title: Can biliary atresia be diagnosed by ultrasonography alone?
abstract: OBJECTIVE
  The triangular cord sign (TCS) is a specific ultrasonographic finding, reflecting a fibrotic mass at the porta hepatis in biliary atresia (BA). We evaluated whether BA can be diagnosed by ultrasonography alone using 3 findings: TCS, gallbladder length (GBL), and gallbladder contractility (GBC).
  
  
  METHODS
  Subjects comprised 85 infants (median age, 47 days; range, 4-144 days) with cholestatic jaundice who underwent ultrasonographic examination for diagnosis between May 1996 and June 2006. Medical records were reviewed with regard to TCS, GBL, and GBC. Positive findings for BA included TCS >or=3 mm, GBL <15 mm, and GBC <68% (for < 12 weeks) or <25% (for >or=12 weeks).
  
  
  RESULTS
  Biliary atresia was diagnosed in 48 patients surgically, with other cholestatic diseases diagnosed in the remaining 37 patients. Triangular cord sign was positive in 41 of 48 infants with BA and negative in 35 of 37 infants without BA. The 7 patients with BA who displayed negative results for TCS displayed positive findings for GBL or GBC. Positive predictive value in the diagnosis of BA was 98% if positive TCS was combined with abnormal gallbladder findings, whereas negative predictive value in diagnosis of BA was 100% if negative TCS was combined with findings of a normal gallbladder.
  
  
  CONCLUSIONS
  Biliary atresia can be accurately diagnosed by ultrasonography using the findings of TCS combined with GBL and GBC.
authors: Department of Surgery, Kobe Children's Hospital, Kobe 654-0081, Japan. takamizawa_kch@hp.pref.hyogo.jp
authors: Shigeru
authors: S
authors: Takamizawa
authors: Azusa
authors: A
authors: Zaima
authors: Toshihiro
authors: T
authors: Muraji
authors: Kimio
authors: K
authors: Kanegawa
authors: Yoshinobu
authors: Y
authors: Akasaka
authors: Shiiki
authors: S
authors: Satoh
authors: Eiji
authors: E
authors: Nishijima
mesh_terms: D001656:Biliary Atresia / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D015331:Cohort Studies; D016001:Confidence Intervals; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D011877:Radionuclide Imaging / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods; D018608:Ultrasonography, Doppler / Q000379:methods*