Acta Scientific Paediatrics (ISSN: 2581-883X)

Research Article Volume 6 Issue 7

Accuracy of Ultrasonography and Hepatobiliary Scintigraphy for the Diagnosis of Biopsy Proven Biliary Atresia

Hasan Mahmud Rumi1*, Syed Shafi Ahmed2, Salahuddin Mahmud3, Sohely Akter4 and Muhammed Nurul Islam Shikdar5

1MD (Paediatrics), Assistant Professor, Department of Paediatrics, Tairunnessa Memorial Medical College and Hospital, Bangladesh
2PhD Professor and Head, Department of Paediatric Gastroenterology, Hepatology and Nutrition, Bangladesh Shishu Hospital and Institute, Bangladesh
3MD (Paediatrics), Associate Professor, Department of Paediatric Gastroenterology, Hepatology and Nutrition, Bangladesh Shishu Hospital and Institute, Bangladesh
4Assistant Professor (CC), Department of Paediatrics, Tairunnessa Memorial Medical College and Hospital, Bangladesh
5Assistant Professor, Department of Paediatrics, Aichi Medical College, Bangladesh

*Corresponding Author: Hasan Mahmud Rumi, MD (Paediatrics), Assistant Professor, Department of Paediatrics, Tairunnessa Memorial Medical College and Hospital, Bangladesh. Email:

Received: June 13, 2023; Published: June 22, 2023


Background: Optimizing outcomes in biliary atresia (BA) requires timely diagnosis. Despite early hepaticoportoenterostomy, BA has still been the most common indication for paediatric liver transplantation. So early diagnosis is extremely important for management. Ultrasonography and hepatobiliary scintigraphy are two major diagnostic methods for the diagnosis of biliary atresia.

Aim of the Study: To determine the accuracy of ultrasonography and hepatobiliary scintigraphy for the diagnosis of biliary atresia.

Material and Methods: The present study was a cross-sectional observational conducted in the Department of Pediatric Gastroenterology, Hematology and Nutrition, Dhaka Shishu (Children) Hospital, Dhaka City from March 2018 to August 2019. Data were processed and analyzed using computer software SPSS statistical package, version 23 (SPSS Inc., Chicago, IL, USA) for Windows XP. Data were expressed as numbers and percentages for qualitative variables and median range (minimum and maximum) for quantitative variables. To compare categorical variables between groups of patients with neonatal cholestasis, the chi-square (χ2) test or Fisher’s exact test was used. Fisher’s exact test was used instead of the χ2-test when the expected value in any one contingency cell was ≤5. Student t-test was used for continuous variables. Validity tests were done for ultrasonography and hepatobiliary scintigraphy with liver biopsy confirmed biliary atresia. A p-value < 0.05 was considered to be statistically significant in all the analyses.

Results: Ultrasonography, hepatobiliary scintigraphy and liver biopsy findings of 50 neonatal cholestasis cases were studied where Hepatobiliary scintigraphy had the highest sensitivity of 90.5% but low specificity of 44.8%. The sensitivity and specificity of USG for the diagnosis of BA were found to be 81.0% and 65.5% respectively in this study. Diagnostic accuracy of USG and hepatobiliary scintigraphy for diagnosis of BA was 72.0% and 64.0% respectively.

Conclusion: This study showed that hepatobiliary scintigraphy had high sensitivity but low specificity for diagnosing biliary atresia. The diagnostic accuracy of ultrasonography is more than hepatobiliary scintigraphy for diagnosing biliary atresia.

 Keywords: Biliary Atresia; Ultrasonography; Hepatobiliary Scintigraphy; Diagnostic Accuracy


