Siyoun Sung MD, Presenter: Nothing to Disclose

Tae Yeon Jeon MD, Abstract Co-Author: Nothing to Disclose

Ji Hye Kim MD, Abstract Co-Author: Nothing to Disclose

So Young Yoo MD, Abstract Co-Author: Nothing to Disclose

Hong Eo, Abstract Co-Author: Nothing to Disclose

Weekyoung Kim MD, Abstract Co-Author: Nothing to Disclose

To evaluate the incremental value of MR cholangiography (MRCP) in combination with US compared with US alone for diagnosing biliary atresia in patients with cholestasis.

Fifty-six neonates and young infants with cholestatic jaundice (mean age, 65 days; male to female ratio, 19:37) were enrolled. All patients underwent both MRCP and detailed US studies. Biliary atresia (n=41) was confirmed with surgical cholangiography, and hepatitis (n=15) was diagnosed with clinical improvement during the follow-up (n=14) or surgical cholangiography (n=1). Two observers independently reviewed a set of US alone and a combined set of MRCP and US, and rated them by a five-point scale. Diagnostic performance was compared using pairwise comparison of the receiver operating characteristics (ROC) curve. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value (NPV) were assessed.

The diagnostic performance (area under the ROC curve [Az]) to diagnose biliary atresia improved significantly after additional review of MRCP images; Az improved from 0.693 to 0.921 (P=.021) for observer 1 and from 0.648 to 0.888 (P=.005) for observer 2. The accuracy of MRCP combined with US (observer 1, 95% [53 of 56]; observer 2, 93% [52 of 56]), and NPV (observer 1, 93% [13 of 14]; observer 2, 92% [12 of 13]) were significantly higher than those of US alone (accuracy: observer 1, 77% [43 of 56], P=.021; observer 2, 73% [41 of 56], P=.007; NPV: observer 1, 57% [8 of 14], P<.001; observer 2, 50% [7 of 15], P<.001).

The combination of MRCP and US yielded better diagnostic performance to evaluate biliary atresia than US alone.

Addition of MRCP to US can improve reader confidence in establishing a final diagnosis of BA and it may be helpful when the probability of US alone is intermediate results.

Sung, S, Jeon, T, Kim, J, Yoo, S, Eo, H, Kim, W, Incremental Value of MR Cholangiography in the Diagnosis of Biliary Atresia.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14046085.html