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Enlarged hepatic hilar lymph node: an additional ultrasonographic feature that may be helpful in the diagnosis of biliary atresia

  • Zongjie Weng
  • Luyao Zhou
  • Qiumei Wu
  • Wenying Zhou
  • Hong Ma
  • Yifan Fang
  • Tingting Dang
  • Min LiuEmail author
Ultrasound
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Abstract

Objectives

To prospectively assess whether the detection of hepatic hilar lymph nodes (LNs) contributes to the diagnosis of biliary atresia (BA).

Methods

A total of 80 jaundiced infants were enrolled in this study and had abdominal ultrasound (US). The hepatic hilar LNs, the gallbladder classification, and the triangular cord (TC) thickness of all infants were evaluated. The area under the receiver operating characteristic curve (AUROC) analysis, t tests, and chi-squared tests were used to compare US signs between infants with BA and those without BA.

Results

BA was found in 45 patients and excluded in 35 patients. The length of the hepatic hilar LNs in infants with BA (median with interquartile range, 11 mm (8, 13.5)) was significantly greater than that in infants without BA (0 mm (0, 0)) (p < 0.001). The AUROCs of the enlarged hepatic hilar LNs, gallbladder classification, and TC thickness were 0.867, 0.894, and 0.832, respectively. The accuracy of LNs (87.5%) in the diagnosis of BA was close to that of the gallbladder classification scheme (88.8%) (p = 0.049) and was higher than that of the TC thickness (82.5%) (p = 0.031). The enlarged LNs had the highest sensitivity (93.3%) in distinguishing BA from non-BA.

Conclusions

The presence of enlarged hepatic hilar LNs is an additional highly sensitive sign for the noninvasive diagnosis of BA. Through the combination of enlarged LNs, gallbladder classification, and TC thickness, most BA could be identified.

Key Points

• An enlarged hepatic hilar LN is an additional US sign for the noninvasive diagnosis of biliary atresia.

• Combining enlarged hepatic hilar LNs, gallbladder classification, and TC thickness, BA could be diagnosed in most infants.

Keywords

Biliary atresia Lymph nodes Ultrasonography Gallbladder 

Abbreviations

BA

Biliary atresia

TC

Triangular cord

US

Ultrasonography

LNs

Lymph nodes

HPE

Hepatic portoenterostomy

AUROCs

Area under receiver operating characteristic curves

Notes

Funding

This study was supported by the Fujian Natural Science Foundation (No: 2017J01235), Fujian Provincial Maternity and Children’s Hospital Science and Technology Innovation Startup Fund (No: Maternal and Child YXCM 18-20), and the National Natural Science Foundation of China (No: 81501480).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Min Liu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Prospective

