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Pediatric Imaging |
1 From the Departments of Radiology (T.S.J., Y.T.K., G.C.L., C.K.W.) and Pediatric Surgery (S.H.C.), Kaohsiung Medical College, 100 Shih-Chuan First Rd, Kaohsiung 807, Taiwan, Republic of China. From the 1997 RSNA scientific assembly. Received April 29, 1998; revision requested June 16; final revision received December 15; accepted January 19, 1999. Address reprint requests to T.S.J. (e-mail: m810101@cc.kmc.edu.tw).
PURPOSE: To evaluate the usefulness of magnetic resonance (MR) cholangiography in excluding biliary atresia as the cause of neonatal cholestasis.
MATERIALS AND METHODS: MR cholangiography was performed on 10 control and 16 jaundiced neonates and infants aged 3 days to 5 months. Diagnosis of biliary atresia (n = 6) was confirmed with surgery and liver biopsy, with or without surgical cholangiography. Diagnosis of neonatal hepatitis (n = 9) was confirmed with clinical follow-up until jaundice resolved. In one infant, paucity of intrahepatic ducts was diagnosed at liver biopsy. MR cholangiography was performed with respiratory-triggered, heavily T2-weighted turbo spin-echo and optional inversion-recovery turbo spin-echo sequences. Diagnosis of biliary atresia was based on nonvisualization of either the common bile duct or common hepatic duct. Cholescintigraphy with technetium 99m disofenin was performed in all 16 jaundiced patients.
RESULTS: In the 10 controls, the nine patients with neonatal hepatitis, and the one infant with paucity of intrahepatic ducts, MR cholangiography clearly depicted the gallbladder and common hepatic and common bile ducts. MR cholangiography was 100% accurate in excluding biliary atresia as the cause of neonatal cholestasis, while 99mTc disofenin cholescintigraphic findings were false-positive in four of 10 patients with nonobstructive cholestasis.
CONCLUSION: MR cholangiography can be used to depict the major biliary structures of neonates and small infants and to exclude biliary atresia as the cause of neonatal cholestasis by allowing visualization of the biliary tract.
Index terms: Bile ducts, abnormalities, 768.1434 • Bile ducts, MR, 768.121411, 768.121413, 768.121415, 768.121416 • Bile ducts, radionuclide studies, 768.12172 • Gallbladder, 762.1434 • Infants, 762.1434
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