title: Ultrasonographic Diagnosis of Biliary Atresia Based on a Decision-Making Tree Model.
abstract: OBJECTIVE
  To assess the diagnostic value of various ultrasound (US) findings and to make a decision-tree model for US diagnosis of biliary atresia (BA).
  
  
  METHODS
  From March 2008 to January 2014, the following US findings were retrospectively evaluated in 100 infants with cholestatic jaundice (BA, n = 46; non-BA, n = 54): length and morphology of the gallbladder, triangular cord thickness, hepatic artery and portal vein diameters, and visualization of the common bile duct. Logistic regression analyses were performed to determine the features that would be useful in predicting BA. Conditional inference tree analysis was used to generate a decision-making tree for classifying patients into the BA or non-BA groups.
  
  
  RESULTS
  Multivariate logistic regression analysis showed that abnormal gallbladder morphology and greater triangular cord thickness were significant predictors of BA (p = 0.003 and 0.001; adjusted odds ratio: 345.6 and 65.6, respectively). In the decision-making tree using conditional inference tree analysis, gallbladder morphology and triangular cord thickness (optimal cutoff value of triangular cord thickness, 3.4 mm) were also selected as significant discriminators for differential diagnosis of BA, and gallbladder morphology was the first discriminator. The diagnostic performance of the decision-making tree was excellent, with sensitivity of 100% (46/46), specificity of 94.4% (51/54), and overall accuracy of 97% (97/100).
  
  
  CONCLUSIONS
  Abnormal gallbladder morphology and greater triangular cord thickness (> 3.4 mm) were the most useful predictors of BA on US. We suggest that the gallbladder morphology should be evaluated first and that triangular cord thickness should be evaluated subsequently in cases with normal gallbladder morphology.
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea.
authors.forename: So Mi
authors.initials: SM
authors.lastname: Lee
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea.
authors.forename: Jung-Eun
authors.initials: JE
authors.lastname: Cheon
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea.
authors.forename: Young Hun
authors.initials: YH
authors.lastname: Choi
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea.
authors.forename: Woo Sun
authors.initials: WS
authors.lastname: Kim
authors.forename: Hyun-Hae
authors.initials: HH
authors.lastname: Cho
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea.
authors.forename: Hyun-Hye
authors.initials: HH
authors.lastname: Cho
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea.
authors.forename: In-One
authors.initials: IO
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea.
authors.forename: Sun Kyoung
authors.initials: SK
authors.lastname: You
mesh_terms: D019540:Area Under Curve; D001656:Biliary Atresia / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003135:Common Bile Duct / Q000000981:diagnostic imaging; D003657:Decision Making; D003937:Diagnosis, Differential; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D041781:Jaundice, Obstructive / Q000150:complications / Q000175:diagnosis; D016015:Logistic Models; D008297:Male; D011169:Portal Vein / Q000000981:diagnostic imaging; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography
keywords: Biliary atresia; Decision trees; Neonatal jaundice; US