Prospective Assessment of Ultrasound Shear Wave Elastography for Discriminating Biliary Atresia from other Causes of Neonatal Cholestasis

To prospectively assess the diagnostic performance of ultrasound shear wave elastography (SWE) and hepatobiliary laboratory biomarkers for discriminating biliary atresia from other causes of neonatal cholestasis. Forty-one patients 2 mg/dL) and possible biliary atresia were prospectively enrolled. B...

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Bibliographic Details
Published in:The Journal of pediatrics 2019-09, Vol.212, p.60-65.e3
Main Authors: Dillman, Jonathan R., DiPaola, Frank W., Smith, Sally J., Barth, Richard A., Asai, Akihiro, Lam, Simon, Campbell, Kathleen M., Bezerra, Jorge A., Tiao, Gregory M., Trout, Andrew T.
Format: Article
Language:English
Subjects:
Alanine Transaminase - blood
Biliary Atresia - diagnostic imaging
Biliary Atresia - pathology
Biomarkers - blood
Cholestasis - diagnostic imaging
Cholestasis - etiology
Cholestasis - pathology
Elasticity Imaging Techniques
Female
gamma-Glutamyltransferase - blood
Humans
Infant
Infant, Newborn
Liver - diagnostic imaging
Liver - pathology
Male
Predictive Value of Tests
Prospective Studies
Ultrasonography
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Summary:To prospectively assess the diagnostic performance of ultrasound shear wave elastography (SWE) and hepatobiliary laboratory biomarkers for discriminating biliary atresia from other causes of neonatal cholestasis. Forty-one patients 2 mg/dL) and possible biliary atresia were prospectively enrolled. Both 2-dimensional (2D) and point ultrasound SWE were performed prior to knowing the final diagnosis. Median 2D (8) and point (10) shear wave speed measurements were calculated for each subject and used for analyses. The Mann-Whitney U test was used to compare shear wave speed and laboratory measurements between patients with and without biliary atresia. Receiver operating characteristic curve analyses and multivariable logistic regression were used to evaluate diagnostic performance. Thirteen subjects (31.7%) were diagnosed with biliary atresia, and 28 subjects (68.3%) were diagnosed with other causes of neonatal cholestasis. Median age at the time of ultrasound SWE was 37 days. Median 2D (2.08 vs 1.49 m/s, P = .0001) and point (1.95 vs 1.21 m/s, P = .0014) ultrasound SWE measurements were significantly different between subjects with and without biliary atresia. Using a cut-off value of >1.84 m/s, 2D ultrasound SWE had a sensitivity = 92.3%, specificity = 78.6%, and area under the receiver operating characteristic curve (AuROC) of 0.89 (P 320 (U/L), gamma-glutamyl transferase (GGT) had a sensitivity = 100.0%, specificity = 77.8%, and AuROC of 0.85 (P 
ISSN:0022-3476
1097-6833
DOI:10.1016/j.jpeds.2019.05.048