Triangular cord sign in detection of biliary atresia: is it a valuable sign?
BACKGROUND
Early detection of biliary atresia (BA) has a vital role in prevention of liver cirrhosis in these patients. There are some evidences that triangular cord (TC) sign, i.e., triangular structure located cranial to the portal vein bifurcation on ultrasonographic examination, is suggestive of BA in suspected cases. The aim of this study is to evaluate and compare the sensitivity, specificity, and accuracy of TC sign with other methods of diagnosis such as hepatobiliary scan.


METHODS
Fifty-eight infants referred to pediatric gastroenterology ward with diagnosis of infantile cholestasis from March 2004 to March 2008 were evaluated to find the cause of cholestasis. Diagnosis was made by means of history, clinical examination, hepatobiliary scan, and liver biopsy. Ultrasonographic examination was focused on presence of TC sign in patients. If the diagnosis was in favor of BA, patient was sent for direct cholangiography as a gold-standard test for confirmation of the diagnosis. The sensitivity, specificity, and accuracy of the tests were compared with golden standard.


RESULTS
Among 58 infants with infantile cholestasis, BA was diagnosed and confirmed in 10 infants (17.2%). Hepatobiliary scintigraphy had 80% sensitivity, 72.9% specificity, and 74.1% accuracy. TC sign had 70% sensitivity, 95.8% specificity, and 91.3% accuracy.


CONCLUSIONS
TC sign is more accurate than hepatobiliary scan and has acceptable sensitivity and specificity for diagnosis of BA.
Imanieh
Mohammad Hadi
MH
Gastroenterohepatology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz 71937-11351, Iran.
Dehghani
Seyed Mohsen
SM
Bagheri
Mohammad Hadi
MH
Emad
Vahid
V
Haghighat
Mahmood
M
Zahmatkeshan
Mozhgan
M
Forutan
Hamid Reza
HR
Rasekhi
Ali Reza
AR
Gheisari
Farshid
F
D001656:Biliary Atresia / Q000000981:diagnostic imaging*; D002758:Cholangiography; D002779:Cholestasis / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011169:Portal Vein / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D014463:Ultrasonography