Ultrasound Evaluation of Biliary Atresia Based on Gallbladder Classification: Is 4 Hours of Fasting Necessary?

Abstract

Objectives-The aim of this study was to evaluate the influence of fasting time on the ultrasound identification and exclusion of biliary atresia in jaundiced infants through the use of the gallbladder classification scheme and to test the value of the gallbladder classification scheme in the diagnosis of biliary atresia in inexperienced individuals.Methods-A total of 188 jaundiced infants were enrolled in this study. All patients received detailed abdominal sonograms. Diagnoses were confirmed via liver biopsy, surgical findings, or follow-up. Infants were grouped into either the fasting group (fasting time ≥ 4 h) or the nonfasting group (fasting time < 4 h). According to the gallbladder classification scheme, the gallbladders were classified into 4 types. The accuracy of diagnosing biliary atresia based on the gallbladder classification scheme was compared between the 2 groups. The gallbladders of 177 infants that were detectable by ultrasonography were used to compare the diagnostic performances between a junior radiologist and an experienced radiologist.Results-The accuracies in the diagnosis of biliary atresia with the gallbladder classification scheme were 86.3% (82 of 95 patients) for the fasting group and 93.5% (87 of 93 patients) for the nonfasting group (P = .100). The diagnostic accuracies of biliary atresia were 88.7% (157 of 177 patients) for the junior radiologist and 90.4% (160 of 177 patients) for the experienced radiologist (P = .250). The κ value for the agreement between the 2 radiologists was 0.859. Conclusions-The performance of gallbladder diagnoses was not influenced by the fasting time with the use of the gallbladder classification scheme. Additionally, the gallbladder classification scheme may help junior radiologists to more effectively identify biliary atresia and nonbiliary atresia.

Interpretable artificial intelligence-based app assists inexperienced radiologists in diagnosing biliary atresia from sonographic gallbladder images

“…Infants were not fed for at least 2 h before the US examination and were kept quiet by feeding during the examination. The scan procedure was the same as those previously reported [ 6 , 26 ], with the additional step to store the dynamic gallbladder videos. More details about the acquisition requirements for US gallbladder videos can be seen in Additional file 1 : Method S7.…”

Ultrasound for the Diagnosis of Biliary Atresia: From Conventional Ultrasound to Artificial Intelligence

“…This classification scheme yielded a sensitivity of 86.8% and a specificity of 90.3% [ 20 ]. It was proved that this scheme could yield similar diagnostic performance even if the infant is fasted for less than 4 h [ 21 ]. No enlargement or contraction of the gallbladder after feeding was reported as another useful indicator for the diagnosis of BA [ 18 ].…”

“…On the other hand, patients with a thickness value less than 2 mm ( Figure 2 d) were deemed as without BA. The diagnostic performance of this modified TC sign could be comparable or superior to that of the gallbladder abnormalities, with the areas under the receiver operating characteristic curve (AUC) ranged from 0.771 to 0.952 [ 20 , 21 , 27 , 28 ]. Higher AUC could be obtained when modified TC thickness combined with the gallbladder abnormalities [ 20 , 21 , 27 , 28 ].…”

“…The diagnostic performance of this modified TC sign could be comparable or superior to that of the gallbladder abnormalities, with the areas under the receiver operating characteristic curve (AUC) ranged from 0.771 to 0.952 [ 20 , 21 , 27 , 28 ]. Higher AUC could be obtained when modified TC thickness combined with the gallbladder abnormalities [ 20 , 21 , 27 , 28 ]. Furthermore, the combination of the modified TC sign, gallbladder classification scheme and GGT level with a cut off-value of 188 IU/L could yielded the sensitivity of 100.0% in the diagnosis of BA among infants less than 30 days [ 29 ].…”

Diagnostic Efficacy of Advanced Ultrasonography Imaging Techniques in Infants with Biliary Atresia (BA): A Systematic Review and Meta-Analysis

“…Ultrasonography is a non-invasive, non-ionising, reliable, readily available, and cost-effective imaging modality [ 12 ], which is used as a screening and diagnostic tool for paediatric cholestasis evaluation to exclude biliary atresia [ 13 ]. Although there are no ultrasounographic features that are definitive of the diagnosis of BA, the triangular cord sign, gallbladder length, gallbladder morphologic characteristics, absence of gallbladder, and the presence of hepatic subcapsular flow are among some of the traditional signs consistent with BA diagnosis at ultrasound [ 14 , 15 ]. Ultrasonography imaging techniques have advanced in recent years, with several emerging techniques such as elastography, three and four-dimension (3D/4D) ultrasound, contrast-enhanced ultrasound (CEUS), and artificial intelligence that enable improved structural, hemodynamic, and functional evaluations of various organs [ 16 ].…”