Incremental Value of MR Cholangiopancreatography in Diagnosis of Biliary Atresia

• Published in: PloS one Vol. 11; no. 6; p. e0158132
• Main Authors: Sung, Siyoun, Jeon, Tae Yeon, Yoo, So-Young, Hwang, Sook Min, Choi, Young Hun, Kim, Woo Sun, Choe, Yon Ho, Kim, Ji Hye
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24.06.2016; Public Library of Science (PLoS)
• Subjects: Bile; Biliary atresia; Biliary Atresia - diagnosis; Biliary Atresia - etiology; Biology and Life Sciences; Biomarkers; Care and treatment; Cholangiopancreatography, Magnetic Resonance - methods; Cholestasis; Comparative analysis; Confidence intervals; Diagnosis; Diagnostic systems; Female; Gallbladder; Gallbladder diseases; Hepatitis; Hospitals; Humans; Image Processing, Computer-Assisted; Infant; Infants; Laboratories; Magnetic resonance; Magnetic resonance imaging; Male; Medical diagnosis; Medicine; Medicine and Health Sciences; Neonates; Newborn babies; Observers; Patients; Pediatrics; People and Places; Reproducibility of Results; Retrospective Studies; ROC Curve; Science; Sensitivity and Specificity; Ultrasonography - methods; Ultrasound; Veins & arteries; South Korea; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0158132

To evaluate the incremental value of a combination of magnetic resonance cholangiopancreatography (MRCP) and ultrasonography (US), compared to US alone, for diagnosing biliary atresia (BA) in neonates and young infants with cholestasis. The institutional review board approved this retrospective study. The US and MRCP studies were both performed on 64 neonates and young infants with BA (n = 41) or without BA (non-BA) (n = 23). Two observers reviewed independently the US alone set and the combined US and MRCP set, and graded them using a five-point scale. Diagnostic performance was compared using pairwise comparison of the receiver operating characteristics (ROC) curve. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value were assessed. The diagnostic performance (the area under the ROC curve [Az]) for diagnosing BA improved significantly after additional review of MRCP images; Az improved from 0.688 to 0.901 (P = .015) for observer 1 and from 0.676 to 0.901 (P = .011) for observer 2. The accuracy of MRCP combined with US (observer 1, 95% [61/64]; observer 2 92% [59/64]) and PPV (observer 1, 95% [40/42]; observer 2 91% [40/44]) were significantly higher than those of US alone for both observers (accuracy: observer 1, 73% [47/64], P = 0.003; observer 2, 72% [46/64], P = 0.004; PPV: observer 1, 76% [35/46], P = 0.016; observer 2, 76% [34/45], P = 0.013). Interobserver agreement of confidence levels was good for US alone (ĸ = 0.658, P < .001) and was excellent for the combined set of US and MRCP (ĸ = 0.929, P < .001). Better diagnostic performance was achieved with the combination of US and MRCP than with US alone for the evaluation of BA in neonates and young infants with cholestasis.