title: Contribution of acoustic radiation force impulse (ARFI) elastography to the ultrasound diagnosis of biliary atresia.
abstract: BACKGROUND
  Children with biliary atresia rapidly develop liver fibrosis secondary to inflammatory destruction of the biliary tract. Noninvasive detection of liver fibrosis in neonatal/infantile cholestasis is an additional criterion for the diagnosis of biliary atresia, leading to prompt surgical exploration.
  
  
  OBJECTIVE
  To assess the value of US with acoustic radiation force impulse (ARFI) elastography to detect biliary atresia in the workup of neonatal/infantile cholestasis.
  
  
  METHODS
  In this retrospective study, 20 children with cholestasis suspected of having biliary atresia were investigated by US and ARFI. We evaluated the association between US findings and the diagnosis of biliary atresia and with two scores of liver fibrosis obtained from liver biopsy.
  
  
  RESULTS
  In univariate analyses, gallbladder size, triangular cord sign, spleen size and ARFI values were found to be associated with biliary atresia, though only the triangular cord sign remained significant when elevated gamma glutamyltransferase (GGT) was included as a predictor. In contrast, spleen size and ARFI correlated with the degree of liver fibrosis on biopsy (r > 0.70, P < 0.001), which remained significant when gamma glutamyltransferase elevation was included as a predictor.
  
  
  CONCLUSIONS
  The addition of ARFI to a standard abdominal US in the initial workup of the neonate with possible infantile cholestasis can provide reliable information on liver fibrosis and help in the diagnosis of biliary atresia.
authors.affiliation: Department of Pediatric Radiology, University Children's Hospital, 6 rue Willy Donzé, Ch 1211, Geneva 14, Switzerland, sylviane.hanquinet-ginter@hcuge.ch.
authors.forename: Sylviane
authors.initials: S
authors.lastname: Hanquinet
authors.forename: Delphine S
authors.initials: DS
authors.lastname: Courvoisier
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Rougemont
authors.forename: Amira
authors.initials: A
authors.lastname: Dhouib
authors.forename: Laura
authors.initials: L
authors.lastname: Rubbia-Brandt
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Wildhaber
authors.forename: Laura
authors.initials: L
authors.lastname: Merlini
authors.forename: Valerie A
authors.initials: VA
authors.lastname: McLin
authors.forename: Mehrak
authors.initials: M
authors.lastname: Anooshiravani
mesh_terms: D001652:Bile Ducts / Q000000981:diagnostic imaging; D001656:Biliary Atresia / Q000150:complications / Q000000981:diagnostic imaging*; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index