Yao Taoyue,Duan Xingxing,Zhou Mengjie,et al.Diagnostic value of ultrasonic shear wave elastography plus blood biochemical indicators for biliary atresia[J].Journal of Clinical Pediatric Surgery,,20():119-125.[doi:10.12260/lcxewkzz.2021.02.004]
Diagnostic value of ultrasonic shear wave elastography plus blood biochemical indicators for biliary atresia
- Keywords:
- Ultrasonography; Shear Wave Elastography; Biochemical Phenomena; Biliary Atresia/DI; Blood/MI
- CLC:
- R604 R575.7 R725.7 R445.1 R446.11+2
- Abstract:
- Objective To explore the diagnostic value of ultrasonic shear wave elastography (SWE) in combination with blood biochemical indicators to biliary atresia (BA).Methods Infants within 90 days who were suspected with cholestatic hepatopathy received conventional ultrasonography (US) and SWE for measuring liver stiffness measurement (LSM).Blood biochemical indicators were collected within 3 days from SWE examination.They were divided into BA (n=24) and non-BA (n=33) groups according to the result of pathological examination.The sensitivity,specificity,positive predictive value,negative predictive and accuracy were compared and analyzed. Results Finally A total of 57 infants with infantile cholestatic hepatopathy (ICH) were selected.In blood biochemical test,gamma glutamyl transpeptadase (GGT) had the best diagnostic performance.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of GGT>282.165 IU/L were 75%,75.8%,69.2%,80.6% and 75.4% respectively.Abnormal gallbladder in BA group was significantly associated with the sign of triangular cord (TC) and hepatic subcapsular flow (HSF) as compared with non-BA group (P<0.001).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of abnormal gallbladder were 95.8%,72.7%,71.8%,96% and 82.5%.The LSM of BA and non-BA groups were (16.2±4.0) and (10.7±2.9) KPa with a significant difference (P<0.001).The sensitivity,specificity,positive predictive value,negative predictive value,accuracy of LSM>11.9 KPa were 91.7%,72.7%,71%,92.3% and 80.7%.In the series,LSM plus abnormal gallbladder had the best diagnostic performance with the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of 87.5%,93.3%,91.3%,91.2% and 91.2% respectively.But its sensitivity was lower than conventional US.GGT plus LSM or abnormal gallbladder had similar diagnostic performance.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 75%,70.8%,87.9%,87.9%,81.8%,81%,82.9%,80.6%,82.5% and 80.7% respectively.Conclusion SWE may employed as a valuable reference indicator for ultrasonic diagnosing BA.SWE measurements plus conventional US or blood biochemical indicators offer better diagnostic performance.However,its sensitivity may not as good as conventional US.
References:
1 Jiao CL,Yu KC,Li DD,et al.A retrospective study of the ideal operation time for preterm biliary atresia patients[J].Pediatr Surg Int,2019,35(6):679-684.DOI:10.1007/s00383-019-04464-7.
2 段星星,彭娅,刘凌萍,等.超声剪切波弹性成像技术对胆道闭锁筛查与诊断的临床价值分析[J].临床小儿外科杂志,2018,17(11):27-31.DOI:10.3969/j.issn.1671-6353.2018.11.005. Duan XX,Peng Y,Liu LP,et al.Value of shear wave elastography in differentiating biliary atresia from cholestatic hepatitis in infants[J].J Clin Ped Sur,2018,17(11):27-31.DOI:10.3969/j.issn.1671-6353.2018.11.005.
3 Barr RG,Ferraioli G,Palmeri ML,et al.Elastography Assessment of Liver Fibrosis:Society of Radiologists in Ultrasound Consensus Conference Statement[J].Radiology,2015,276(3):845-861.DOI:10.1148/radiol.2015150619.
4 Dillman JR,Chen S,Davenport MS,et al.Superficial ultrasound shear wave speed measurements in soft and hard elasticity phantoms:repeatability and reproducibility using two ultrasound systems[J].Pediatr Radiol,2015,45(3):376-385.DOI:10.1007/s00247-014-3150-6.
5 Wu JF,Lee CS,Lin WH,et al.Transient elastography is useful in diagnosing biliary atresia and predicting prognosis after hepatoportoenterostomy[J].Hepatology,2018,68(2):616-624.DOI:10.1002/hep.29856.
6 Fawaz R,Baumann U,Ekong U,et al.Guideline for the Evaluation of Cholestatic Jaundice in Infants:Joint Recommendations of the North American Society for Pediatric Gastroenterology,Hepatology,and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology,Hepatology,and Nutrition[J].J Pediatr Gastroenterol Nutr,2017,64(1):154-168.DOI:10.1097/MPG.0000000000001334.
