Prediction of Fetal Biliary Atresia Based on Second and Third-Trimester Ultrasound Characteristics

Abstract

Objective To explore the diagnostic performance of prenatal ultrasound in the prediction of biliary atresia (BA).

Methods We prospectively collected cases of suspected biliary abnormalities in the 2^nd trimester of pregnancy and performed a series (at least 3) of prenatal ultrasound examinations in the 2^nd and 3^rd trimester. The presence of the gallbladder was examined each time, and its size and shape were assessed if the gallbladder was visible. The existence of other abnormalities was carefully evaluated. Neonatal ultrasound examination was conducted within 1 month after birth, and clinical data were followed-up for 6 months after birth.

Results Among the 41 895 patients, 298 were suspected to have biliary abnormalities, while 82 patients were excluded due to loss to follow-up or induced labor caused by other abnormalities. A total of 216 patients were included in this study, and 15 were diagnosed with BA. We summarized the ultrasound findings of the gallbladders and defined a high-risk gallbladder for the prenatal diagnosis of BA. This was demonstrated to have the best diagnostic performance as a single parameter, with an area under the curve of 0.914 (95 %CI: 0.869–0.948). In addition, higher incidences of biliary cysts, right hepatic artery dilation, echogenic bowel, and ascites were observed in BA fetuses. Logistic regression analysis showed that the combination of 5 parameters had better diagnostic performance, with an area under the curve of 0.995 (95 %CI: 0.973–0.999).

Conclusion The fetal gallbladder was found to be a critical feature for the identification of BA. Concomitant abnormalities could be helpful to improve the accuracy of the diagnosis.

Zusammenfassung

Ziel Untersuchung der diagnostischen Leistung des pränatalen Ultraschalls bei der Vorhersage einer Gallengangatresie (BA).

Methoden Wir sammelten prospektiv Fälle mit Verdacht auf Gallenanomalien im 2. Trimenon der Schwangerschaft und führten eine Serie von (mindestens 3) pränatalen Ultraschalluntersuchungen im 2. und 3. Trimenon durch. Das Vorhandensein der Gallenblase wurde jedes Mal überprüft, und wenn die Gallenblase sichtbar war, wurden ihre Größe und Form beurteilt. Auch das Vorhandensein anderer Anomalien wurde sorgfältig geprüft. Eine Ultraschalluntersuchung des Neugeborenen wurde innerhalb des ersten Lebensmonats durchgeführt, und die klinischen Daten wurden 6 Monate postpartum nachverfolgt.

Ergebnisse Bei 298 von 41 895 Patienten bestand der Verdacht auf Gallenanomalien, wobei 82 Patienten wegen fehlender Nachbeobachtung oder wegen eingeleiteter Wehen aufgrund anderer Anomalien ausgeschlossen wurden. Insgesamt wurden 216 Patienten in diese Studie eingeschlossen, bei 15 wurde eine BA diagnostiziert. Wir fassten die Ultraschallbefunde der Gallenblasen zusammen und definierten eine Hochrisikogallenblase für die pränatale Diagnose einer BA. Es zeigte sich, dass dieser Parameter mit einer Fläche unter der Kurve (AUC) von 0,914 (95 %-KI 0,869–0,948) die beste diagnostische Leistung als Einzelparameter aufwies. Darüber hinaus wurde bei BA-Föten eine höhere Inzidenz von Gallenzysten, Dilatation der rechten Leberarterie, echogenem Darm und Seroperitoneum beobachtet. Die logistische Regressionsanalyse zeigte, dass die Kombination von 5 Parametern eine bessere diagnostische Leistung aufwies, mit einer AUC von 0,995 (95 %-KI 0,973–0,999).

Schlussfolgerung Die fetale Gallenblase erwies sich als entscheidender Marker für die Identifizierung einer BA. Begleitende Anomalien könnten hilfreich sein, um die diagnostische Genauigkeit zu verbessern.

Key words

biliary atresia - gallbladder - fetus - prenatal diagnosis - ultrasound

Publication History

Received: 05 December 2020

Accepted: 15 July 2021

Article published online:
08 March 2022

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