  1. Bezerra JA and Balistreri WF. “Cholestatic syndromes of infancy and childhood”. Seminars of Gastrointestinal Disease 2 (2001): 54-65.
  2. Balistreri WF. “Neonatal cholestasis”. The Journal of Pediatrics2 (1985): 171-184.
  3. Karim A and Kamal M. “Cholestatic jaundice during infancy: experience at a tertiary-care center in Bangladesh”. Indian Journal of Gastroenterology 2 (2005): 52-54.
  4. Park WH., et al. “A New Diagnostic Approach to Biliary Atresia With Emphasis on the Ultrasonographic Triangular Cord Sign: Comparison of Ultrasonography, Hepatobiliary Scintigraphy, and Liver Needle Biopsy in the Evaluation of Infantile Cholestasis”. Journal of Pediatric Surgery 11 (1997): 1555-1559.
  5. Farrant P., et al. “Ultrasound features of the gall bladder in infants presenting with conjugated hyperbilirubinaemia”. The British Journal of Radiology 875 (2000): 1154-1158.
  6. Choi SO., et al. “Ultrasonographic “triangular cord”: the most definitive finding for non-invasive diagnosis of extrahepatic biliary atresia”. Europian Journal of Pediatric Surgery 1 (1998): 12-16.
  7. Tan Kendrick AP., et al. “Biliary atresia: making the diagnosis by the gallbladder ghost triad”. Pediatric Radiology5 (2003): 311-315.
  8. Davenport M., et al. “The biliary atresia splenic malformation syndrome”. Surgery6 (1993): 662-668.
  9. Howard ER. “Biliary atresia: etiology, management and complications”. In Howard, E.R., Stringer, M.D. and Colombani, P.M. (eds) Surgery of the liver, bile ducts and pancreas in children. 2nd London, England: Arnold, (2002): 103-132.
  10. Kim WS., et al. “Hepatic arterial diameter measured with US: adjunct for US diagnosis of biliary atresia”. Radiology,2 (2007): 549-555.
  11. Lee MS., et al. “Biliary atresia: color Doppler US findings in neonates and infants”. Radiology 1 (2009): 282-289.
  12. Sultana N., et al. “Role of Hepatobiliary Scintigraphy and Ultrasonography in the Diagnosis of Biliary Atresia in Infant with Neonatal Jaundice - Experiences in NINMAS”. Bangladesh Journal of Nuclear Medicine 1 (2015): 51-53.
  13. Moyer V., et al. “Guideline for the evaluation of cholestatic jaundice in infants: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition”. Journal of Pediatric Gastroenterology and Nutrition, 3 (2004): 115-128.
  14. Majd M., et al. “Hepato-biliary scintigraphy with 99m Tc-PIPIDA in evaluation of neonatal jaundice”. Paediatrics1 (1981): 142-145.
  15. Gerhold JP., et al. “Diagnosis of biliary atresia with radionuclide Hepato-biliary imaging”. Radiology2 (1983): 499-504.
  16. Nadel HR. “Hepatobiliary Scintigraphy in children”. Seminars in Nuclear Medicine1 (1996): 25-42.
  17. Lin WY., et al. “Comparison technetium of Tc-99m disofenincholescintigraphy with ultrasonography in the differentiation of biliary atresia from other forms of neonatal jaundice”. Pediatric Surgery International 1 (1997): 30-33.
  18. Gupta DK., et al. “AIIMS Clinical score: a reliable aid to distinguish neonatal hepatitis from extra hepatic biliary atresia”. The Indian Journal of Pediatrics 7 (2001): 605-608.
  19. Poddar U., et al. “Neonatal cholestasis: differentiation of biliary atresia from neonatal hepatitis in a developing country”. Acta Paediatrica8 (2009): 1260-1264.
  20. Rastogi A., et al. “Histopathological features and accuracy for diagnosing biliary atresia by prelaparotomy liver biopsy in developing countries”. Journal of Gastroenterology and Hepatology 1 (2009): 97-102.
  21. Lee WS and Chai PF. “Clinical Features Differentiating Biliary Atresia from Other Causes of Neonatal Cholestasis”. Annals of the Academy of Medicine Singapore8 (2010): 648-654.
  22. Yang JG., et al. “Comparison of different diagnostic methods for differentiating biliary atresia from idiopathic neonatal hepatitis”. Clinical Imaging6 (2009): 439-446.


Citation: Hasan Mahmud Rumi., et al. “Accuracy of Ultrasonography and Hepatobiliary Scintigraphy for the Diagnosis of Biopsy Proven Biliary Atresia”. Acta Scientific Paediatrics 6.7 (2023): 17-22.


Copyright: © 2023 Hasan Mahmud Rumi., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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