7 杜妍妍,符柳江,张向向,等.高频彩色多普勒超声在诊断小儿胆道闭锁中的应用[J].临床小儿外科杂志,2017,16(1):89-91.DOI:10.3969/j.issn.1671-6353.2017.01.021. Du YY,Fu LJ,Zhang XX,et al.Application of high-frequency color Doppler ultrasound in the diagnosis of biliary atresia in children[J].J Clin Ped Sur,2017,16(1):89-91.DOI:10.3969/j.issn.1671-6353.2017.01.021.
8 段星星,陈文娟,何静波,等.高频彩色多普勒超声对3个月以内婴儿胆道闭锁的诊断价值[J].临床小儿外科杂志,2013,12(5):410-413.DOI:10.3969/j.issn.1671-6353.2013.05.020. Duan XX,Chen WJ,He JB,et al.Value of high-frequency color Doppler ultrasound in the diagnosis of biliary atresia in infants less than 3 months[J].J Clin Ped Sur,2013,12(5):410-413.DOI:10.3969/j.issn.1671-6353.2013.05.020.
9 蒋宏,刘钧澄.胆道闭锁的早期诊断及误诊原因分析[J].临床小儿外科杂志,2015,17(1):7-9.DOI:10.3969/j.issn.1671-6353.2015.01.003. Jiang H,Liu JC.Early diagnosis and misdiagnostic causes of biliary atresia[J].J Clin Ped Sur,2015,17(1):7-9.DOI:10.3969/j.issn.1671-6353.2015.01.003.
10 Dietrich CF,Bamber J,Berzigotti A,et al.EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography,Update 2017 (Short Version)[J].Ultraschall Med,2017,38(4):377-394.DOI:10.1055/s-0043-103955.
11 Shiina T,Nightingale KR,Palmeri ML,et al.WFUMB gu-idelines and recommendations for clinical use of ultrasound elastography:Part 1:basic principles and terminology[J].Ultrasound Med Biol,2015,41(5):1126-1147.DOI:10.1016/j.ultrasmedbio.2015.03.009.
12 Wang XM,Qian LX,Jia LQ,et al.Utility of shear wave elastography for differentiating biliary atresia from infantile hepatitis syndrome[J].Ultrasound Med,2016,35(7):1475-1479.DOI:10.7863/ultra.15.08031.
13 刘洪江,张明满.胆道闭锁早期诊断方法的研究进展[J].临床小儿外科杂志,2017,16(2):113-116.DOI:10.3969/j.issn.1671-6353.2017.02.003. Liu HJ,Zhang MM.Advances in methods and researches of early diagnosing biliary atresia[J].J Clin Ped Sur,2017,16(2):113-116.DOI:10.3969/j.issn.1671-6353.2017.02.003.
14 Zhou LY,Jiang H,Shan QY,et al.Liver stiffness measurements with supersonic shear wave elastography in the diagnosis of biliary atresia:a comparative study with grey-scale US[J].Eur Radiol,2017,27(8):3474-348.DOI:10.1007/s00330-016-4710-y.
15 Sun Y,Zheng S,Qian Q.Ultrasonographic evaluation in the differential diagnosis of biliary atresia and infantile hepatitis syndrome[J].Pediatr Surg Int,2011,27(7):675-679.DOI:10.1007/s00383-010-2814-z.
16 El-Guindi MA,Sira MM,Sira AM,et al.Design and validation of a diagnostic score for biliary atresia[J].J Hepatol,2014,61(1):116-123.DOI:10.1016/j.jhep.2014.03.016.
17 卫园园,陈扬,高婷.谷氨酰转肽酶测定联合超声诊断先天性胆道闭锁[J].中华普通外科杂志,2017,32(5):425-428.DOI:10.3760/cma.j.issn.1007-631X.2017.05.014. Wei YY,Chen Y,Gao T.The diagnostic value of GGT combined with ultrasound found gallbladder abnormality in infants with biliary atresia[J].Chin J Gen Surg,2017,32(5):425-428.DOI:10.3760/cma.j.issn.1007-631X.2017.05.014.
18 王增萌,陈亚军,彭春辉.肝脏硬度测量在胆道闭锁与其他婴儿胆汁淤积鉴别诊断中的应用价值[J].中华小儿外科杂志,2017,38(4):283-287.DOI:10.3760/cma.j.issn.0253-3006.2017.04.009. Wang ZM,Chen YJ,Peng CH.Utility of liver stiffness measurement for differentiating biliary atresia from other causes of infantile cholestasis[J].Chin J Pediatr Surg,2017,38(4):283-287.DOI:10.3760/cma.j.issn.0253-3006.2017.04.009.
Memo
收稿日期:2019-11-05。
基金项目:湖南省出生缺陷协调防治科技重大专项（编号：2019SK1010）；湖南省自然科学基金（编号：2017JJ2141）；湖南省卫生健康委科研计划项目（编号：20200149）
通讯作者:陈文娟,Email:chenwjok@126.com