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Objective Criteria of Triangular Cord Sign in Biliary Atresia on US Scans¹

¹ From the Departments of Diagnostic Radiology (H.J.L., S.M.L.) and Pediatric Surgery (W.H.P., S.O.C.), School of Medicine & Institute for Medical Science, Keimyung University Dongsan Medical Center, 196 Dongsandong, Chunggu, Taegu 700–310, Korea. Received April 22, 2002; revision requested June 21; final revision received February 26, 2003; accepted March 20. Supported by the research promoting grant from the Keimyung University Dongsan Medical Center in 2001. Address correspondence to H.J.L. (e-mail: hjlee@dsmc.or.kr).

View larger version (142K): [in a new window]   Figure 1a. Surgical findings of biliary atresia. (a) Photograph of surgical specimen of obliterated extrahepatic bile ducts shows the fibrous ductal remnant (black arrowheads) in the porta hepatis, atretic gallbladder (arrow), and fibrous common bile duct (white arrowhead). The fibrous ductal remnant is a triangular cone-shaped mass. (b) Schematic drawing represents the anatomic relationship between the fibrous ductal remnant and blood vessels around the porta hepatis. The triangular, cone-shaped, fibrous ductal remnant (black arrowheads, green) is positioned anterior and slightly superior to the portal vein (long arrow, blue) and the hepatic artery (short arrow, red).

View larger version (40K): [in a new window]   Figure 1b. Surgical findings of biliary atresia. (a) Photograph of surgical specimen of obliterated extrahepatic bile ducts shows the fibrous ductal remnant (black arrowheads) in the porta hepatis, atretic gallbladder (arrow), and fibrous common bile duct (white arrowhead). The fibrous ductal remnant is a triangular cone-shaped mass. (b) Schematic drawing represents the anatomic relationship between the fibrous ductal remnant and blood vessels around the porta hepatis. The triangular, cone-shaped, fibrous ductal remnant (black arrowheads, green) is positioned anterior and slightly superior to the portal vein (long arrow, blue) and the hepatic artery (short arrow, red).

View larger version (150K): [in a new window]   Figure 2. Depiction of TC sign. The EARPV was 5.4 mm thick on this longitudinal US scan, which shows the TC sign (cursors) as a thick, tubular, echogenic area along the anterior aspect of the right portal vein (long arrow). The right hepatic artery (short arrow) is encased within the EARPV.

View larger version (157K): [in a new window]   Figure 3a. US images of a 35-day-old boy with biliary atresia. (a) Longitudinal scan shows TC sign (cursors) with a 5.1-mm-thick EARPV. (b) Transverse scan shows triangular echogenic area (cursors) in the anterior aspect of the portal vein in the porta hepatis.

View larger version (148K): [in a new window]   Figure 3b. US images of a 35-day-old boy with biliary atresia. (a) Longitudinal scan shows TC sign (cursors) with a 5.1-mm-thick EARPV. (b) Transverse scan shows triangular echogenic area (cursors) in the anterior aspect of the portal vein in the porta hepatis.

View larger version (154K): [in a new window]   Figure 4. US image of a 36-day-old boy with neonatal hepatitis. Longitudinal scan shows no demonstrable TC sign (cursors). The EARPV is 1.5 mm thick between cursors.

View larger version (128K): [in a new window]   Figure 5a. Images of a 36-day-old boy with biliary atresia but no demonstrable TC sign. (a) Longitudinal US scan shows EARPV is 3.0 mm thick between cursors. (b) Surgical specimen of the fibrous ductal remnant is a pattern of fibrous hepatic duct (arrowheads) in the porta hepatis.

View larger version (101K): [in a new window]   Figure 5b. Images of a 36-day-old boy with biliary atresia but no demonstrable TC sign. (a) Longitudinal US scan shows EARPV is 3.0 mm thick between cursors. (b) Surgical specimen of the fibrous ductal remnant is a pattern of fibrous hepatic duct (arrowheads) in the porta hepatis.

View larger version (18K): [in a new window]   Figure 6. Scattergram shows the thickness of the EARPV in patients with biliary atresia and neonatal hepatitis. The difference in thickness was statistically significant between patients with biliary atresia and those with neonatal hepatitis. Dotted line indicates the 4-mm thickness as the criterion for the TC sign. Solid lines represent mean thickness in the groups. A single point in the scattergram is used to indicate the seven patients with a 1-mm-thick EARPV.