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Diffusion-Weighted Imaging for Differentiation of Biliary Atresia and Grading of Hepatic Fibrosis in Infants with Cholestasis

 Jisoo Kim  ;  Hyun Joo Shin  ;  Haesung Yoon  ;  Seok Joo Han  ;  Hong Koh  ;  Myung Joon Kim  ;  Mi Jung Lee 
 KOREAN JOURNAL OF RADIOLOGY, Vol.22(2) : 253-262, 2021-02 
Journal Title
Issue Date
Area Under Curve ; Biliary Atresia / complications ; Biliary Atresia / diagnosis* ; Cholestasis / complications* ; Diffusion Magnetic Resonance Imaging* ; Female ; Humans ; Image Processing, Computer-Assisted ; Infant ; Infant, Newborn ; Liver / diagnostic imaging ; Liver / physiology ; Liver Cirrhosis / complications ; Liver Cirrhosis / diagnosis* ; Liver Cirrhosis / pathology ; Male ; ROC Curve ; Retrospective Studies ; Severity of Illness Index ; Spleen / diagnostic imaging ; Spleen / physiology
Biliary atresia ; Diffusion magnetic resonance imaging ; Liver cirrhosis
Objective: To determine whether the values of hepatic apparent diffusion coefficient (ADC) can differentiate biliary atresia (BA) from non-BA or be correlated with the grade of hepatic fibrosis in infants with cholestasis.

Materials and methods: This retrospective cohort study included infants who received liver MRI examinations to evaluate cholestasis from July 2009 to October 2017. Liver ADC, ADC ratio of liver/spleen, aspartate aminotransferase to platelet ratio index (APRI), and spleen size were compared between the BA and non-BA groups. The diagnostic performances of all parameters for significant fibrosis (F3-4) were obtained by receiver-operating characteristics (ROCs) curve analysis.

Results: Altogether, 227 infants (98 males and 129 females, mean age = 57.2 ± 36.3 days) including 125 BA patients were analyzed. The absolute ADC difference between two reviewers was 0.10 mm²/s for both liver and spleen. Liver ADC value was specific (80.4%) and ADC ratio was sensitive (88.0%) for the diagnosis of BA with comparable performance. There were 33 patients with F0, 15 with F1, 71 with F2, 35 with F3, and 11 with F4. All four parameters of APRI (τ= 0.296), spleen size (τ= 0.312), liver ADC (τ= -0.206), and ADC ratio (τ= -0.288) showed significant correlation with fibrosis grade (all, p < 0.001). The cutoff values for significant fibrosis (F3-4) were 0.783 for APRI (area under the ROC curve [AUC], 0.721), 5.9 cm for spleen size (AUC, 0.719), 1.044 × 10-3 mm²/s for liver ADC (AUC, 0.673), and 1.22 for ADC ratio (AUC, 0.651).

Conclusion: Liver ADC values and ADC ratio of liver/spleen showed limited additional diagnostic performance for differentiating BA from non-BA and predicting significant hepatic fibrosis in infants with cholestasis.
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1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Koh, Hong(고홍) ORCID logo https://orcid.org/0000-0002-3660-7483
Kim, Myung Joon(김명준) ORCID logo https://orcid.org/0000-0002-4608-0275
Kim, Jisoo(김지수)
Shin, Hyun Joo(신현주) ORCID logo https://orcid.org/0000-0002-7462-2609
Yoon, Haesung(윤혜성) ORCID logo https://orcid.org/0000-0003-0581-8656
Lee, Mi-Jung(이미정) ORCID logo https://orcid.org/0000-0003-3244-9171
Han, Seok Joo(한석주) ORCID logo https://orcid.org/0000-0001-5224-1437
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