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. 2020 Nov;23(6):531-538.
doi: 10.5223/pghn.2020.23.6.531. Epub 2020 Nov 5.

Cyst Size in Fetuses with Biliary Cystic Malformation: An Exploration of the Etiology of Congenital Biliary Dilatation

Kengo Hattori  1   2 , Yoshinori Hamada  2 , Masahito Sato  3
Affiliations

Cyst Size in Fetuses with Biliary Cystic Malformation: An Exploration of the Etiology of Congenital Biliary Dilatation

Kengo Hattori et al. Pediatr Gastroenterol Hepatol Nutr. 2020 Nov.

Abstract

Purpose: Our aim was the longitudinal assessment of cyst size in fetuses with biliary cystic malformation (BCM) to explore its etiology and the possibility of antenatal differentiation between biliary atresia (BA) and congenital biliary dilatation (CBD).

Methods: We conducted a retrospective review of all patients diagnosed antenatally with BCM from 1994 to 2014 at our institutions.

Results: The study cohort comprised of three patients with BA and six with CBD. There were no significant differences in the gestational age and cyst size at the first detection of BCM between the two groups. In fetuses with CBD, the cyst size steadily increased as the gestational age advanced, while it fluctuated around 1.5 cm and remained below 2.1 cm in those with BA. However, the ratio of cystic area to fetal trunk area was approximately constant due to linear fetal growth in fetuses with CBD.

Conclusion: Fetuses with BCM <2.1 cm in the late gestation period were more likely to have BA than CBD. Our observation of cyst enlargement with advancing gestational age in the CBD group was attributed solely to fetal growth. Biliary dilatation in fetuses with CBD and BA might be completed at the onset of BCM.

Keywords: Biliary atresia; Biliary cystic malformations; Choledochal cyst; Diagnostic imaging; Prenatal diagnosis.

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Conflict of interest statement

Conflict of Interest: The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1. Antenatal cyst size from 22 to 38 weeks of gestation in patients with biliary cystic malformation. Mean cyst sizes were calculated fortnightly from the measured and estimated cyst sizes in the CBD (black triangles) and BA (black circles) groups. Data are shown as mean with standard deviation. CBD: congenital biliary dilatation, BA: biliary atresia. The difference between the CBD and BA groups at each gestational age was not statistically significant. Statistical analyses were performed using the Mann–Whitney U-test.
Fig. 2
Fig. 2. Antenatal cyst area from 22 to 38 weeks of gestation in patients with biliary cystic malformation. Mean cyst areas were calculated fortnightly from the measured and estimated cyst areas in the CBD (black triangles) and BA (black circles) groups. CBD: congenital biliary dilatation, BA: biliary atresia. Data are shown as mean with standard deviation. The difference between the CBD and BA groups at each gestational age was not statistically significant. Statistical analyses were performed using the Mann–Whitney U-test. The dotted line represents the linear regression line between the mean cyst area and gestational age in CBD patients. The equation of the line y=0.178×−1.301 (R2=0.733).
Fig. 3
Fig. 3. Scatterplot between fetal trunk area in ultrasonography scans and gestational age in the congenital biliary dilatation (CBD) group. The dotted line represents the linear regression line whose equation is y=3.538×−54.64 (R2=0.885).
Fig. 4
Fig. 4. Fortnightly-assessed means of the calculated cystic area-to-fetal trunk area ratios in the CBD (black triangles) and BA (black circles) groups from 22 to 38 weeks of gestation.
CBD: congenital biliary dilatation, BA: biliary atresia. The dotted lines represent linear regressions lines whose equations are: y=–0.002x+0.149 (R2=0.700) for CBD and y=–0.003x+0.129 (R2=0.929) for BA.
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