• Diagnostic study or prognostic study

• Performed at one institution

References

  1. 1.
    Landing BH (1974) Considerations of the pathogenesis of neonatal hepatitis, biliary atresia and choledochal cyst--the concept of infantile obstructive cholangiopathy. Prog Pediatr Surg 6:113–139Google Scholar
  2. 2.
    Hartley JL, Davenport M, Kelly DA (2009) Biliary atresia. Lancet 374:1704–1713CrossRefGoogle Scholar
  3. 3.
    Kasai M, Suzuki H, Ohashi E, Ohi R, Chiba T, Okamoto A (1978) Technique and results of operative management of biliary atresia. World J Surg 2:571–579CrossRefGoogle Scholar
  4. 4.
    Zhou L, Shan Q, Tian W, Wang Z, Liang J, Xie X (2016) Ultrasound for the diagnosis of biliary atresia: a meta-analysis. AJR Am J Roentgenol 206:W73–82CrossRefGoogle Scholar
  5. 5.
    Zhou LY, Wang W, Shan QY et al (2015) Optimizing the US diagnosis of biliary atresia with a modified triangular cord thickness and gallbladder classification. Radiology 277:181–191CrossRefGoogle Scholar
  6. 6.
    Leschied JR, Dillman JR, Bilhartz J, Heider A, Smith EA, Lopez MJ (2015) Shear wave elastography helps differentiate biliary atresia from other neonatal/infantile liver diseases. Pediatr Radiol 45:366–375CrossRefGoogle Scholar
  7. 7.
    Wang X, Qian L, Jia L et al (2016) Utility of shear wave Elastography for differentiating biliary atresia from infantile hepatitis syndrome. J Ultrasound Med 35:1475–1479CrossRefGoogle Scholar
  8. 8.
    Zhou LY, Jiang H, Shan QY et al (2017) Liver stiffness measurements with supersonic shear wave elastography in the diagnosis of biliary atresia: a comparative study with grey-scale US. Eur Radiol 27:3474–3484CrossRefGoogle Scholar
  9. 9.
    Sakamoto N, Muraji T, Ohtani H, Masumoto K (2017) The accumulation of regulatory T cells in the hepatic hilar lymph nodes in biliary atresia. Surg Today 47:1282–1286CrossRefGoogle Scholar
  10. 10.
    Bove KE, Sheridan R, Fei L et al (2018) Hepatic hilar lymph node reactivity at Kasai portoenterostomy for biliary atresia: correlations with age, outcome, and histology of proximal biliary remnant. Pediatr Dev Pathol 21:29–40CrossRefGoogle Scholar
  11. 11.
    Chardot C, Carton M, Spire-Bendelac N, Le Pommelet C, Golmard JL, Auvert B (1999) Epidemiology of biliary atresia in France: a national study 1986-96. J Hepatol 31:1006–1013CrossRefGoogle Scholar
  12. 12.
    Hsiao CH, Chang MH, Chen HL et al (2008) Universal screening for biliary atresia using an infant stool color card in Taiwan. Hepatology 47:1233–1240CrossRefGoogle Scholar
  13. 13.
    McKiernan PJ, Baker AJ, Kelly DA (2000) The frequency and outcome of biliary atresia in the UK and Ireland. Lancet 355:25–29CrossRefGoogle Scholar
  14. 14.
    Nakamura K, Tanoue A (2013) Etiology of biliary atresia as a developmental anomaly: recent advances. J Hepatobiliary Pancreat Sci 20:459–464CrossRefGoogle Scholar
  15. 15.
    Petersen C, Davenport M (2013) Aetiology of biliary atresia: what is actually known? Orphanet J Rare Dis 8:128CrossRefGoogle Scholar
  16. 16.
    Sokol RJ, Mack C (2001) Etiopathogenesis of biliary atresia. Semin Liver Dis 21:517–524CrossRefGoogle Scholar
  17. 17.
    El-Guindi MA, Sira MM, Konsowa HA, El-Abd OL, Salem TA (2013) Value of hepatic subcapsular flow by color Doppler ultrasonography in the diagnosis of biliary atresia. J Gastroenterol Hepatol 28:867–872CrossRefGoogle Scholar
  18. 18.
    Kim WS, Cheon JE, Youn BJ et al (2007) Hepatic arterial diameter measured with US: adjunct for US diagnosis of biliary atresia. Radiology 245:549–555CrossRefGoogle Scholar
  19. 19.
    Lee MS, Kim MJ, Lee MJ et al (2009) Biliary atresia: color doppler US findings in neonates and infants. Radiology 252:282–289CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Zongjie Weng
    • 1
  • Luyao Zhou
    • 2
  • Qiumei Wu
    • 1
  • Wenying Zhou
    • 2
  • Hong Ma
    • 3
  • Yifan Fang
    • 4
  • Tingting Dang
    • 1
  • Min Liu
    • 1
    Email author
  1. 1.Department of Medical Ultrasonics, Fujian Provincial Maternity and Children’s HospitalAffiliated Hospital of Fujian Medical UniversityFuzhou CityPeople’s Republic of China
  2. 2.Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, the First Affiliated HospitalSun Yat-Sen UniversityGuangzhouPeople’s Republic of China
  3. 3.Department of Pathology, Fujian Provincial Maternity and Children’s HospitalAffiliated Hospital of Fujian Medical UniversityFuzhou CityPeople’s Republic of China
  4. 4.Department of Pediatric Surgery, Fujian Provincial Maternity and Children’s HospitalAffiliated Hospital of Fujian Medical UniversityFuzhou CityPeople’s Republic of China

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