], most studies report accuracy of 70-90% for this sign [4].…”

Section: Introductionmentioning

confidence: 95%