Document Type : original article


1 Department of Pediatric,Mashhad University of Medical Sciences,Mashhad,Iran

2 Department of Pediatric Gastroenterology, Mashhad University of medical sciences, Mashhad, Iran.

3 Department of Pediatric, Mashhad University of Medical Sciences , Mashhad, Iran.

4 Department of Radioloy, Mashhad University of Medical Sciences, Mashhad, Iran

5 Department of Radiology, Mashhad University of Medical Sciences, Mashhad, Iran.

6 Department of Pediatrics, Mashhad University of medical sciences, Mashhad, Iran.

7 Research Center for Patient Safety, Mashhad University of Medical Sciences, Mashhad, Iran


Background: Biliary atresia (BA) is one of the most common etiologies of cholestasis in infants and toddlers. The most important factor in case of patients’ prognosis is its early diagnosis. There are many diagnostic tools in this field, sonography seems to be the most appropriate and fastest tool in early detecting and differentiating BA from other causes of neonatal cholestasis. The aim of this study was to evaluate the diagnostic value of new ultrasound and Doppler ultrasound methods in BA in infants and toddlers.
Methods: This cross-sectional study was performed during a one-year period on 35 infants and toddlers admitted to the gastrointestinal department of Akbar Children's Hospital with suspicion of cholestasis. These children underwent sonography by a radiologist to diagnose BA. All required information was extracted from the hospital records of these children and analyzed after entering the checklist. Data were analyzed using SPSS software version 26.
Results: Totally, 35 patients including 18 boys (51.4%) and 17 girls (6.48%) with a mean age of 4/29±4/17 months were enrolled. According to the findings of the analysis, 21 patients (60%) had bile duct atresia and 14 patients (40%) had other diseases. Ultrasound sensitivity in the diagnosis of bile duct atresia was 90%, with an accuracy of 74%, specificity of 50% and positive and negative predictive value of 73% and 77%, respectively. The highest diagnostic value was related to the former hepatic capsular flow.
Conclusion: Biliary atresia can be accurately diagnosed by ultrasonography. The high sensitivity and accuracy of ultrasound indicate the appropriateness of this method in diagnosing this disease


