Making the diagnosis of biliary atresia using the triangular cord sign and gallbladder length

被引:75
作者
Kendrick, APT
Phua, KB
Subramaniam, R
Goh, ASW
Ooi, BC
Tan, CE
机构
[1] Kandang Kerbau Womens & Childrens Hosp, Dept Diagnost Imaging, Singapore 229899, Singapore
[2] Kandang Kerbau Womens & Childrens Hosp, Dept Paediat Surg, Singapore 229899, Singapore
[3] Singapore Gen Hosp, Dept Nucl Med, Singapore 169608, Singapore
关键词
D O I
10.1007/s002470050017
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Background. To evaluate the accuracy and utility of the triangular cord sign and gallbladder length in diagnosing biliary atresia by sonography. Materials and methods. Sixty fasted infants with cholestatic jaundice aged 2-12 weeks were examined sonographically using a 5-10 MHz linear array transducer, focusing on the triangular cord sign (as described by Choi et al. [I]), the gallbladder, and ducts. The triangular cord is defined as a triangular or tubular echogenic density seen immediately cranial to the portal vein bifurcation; it represents the fibrotic remnant of the obliterated cord in biliary atresia. The findings were blinded to blood chemistry, Tc-99m-DISIDA hepatobiliary scintigraphy, and liver biopsy. Diagnosis of biliary atresia was confirmed at surgery and histology. Non-biliary atresia infants resolved medically. Comparative charges of the various investigations was made. Results. Twelve infants had biliary atresia, and ten demonstrated a definite triangular cord. The two false-negatives had small or nonvisualized,gallbladders. No false-positives were recorded. Gallbladder length ranged from 0-1.45 cm with a mean of 0.52 cm in biliary atresia compared to a mean of 2.39 cm in nonbiliary atresia infants. Tc-99m-DISIDA hepatobiliary scintigraphy showed no excretion (false-positive) in 23 % of nonbiliary atresia cases. Scintigraphy and liver biopsy charges were 2 and 6 times that of sonography, respectively. Conclusion. The triangular cord sign and gallbladder length together are noninvasive, inexpensive, and very useful markers for biliary atresia.
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页码:69 / 73
页数:5
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