title: Efficacy of US-guided percutaneous cholecystocholangiography for the early exclusion and type determination of biliary atresia.
abstract: OBJECTIVE
  To evaluate the efficacy of ultrasonographically (US)-guided percutaneous cholecystocholangiography (PCC) for early diagnosis and characterization of biliary atresia in infants with cholestatic liver disease.
  
  
  METHODS
  Institutional review board approval was obtained for this study. Parental informed written consent was obtained. From October 2003 to August 2010, 22 infants (12 male, 10 female; age range, 1-138 days) were referred to the radiology department for PCC. Indications for PCC were suspected biliary atresia at 24-hour delayed technetium 99m-diisopropyl-phenylcarbamoylmethyl-iminodiacetic acid (DISIDA) scintigraphy because no excretion was observed in the small bowel (n = 17) or when the results of the scan or liver biopsy could not be obtained within 3 days because of a delay in schedule (n = 5). A diagnosis of biliary atresia was excluded when there was contrast material visualized in the gallbladder, biliary system, and passage to the duodenum. Patients with biliary atresia underwent surgery as the reference standard.
  
  
  RESULTS
  Among the 18 patients who underwent successful PCC, biliary atresia was excluded in 13, with diagnoses as follows: total parenteral nutrition-associated cholestasis (TPNAC) (n = 6), neonatal hepatitis (n = 4), congenital syphilis (n = 1), neonatal lupus (n = 1), and congenital cytomegalovirus hepatitis (n = 1). Biliary atresia was diagnosed in five patients (four with type IIIb and one with type IIIa) and was confirmed at surgery. In four infants in whom US-guided gallbladder puncture had failed, biliary atresia (n = 2) and TPNAC (n = 2) were diagnosed.
  
  
  CONCLUSIONS
  PCC is a safe and useful technique for early exclusion when biliary atresia cannot be ruled out after traditional screening tests; in addition, it may be useful for preoperative type determination of biliary atresia. © RSNA, 2011.
authors: Department of Radiology, Kyungpook National University School of Medicine, 101 Dongin dong 2 Ga, Jung gu, Daegu 700-422, Republic of Korea.
authors: Sang Yub
authors: SY
authors: Lee
authors: Gab Chul
authors: GC
authors: Kim
authors: Byung-Ho
authors: BH
authors: Choe
authors: Hun Kyu
authors: HK
authors: Ryeom
authors: Yun-Jin
authors: YJ
authors: Jang
authors: Hye Jung
authors: HJ
authors: Kim
authors: Jin Young
authors: JY
authors: Park
authors: Seung Man
authors: SM
authors: Cho
mesh_terms: D001656:Biliary Atresia / Q000000981:diagnostic imaging* / Q000601:surgery; D002758:Cholangiography / Q000379:methods*; D002765:Cholecystography / Q000379:methods*; D002779:Cholestasis / Q000000981:diagnostic imaging* / Q000601:surgery; D003287:Contrast Media; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D019785:Technetium Tc 99m Disofenin; D016896:Treatment Outcome; D014283:Triiodobenzoic Acids; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals; D014283:Triiodobenzoic Acids; C054871:ioversol; D019785:Technetium Tc 99m Disofenin