ArticleEuropean radiology2020
Three-color risk stratification for improving the diagnostic accuracy for biliary atresia.
Article in European radiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
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Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it, 16 citations in OpenAlex.
- The diagnostic performance of ultrasound features for biliary atresia: a systematic review and updated meta-analysis.Pediatric surgery international · 2025Pooled it
- Use of shear wave elastography for the diagnosis and follow-up of biliary atresia: A meta-analysis.World journal of gastroenterology · 2022Pooled it
- Early Prediction of Biliary Atresia Using Combi-Elastography in Infants ≤ 60 Days of Age.Diagnostics (Basel, Switzerland) · 2026Article
- Diagnostic Accuracy of Ultrasound in Cholestatic Infants with Biliary Atresia.Turkish archives of pediatrics · 2024Article
- A convenient nomogram for predicting early death or liver transplantation after the Kasai procedure in patients with biliary atresia.Langenbeck's archives of surgery · 2024Article
- Post-hepatoportoenterostomy Acoustic Radiation Force Impulse Elastography to Predict Two-year Outcome of Biliary Atresia.Journal of clinical and translational hepatology · 2023Article
- A novel prediction tool based on shear wave elastography, gallbladder ultrasound, and serum biomarkers for the early diagnosis of biliary atresia in infants younger than 60 days old.Quantitative imaging in medicine and surgery · 2023Article
- Diagnostic Efficacy of Advanced Ultrasonography Imaging Techniques in Infants with Biliary Atresia (BA): A Systematic Review and Meta-Analysis.Children (Basel, Switzerland) · 2022Review
- Ultrasound elastography in the diagnosis of biliary atresia in pediatric surgery: a systematic review and meta-analysis of diagnostic test.Translational pediatrics · 2022Article
- Ultrasound for the Diagnosis of Biliary Atresia: From Conventional Ultrasound to Artificial Intelligence.Diagnostics (Basel, Switzerland) · 2021Review
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- Development and Assessment of Screening Nomogram for Biliary Atresia Based on Hepatobiliary Ultrasonographic Features.Frontiers in pediatrics · 2021Article
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
objectivesIt is challenging to early differentiate biliary atresia from other causes of cholestasis. We aimed to develop an algorithm with risk stratification to distinguish biliary atresia from infantile cholestasis.
methodsIn this study, we enrolled infants with cholestasis into 2 subgroups from January 2010 to April 2019. A prospective cohort (subgroup 2) of 187 patients (107 with biliary atresia and 80 without biliary atresia) underwent acoustic radiation force impulse elastography. Stepwise regression was used to identify significant predictors of biliary atresia. A sequential algorithm with risk stratification was constructed.
resultsAmong 187 patients, shear wave speed > 1.35 m/s and presence of the triangular cord sign were considered high risk for biliary atresia (red), in which 73 of 78 patients (accuracy of 93.6%) with biliary atresia were identified. Afterwards, γ-GT, abnormal gallbladder, and clay stool were introduced into the algorithm and 55 intermediate-risk infants were identified (yellow) with a diagnostic accuracy of 60% for biliary atresia. Of the remaining 54 infants who were classified as low-risk patients (green), the accuracy for excluding biliary atresia was 98.1%. By applying a three-color risk stratification tool, 70.6% patients were identified as either high risk or low risk for biliary atresia (area under the curve, 0.983; sensitivity, 98.7%; specificity, 91.4%). We also estimated the risk of biliary atresia in different color groups, which was 94.7% (95%CI, 94.3-95.5%) in the red group and 7.2% (95%CI, 6.6-8.3%) in the green group.
conclusionsOur simple noninvasive approach was able to identify biliary atresia with high accuracy. KEY POINTS: • Five predictors, namely shear wave speed, triangle cord sign, γ-glutamyl transferase, abnormal gallbladder, and clay stool, were selected to identify biliary atresia in cholestasis. • Shear wave speed > 1.35 m/s and presence of the triangle cord sign were considered high-risk patients with a diagnostic accuracy of 93.6% for biliary atresia. • Risk for biliary atresia was high (red), intermediate (yellow), or low (green). In the red and green group, we achieved an extremely high diagnostic performance (area under the curve, 0.983; sensitivity, 98.7%; specificity, 91.4%).
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