Background and Objectives: Differential diagnosis between biliary atresia (BA) and total parenteral nutrition-associated cholestasis (TPN-AC) and early treatment of cholestatic infants are challenges for evaluating neonatal or infantile cholestasis. The aim of our retrospective study was to apply non-invasive indices of magnetic resonance images to differentiate BA from TPN-AC.
Methods: Forty-four patients diagnosed with BA (n = 30) or TPN-AC (n = 14) were included in this retrospective study and underwent abdominal MRI to evaluate the possibility of BA. The left lateral hepatic angle was determined from the coronal image of the left portal vein and portal vein of segment II. Adjusted volume indices of the right hepatic lobe (AVIR) and left lateral segment (AVILL) were calculated as the product of three diameters (cm) divided by each patient's body weight.
Results: The left lateral hepatic angles of BA patients (74 +/- 21 degrees) were significantly larger than for TPN-AC patients (33 +/- 9 degrees) and controls (36 +/- 5 degrees, P < 0.05). AVILL of the BA (0.037 +/- 0.012 cm3/g) and TPN-AC groups (0.042 +/- 0.030 cm3/g) were not significantly different (P = 0.61) but were significantly larger than for controls (0.020 +/- 0.011 cm3/g) (P < 0.05). The right hepatic lobe to left lateral hepatic segment ratio (RLR) of BA patients was significantly (P < 0.05) smaller (1.61 +/- 0.58) than for TPN-AC patients (3.08 +/- 2.43) and controls (2.98 +/- 0.92). BA patients could have relative sparing and selective enlargement of the left lateral liver with a resultant lobar difference and blunt left lateral hepatic angle.
Conclusions: Non-invasive indices of lobar difference and left lateral hepatic angle help differentiate BA from TPN-AC patients.
(C) 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,