  1. Friedmacher F, Ford K, Davenport M. Biliary atresia: a scientometric analysis of the global research architecture and scientific developments. Journal of Hepato‐Biliary‐Pancreatic Sciences. 2019; 26(6):201-10.
  2. Hopkins PC, Yazigi N, Nylund CM. Incidence of biliary atresia and timing of hepatoportoenterostomy in the United States. The Journal of pediatrics. 2017; 187:253-7.
  3. Chardot C, Buet C, Serinet M-O, Golmard J-L, Lachaux A, Roquelaure B, Gottrand F, Broué P, Dabadie A, Gauthier F, Jacquemin E. improving outcomes of biliary atresia: French national series 1986–2009. Journal of hepatology. 2013; 58(6):1209-17.
  4. Van Wessel DB, Boere T, Hulzebos CV, de Kleine RH, Verkade HJ, Hulscher JB. Preterm infants with biliary atresia: a nationwide cohort analysis from the Netherlands. Journal of pediatric gastroenterology and nutrition. 2017; 65(4):370-4.
  5. Tam PK, Yiu RS, Lendahl U, Andersson ER. Cholangiopathies–towards a molecular understanding. EBioMedicine. 2018; 35:381-93.
  6. Tam PK, Yiu RS, Lendahl U, Andersson ER. Corrigendum to “Cholangiopathies–Towards a molecular understanding” [EBioMedicine 35 (2018) 381–393]. EBioMedicine. 2018; 36:564.
  7. Chung PHY, Zheng S, Tam PKH, editors. Biliary atresia: east versus west. Seminars in Pediatric Surgery; 2020: Elsevier.
  8. Sahranavard M, Rezayat AA, Bidary MZ, Omranzadeh A, Rohani F, Farahani RH, Farahani RH, Hazrati E, Mousavi SH, Ardalan MA, Soleiman-Meigooni S, Hosseini-Shokouh SJ, Hejripour Z, Nassireslami E, Laripour R, Salarian A, Nourmohammadi A, Mosaed R. Cardiac complications in COVID-19: a systematic review and meta-analysis. Archives of Iranian Medicine. 2021; 24(2):152.
  9. Scottoni F, Davenport M, editors. Biliary atresia: Potential for a new decade. Seminars in Pediatric Surgery; 2020: Elsevier.
  10. Khadem Rezaiyan M, Omranzadeh A, Akhavan Rezayat A, Youssefi M. From Prestige to Humanism: The Experiences of Medical Students about Motivational Factors. Journal of Medical Education Development. 2019; 12(34):14-21.
  11. Kitagawa H. Definition and Classifications of Biliary Atresia. Introduction to Biliary Atresia: Springer; 2021. p. 11-7.
  12. Abou-Taleb A, Abdelhameed W, Ahmed A, El-Hennawy A. Non-invasive diagnostic methods for differentiation of biliary atresia from neonatal hepatitis in upper Egypt. International Journal of Pediatrics. 2019; 7(4):9265-75.
  13. Adeyemi A, States L, Wann L, Lin HC, Rand EB. Biliary excretion noted on hepatobiliary iminodiacetic acid scan does not exclude diagnosis of biliary atresia. The Journal of pediatrics. 2020; 220:245-8.
  14. Jiang J, Wang J, Shen Z, Lu X, Chen G, Huang Y, et al. Serum MMP-7 in the diagnosis of biliary atresia. Pediatrics. 2019; 144(5).
  15. Govindarajan KK. Biliary atresia: Where do we stand now? World journal of hepatology. 2016; 8(36):1593.
  16. Takamizawa S, Zaima A, Muraji T, Kanegawa K, Akasaka Y, Satoh S, Nishijima E. Can biliary atresia be diagnosed by ultrasonography alone? Journal of pediatric surgery. 2007; 42(12):2093-6.
  17. Yoon HM, Suh CH, Kim JR, Lee JS, Jung AY, Cho YA. Diagnostic Performance of Sonographic Features in Patients with Biliary Atresia: A Systematic Review and Meta‐analysis. Journal of Ultrasound in Medicine. 2017; 36(10):2027-38.
  18. Omranzadeh A, Hoseini Jebeli SM, Ghodsi A, Mahdavi Rashed M. Mediastinal epidermoid cyst in an old man with recurrent pneumonia: A case report. Journal of Cardio-Thoracic Medicine. 2020; 8(3):666-9.
  19. Lee MS, Kim M-J, Lee M-J, Yoon CS, Han SJ, Oh J-T, Park YN. Biliary atresia: color doppler US findings in neonates and infants. Radiology. 2009; 252(1):282-9.
  20. Omranzadeh A, Baradaran A, Ghodsi A, Arekhi S, Dadgar Moghaddam M, Mirshekar A, et al. Neutrophil-to-Lymphocyte Ratio as an Inflammatory Marker in Familial Mediterranean Fever: A Systematic Review and Meta-analysis. Journal of Child Science. 2021; 11(01):e100-e9.
  21. Goodhue C, Fenlon M, Wang KS. Newborn screening for biliary atresia in the United States. Pediatric surgery international. 2017; 33(12):1315-8.
  22. Bidary MZ, Sahranavard M, Rezayat AA, Omranzadeh A, Hoseiny SH, Kabirian A, Sahebkar A. Opium as a carcinogen: A systematic review and meta-analysis. EClinicalMedicine. 2021; 33:100768.
  23. Woolfson JP, Schreiber RA, Butler AE, MacFarlane J, Kaczorowski J, Masucci L, Bryan S, Collet JP. Province-wide biliary atresia home screening program in British Columbia: evaluation of first 2 years. Journal of pediatric gastroenterology and nutrition. 2018; 66(6):845-9.
  24. Ghodsi A, Miri Moghaddam MM, Sarabi M, Dehghan Tarazjani A, Omranzadeh A, Mahdavi Rashed M, et al. Neutrophil-to-lymphocyte ratio as a novel and valuable marker for assessing disease severity in Ulcerative colitis, Multiple sclerosis, and Kawasaki disease: A review. Journal of Basic Research in Medical Sciences. 2020; 7(3):62-70.
  25. Lee SM, Cheon J-E, Choi YH, Kim WS, Cho H-H, Kim I-O, et al. Ultrasonographic Diagnosis of Biliary Atresia Based on a Decision-Making Tree Model. kjr. 2015; 16(6):1364-72.
  26. Jancelewicz T, Barmherzig R, Chung CT-S, Ling SC, Kamath BM, Ng VL, Amaral J, O'Connor C, Fecteau A, Langer JC. A screening algorithm for the efficient exclusion of biliary atresia in infants with cholestatic jaundice. Journal of pediatric surgery. 2015; 50(3):363-70.
  27. El‐Guindi MAS, Sira MM, Konsowa HAS, El‐Abd OL, Salem TAH. Value of hepatic subcapsular flow by color Doppler ultrasonography in the diagnosis of biliary atresia. Journal of gastroenterology and hepatology. 2013; 28(5):867-72.
  28. Ho A, Sacks MA, Sapra A, Khan FA. The Utility of Gallbladder Absence on Ultrasound for Children with Biliary Atresia. Frontiers in Pediatrics. 2021; 9(530).
  29. Hartley J, Davenport M. Kelly DAJTL. 2009. Biliary atresia.374:1704-13.
  30. Zhou L, Shan Q, Tian W, Wang Z, Liang J, Xie X. Ultrasound for the diagnosis of biliary atresia: a meta-analysis. American Journal of Roentgenology. 2016; 206(5):W73-W82.
  31. Jafari S, Khakshour A, Kianifar H, Farahmand F, Mahdizadeh M, Fallahi G, Esmaeili HA, Purnaghi SJ. Comparison of Triangular Cord Sign with Finding of Liver Histopathology in Infants with Biliary Atresia in Children. 2012.
  32. Wu JF, Lee CS, Lin WH, Jeng YM, Chen HL, Ni YH, et al. Transient elastography is useful in diagnosing biliary atresia and predicting prognosis after hepatoportoenterostomy. Hepatology. 2018; 68(2):616-24.
  33. RAFIEI M, NEMATI M, Nazarpour S. Diagnostic value of ultrasonography in biliary ducts atresia. 2009.
  34. Liu B, Cai J, Xu Y, Peng X, Zheng H, Huang K, Yang J. Three-dimensional magnetic resonance cholangiopancreatography for the diagnosis of biliary atresia in infants and neonates. PLoS One. 2014; 9(2):e88268.