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Review
. 2022 Oct 31;9(11):1676.
doi: 10.3390/children9111676.

Diagnostic Efficacy of Advanced Ultrasonography Imaging Techniques in Infants with Biliary Atresia (BA): A Systematic Review and Meta-Analysis

Simon Takadiyi Gunda  1 , Nonhlanhla Chambara  1 , Xiangyan Fiona Chen  1 , Marco Yiu Chung Pang  2 , Michael Tin-Cheung Ying  1
Affiliations
Review

Diagnostic Efficacy of Advanced Ultrasonography Imaging Techniques in Infants with Biliary Atresia (BA): A Systematic Review and Meta-Analysis

Simon Takadiyi Gunda et al. Children (Basel). .

Abstract

The early diagnosis of biliary atresia (BA) in cholestatic infants is critical to the success of the treatment. Intraoperative cholangiography (IOC), an invasive imaging technique, is the current strategy for the diagnosis of BA. Ultrasonography has advanced over recent years and emerging techniques such as shear wave elastography (SWE) have the potential to improve BA diagnosis. This review sought to evaluate the diagnostic efficacy of advanced ultrasonography techniques in the diagnosis of BA. Six databases (CINAHL, Medline, PubMed, Google Scholar, Web of Science (core collection), and Embase) were searched for studies assessing the diagnostic performance of advanced ultrasonography techniques in differentiating BA from non-BA causes of infantile cholestasis. The meta-analysis was performed using Meta-DiSc 1.4 and Comprehensive Meta-analysis v3 software. Quality Assessment of Diagnostic Accuracy Studies tool version 2 (QUADAS-2) assessed the risk of bias. Fifteen studies consisting of 2185 patients (BA = 1105; non-BA = 1080) met the inclusion criteria. SWE was the only advanced ultrasonography technique reported and had a good pooled diagnostic performance (sensitivity = 83%; specificity = 77%; AUC = 0.896). Liver stiffness indicators were significantly higher in BA compared to non-BA patients (p < 0.000). SWE could be a useful tool in differentiating BA from non-BA causes of infantile cholestasis. Future studies to assess the utility of other advanced ultrasonography techniques are recommended.

Keywords: biliary atresia; diagnostic accuracy; diagnostic performance; elastography; intraoperative cholangiography (IOC); ultrasonography.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study selection process (flow chart diagram).
Figure 2
Figure 2
Frequency distribution of participants in the fifteen included studies [11,61,62,63,64,65,66,67,68,69,70,71,72,73,74].
Figure 3
Figure 3
A comparison of the liver stiffness value between the patients with and without BA for all the studies (KPa and SWV) [11,61,62,63,64,65,66,67,68,69,70,71,72,73,74].
Figure 4
Figure 4
A comparison of the liver stiffness parameter (kPa) between BA and non-BA patients [62,63,67,68,69,70,71,72].
Figure 5
Figure 5
A comparison of the liver stiffness parameter (SWV) between BA and non-BA patients [11,61,65,66,67,74].
Figure 6
Figure 6
(a): Sensitivity forest plot for studies using SWE (kPa). (b): Specificity forest plot for studies using SWE (kPa). (c): Summary receiver operating characteristic curve for studies using SWE (kPa). (d): Forest plot showing overall diagnostic odds ratio for studies using SWE (kPa) [62,63,64,68,69,70,71,72,73].
Figure 6
Figure 6
(a): Sensitivity forest plot for studies using SWE (kPa). (b): Specificity forest plot for studies using SWE (kPa). (c): Summary receiver operating characteristic curve for studies using SWE (kPa). (d): Forest plot showing overall diagnostic odds ratio for studies using SWE (kPa) [62,63,64,68,69,70,71,72,73].
Figure 7
Figure 7
(a): Sensitivity forest plot for studies using shear wave velocity. (b): Specificity forest plot for studies using shear wave velocity. (c): Summary receiver-operating characteristic curve for studies using shear wave velocity. (d): Forest plot showing overall diagnostic odds ratio for studies using shear wave velocity. [11,61,65,67].
Figure 7
Figure 7
(a): Sensitivity forest plot for studies using shear wave velocity. (b): Specificity forest plot for studies using shear wave velocity. (c): Summary receiver-operating characteristic curve for studies using shear wave velocity. (d): Forest plot showing overall diagnostic odds ratio for studies using shear wave velocity. [11,61,65,67].
Figure 8
Figure 8
(a): Sensitivity forest plots for all included studies. (b): Specificity forest plots for all included studies. (c): Summary receiver operating characteristic curve for all included studies. (d): Forest plot showing overall diagnostic odds ratio for all included studies [11,61,62,63,64,65,67,68,69,70,71,72,73].
Figure 8
Figure 8
(a): Sensitivity forest plots for all included studies. (b): Specificity forest plots for all included studies. (c): Summary receiver operating characteristic curve for all included studies. (d): Forest plot showing overall diagnostic odds ratio for all included studies [11,61,62,63,64,65,67,68,69,70,71,72,73].
Figure 9
Figure 9
Funnel plot of precision (inverse standard error) by standardised difference in means assessing bias.
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