摘要
Abstract
Objective To evaluate the value of triangular cord sign( TC Sign) and abnormal gallbladder on ultrasound im-ages in the diagnosis of biliary atresia ( BA) , with surgery and Pathology as the reference standard. Methods Infants with choles-tatic jaundice were examined by sonography. Of them, 60 infants performed the intraoperative cholangiography and 47 infants was confirmed with BA. The ultrasund examinations focused on the visualization of the triangular cord sign and assessment of abnormal gallbladder. Thickness of the echogenic anterior wall of the right portal vein ( EARPV) was measured. The TC sign was defined as thickness of the EARPV of more than 4 mm. Abnormal gallbladder contained no gallbladder in the area of calot triangle or the gall-bladder without lumen, small gallbladder with length less than 15mm and irregular gallbladder wall. Sensitivity, specificity, positive and negative predictive values were calculated for TC Sign,abnormal gallbladder, concurrence of TC Sign and abnormal gallbladder, and TC Sign and abnormal gallbladder conbined. Results Right-and-left hepatic duct and porta hepatis bile duct was dilated in 9infants. choledochal cyst co-existed with biliary atresia in 3 (3/9)infants and the misdiagnosis was that of choledochal cyst. The Tri-angular cord (TC)sign was present in 31of47infants with BA and was not appeared in 16 infants with BA. Abnormal gallbladder pres-ented in 37 of 47 infants was confirmed BA, Including 11 infants without gallbladder, 4 infants’ gallbladder without lumen, 22 in-fants with small gallbladder or abnormal gallbladder wall. Sensitivity, specificity, and positive and negative predictive values of TC Sign were 66%, 100%,100% and 45%. Abnormal gallbladder had 78. 7% sensitivity, 84. 6% specificity, 94. 9% and 52. 4% pos-itive and negative predictive values respectively. Concurrence of TC Sign and abnormal gallbladder was in a sensitivity of 53. 2%, specificity of 100%,and positive and negative predictive values of 100% and 52. 4% for the diagnosis of BA. TC Sign and abnormal gallbladder conbined had 87. 2% sensitivity, 84. 6% specificity, 95. 3% and 64. 7% positive and negative predictive values respec-tively. Conclusion TC Sign and abnormal gallbladder on ultrasound images are high specificity in the diagnosis of biliary atresia, TC Sign and abnormal gallbladder conbined can improve the sensitivity for the diagnosis of biliary atresia. In addition, we should attached great importance to the presence of biliary lake in the area of the hepatic portal system, and avoided misdignosis.关键词
胆道闭锁/肝门纤维块/胆囊异常/胆汁湖/超声Key words
biliary atresia/triangular cord sign/abnormal gallbladder/bile lake/ultrasound分类
医药卫生
