Published online Jun 7, 2020. doi: 10.3748/wjg.v26.i21.2821
Peer-review started: December 26, 2019
First decision: January 13, 2020
Revised: March 27, 2020
Accepted: May 26, 2020
Article in press: May 26, 2020
Published online: June 7, 2020
Untreated neonatal cholestasis can progress to liver cirrhosis or end stage liver disease in infants due to prolonged hepatocyte and biliary tree injury and may require liver transplantation. Therefore, non-invasive evaluation of hepatic fibrosis is important in infants with cholestasis including biliary atresia.
Some serologic tests and splenomegaly are known markers for the evaluation of hepatic fibrosis in adults, but there is limited study about these parameters in infants. Periportal thickening (PT) was only considered as the finding of biliary atresia and has not been evaluated for assessing hepatic fibrosis in infants with cholestasis.
We investigated whether the PT and spleen size measured on magnetic resonance imaging (MRI) is associated with pathologically assessed hepatic fibrosis in patients with infantile cholestasis including biliary atresia.
This retrospective study included infants less than 6 mo with liver MRI and biopsy for the evaluation of infantile cholestasis. Not only PT and spleen size measured on MRI, but also serologic assessment of aspartate transaminase to platelet ratio index (APRI) were evaluated and compared with histopathologic METAVIR grading of hepatic fibrosis. We calculated normalized spleen size ratio (SR) using the upper normal size limit.
A total of 155 patients were evaluated including 110 with biliary atresia. Mean age at the time of MRI was 57.6 ± 34.4 d. There were positive correlations between fibrosis grade and PT and SR, even after adjusting age. The finding of PT with a cutoff value of 4.2 mm has better diagnostic performance to predict clinically significant fibrosis than either SR or APRI. And SR had the highest diagnostic performance value for differentiating cirrhosis.
Liver MRI findings of PT and SR are useful to assess clinically significant hepatic fibrosis (F2 and higher) in infants with cholestasis including biliary atresia.
The degree of hepatic fibrosis is an important prognostic factor after Kasai operation in patients with biliary atresia. Therefore, PT and SR measured on MRI may help predict prognosis of biliary atresia and suggest more effective non-invasive treatment options.