title: The porta hepatis microcyst: an additional sonographic sign for the diagnosis of biliary atresia.
abstract: OBJECTIVE
  To describe and evaluate an additional sonographic sign in the diagnosis of biliary atresia (BA), the microcyst of the porta hepatis, in comparison with previously described signs.
  
  
  METHODS
  Ultrasound performed in 321 infants (mean age 55 days) with cholestasis were retrospectively analyzed. BA was surgically confirmed in 193 patients and excluded in 128. US evaluated gallbladder type (1: normal; 2: consistent with BA; 3: suspicious), triangular cord sign (TCS), microcyst and macrocyst, polysplenia syndrome, portal hypertension, and bile duct dilatation. T test and Pearson χ2test were used to compare US signs between the two groups, followed by univariate regression analysis.
  
  
  RESULTS
  The highest specificity and sensitivity for BA (p < 0.001) were respectively obtained with non-visible gallbladder (100 %-13 %), macrocyst (99 %-10 %), polysplenia (99 %-11 %), microcyst (98 %-20 %), type 2 gallbladder (98 %-34 %), and TCS (97 %-30 %). Combination of signs (macro or microcyst; cyst and no bile duct dilatation; microcyst and/or TCS; type 2 gallbladder and/or cyst) provided better sensitivities (25-49 %) with similar specificities (95-98 %) (p < 0.001). On univariate analysis, the single US signs most strongly associated with BA were polysplenia (odds ratio, OR 16.3), macrocyst (OR 14.7), TCS (OR 13.4) and microcyst (OR 8).
  
  
  CONCLUSIONS
  Porta hepatis microcyst is a reliable US sign for BA diagnosis.
  
  
  CONCLUSIONS
  • The porta hepatis microcyst is a specific sign of biliary atresia. • It was found in 31 (16.1 %) of 193 patients with biliary atresia. • Its specificity was 98 % (p < 0.001). • High frequency transducer and color Doppler can show the porta hepatis microcyst.
authors.affiliation: Pediatric Radiology, Hautepierre Universitary Hospital, Avenue Molière, 67098, Strasbourg, France. meriam.koob@chru-strasbourg.fr.|Icube Laboratory, UMR 7357 / Strasbourg University - CNRS, Strasbourg, France. meriam.koob@chru-strasbourg.fr.
authors.forename: Mériam
authors.identifier: http://orcid.org/0000-0002-3594-6272
authors.initials: M
authors.lastname: Koob
authors.affiliation: Pediatric Radiology, Bicêtre Hospital, 94270, Le Kremlin Bicêtre, Paris, France.
authors.forename: Danièle
authors.initials: D
authors.lastname: Pariente
authors.affiliation: Pediatric Hepatology, Bicêtre Hospital, 94270, Le Kremlin Bicêtre, Paris, France.
authors.forename: Dalila
authors.initials: D
authors.lastname: Habes
authors.affiliation: Department of Statistics, Bicêtre Hospital, 94270, Le Kremlin Bicêtre, Paris, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Ducot
authors.affiliation: Pediatric Radiology, Bicêtre Hospital, 94270, Le Kremlin Bicêtre, Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Adamsbaum
authors.affiliation: Pediatric Radiology, Bicêtre Hospital, 94270, Le Kremlin Bicêtre, Paris, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Franchi-Abella
mesh_terms: D001649:Bile Duct Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D001656:Biliary Atresia / Q000150:complications / Q000000981:diagnostic imaging*; D002779:Cholestasis / Q000150:complications / Q000000981:diagnostic imaging*; D003560:Cysts / Q000150:complications / Q000000981:diagnostic imaging*; D004108:Dilatation, Pathologic / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging*; D059446:Heterotaxy Syndrome / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000000981:diagnostic imaging*; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000000981:diagnostic imaging*; D008297:Male; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography
keywords: Biliary atresia; Cyst; Gallbladder; Triangular cord sign; Ultrasound