Application Value Of Multimodal Ultrasound In Early Diagnosis And Postoperative Follow-up Of Biliary Atresia

Objective: To analyze the characteristics of two-dimensional ultrasound,color Doppler and shear wave elastic imaging in infants with high suspected biliary atresia,and explore the sensitivity,specificity and accuracy of multimode ultrasound in the early diagnosis of biliary atresia.The difference of liver Young’s modulus before and after surgery between cholangitis group and non-cholangitis group in children with biliary atresia after Kasai surgery was compared and analyzed,and the diagnostic value of shear wave elastography(SWE)in the complication of cholangitis after Kasai surgery was explored.Methods:Sixty cases of infant jaundice children with high suspicion of biliary atresia were selected from Anhui Children’s Hospital from January 1,2020 to February 1,2022 as the research objects.Ultrasound examination was performed on all the children to determine the bile duct morphology,liver blood flow,and liver elasticity of the children.Intraoperative cholangiography and surgical pathology were used as the "gold standard" to confirm whether the children had biliary atresia.Meanwhile,the improvement of jaundice after clinical medical treatment was taken as the standard to exclude biliary atresia.The children with infant jaundice highly suspected of biliary atresia were divided into biliary atresia group and non-biliary atresia group.The ultrasonic parameters of children with biliary atresia and non-biliary atresia were compared and analyzed to explore the value of multi-mode ultrasound in the early diagnosis of infant biliary atresia.At the same time,45 children with biliary atresia diagnosed by intraoperative cholangiography and surgical pathology and undergoing Kasai surgery in our hospital were divided into cholangitis group and non-cholangitis group according to whether cholangitis occurred after surgery,including 28 patients in the cholangitis group and 17 patients in the non-cholangitis group.2D-SWE was used to measure the mean value of Young’s modulus of liver in the two groups before and after surgery.The changes of hepatic Young’s modulus before and after operation within and between the two groups were compared.Results:Among the 60 cases of infant jaundice with highly suspected biliary atresia,48 cases were confirmed as biliary atresia through clinical diagnosis,including 7 cases of type I biliary atresia,1 case of type II biliary atresia,and 40 cases of type III biliary atresia.There were 46 cases of biliary atresia diagnosed by ultrasound,and 1 case was misdiagnosed by ultrasound as choledochal cyst,extrahepatic fibrous tissue hyperplasia and gallbladder abnormalities were found in surgical exploration,and no obvious abnormalities were found in gallbladder in 1 case,and external choledochal fibrous hyperplasia was found by surgical examination.Twelve cases were diagnosed as non-biliary atresia(7 cases were confirmed by intraoperative cholangiography,and 5cases were confirmed to be discharged from hospital after improvement after clinical medical treatment with decreased jaundice value),among which 3 cases were misdiagnosed as biliary atresia by ultrasound.There were no significant differences in the right lower costal margin diameter and hepatic artery resistance index(RI)between the non-biliary atresia and the non-biliary atresia children(P > 0.05).The ratio of hepatic artery to portal vein diameter(HA/PV)and hepatic artery diameter(HA)in the non-biliary atresia children were significantly lower than those in the non-biliary atresia children(P < 0.05).The mean value of LSM in biliary atresia group and non-biliary atresia group was(11.7 ± 5.5)k Pa and(7.9 ± 3.3)k Pa,with significant difference(P<0.05).The sensitivity,specificity and accuracy of ultrasonic diagnosis of biliary atresia were 95%,75% and 91%,respectively.Among the 45 children diagnosed with biliary atresia and undergoing Kasai surgery,there was no statistically significant difference in the preoperative hepatic Young’s modulus between cholangitis group and non-cholangitis group,and the postoperative hepatic Young’s modulus in cholangitis group was significantly higher than that in non-cholangitis group [(15.24,4.98)k Pa vs.(10.20,5.33)k Pa].The difference was statistically significant(t=-2.576,P=0.015).Conclusion: Ultrasonic diagnosis of infant biliary atresia has high accuracy,and different forms of biliary atresia can be diagnosed by ultrasonic images.HA/PV and HA can obviously indicate biliary atresia in children.Clinical diagnosis and treatment of children with biliary atresia should be combined with relevant indicators.Shear wave elastography(SWE)has a certain clinical value in the diagnosis of postoperative cholangitis in children with biliary atresia.