Magnetic resonance cholangiopancreatography as a diagnostic tools to diagnose biliary atresia at Dr.Soetomo hospital

Gina Noor Djalilah, Reny Widayanti, Bagus Setyoboedi, Sjamsul Arief

Abstract

ABSTRACT

 

Cholestasis jaundice results from diminished bile flow and/or excretion, and caused by a number of disorders such as biliary atresia (BA). Magnetic resonance cholangiopancreatography (MRCP) is widely accepted as one of the modalities for biliary system imaging; however, liver biopsy still generally used for BA diagnosis, especially in developing countries. This aim study was to evaluate the diagnostic value of biliary atresia from MRCP compared to the result of a liver biopsy. A cross-sectional for diagnostic study documented of hospitalized patients from June 2014 to June 2015. All patients had MRCP and liver biopsy examination. The collection of data including age, gender, clinical manifestation and the result of MRCP and liver biopsy with ROC to evaluate the sensitivity and specificity was done. Liver biopsy revealed of biliary atresia was made based on proliferation, degeneration, and fibrosis of bile ducts. ROC to evaluate the sensitivity and specificity was done. The sensitivity, specificity, negative predictive value, positive predictive value of MRCP in diagnosing BA were calculated. There were 16 patients enrolled in this study with a median age of diagnosis was 6 months old (range 3-11). There were nine female patients out of the 16 patient. The median age of jaundice onset was 5 days (range 2-14 days). All patients had hepatomegaly and splenomegaly. Histopathology from liver biopsy revealed biliary atresia in 12 patients. From the ROC curve, the sensitivity of MRCP was 87.5% and specificity 62.5% with PPV 70% and NPV 80%. Five patients underwent a Kasai procedure and revealed biliary atresia. MRCP is sensitive but not specific for diagnosing BA, and MRCP has moderate sensitivity and specificity for BA diagnosis.

Keyword: biliary atresia, magnetic resonance cholangiopancreatography, liver biopsy, diagnostic test.

Correspondence: geendjk@gmail.com

 

ABSTRAK

Ikterus dikarenakan kolestasis terjadi akibat berkurangnya aliran empedu dan/ atau ekskresi, dan dapat disebabkan oleh sejumlah gangguan seperti atresia biliaris (BA). Magnetic resonance cholangiopancreatography (MRCP) secara luas diterima sebagai salah satu modalitas untuk pencitraan sistem empedu, namun biopsi hati masih secara umum digunakan untuk diagnosis BA, terutama di negara berkembang. Studi ini bertujuan untuk mengevaluasi nilai diagnostik atresia biliaris dari MRCP ke hasil biopsi hati. Sebuah cross sectional untuk studi diagnostik didokumentasikan pasien rawat inap dari Juni 2014 hingga Juni 2015. Semua pasien menjalani MRCP dan pemeriksaan biopsi hati. Data usia, jenis kelamin, manifestasi klinis dan hasil MRCP dan biopsi hati dengan ROC untuk mengevaluasi sensitivitas dan spesifisitas dilakukan. Biopsi hati mengungkapkan atresia biliar dibuat berdasarkan proliferasi, degenerasi dan fibrosis saluran empedu. ROC untuk mengevaluasi sensitivitas dan spesifisitas yang dilakukan. Dilakukan perhitungan sensitivitas, spesifisitas, nilai prediktif negatif, nilai prediksi positif MRCP dalam mendiagnosis BA. Terdapat 16 pasien yang terdaftar dalam penelitian ini dengan median usia diagnosis adalah 6 (kisaran 3-11) bulan. Terdapat 9 perempuan dari 16 pasien tersebut. Usia rata-rata onset penyakit kuning adalah 5 (kisaran 2-14) hari. Semua pasien mengalami hepatomegali dan splenomegali. Histopatologi dari biopsi hati mengungkapkan atresia bilier pada 12 dari 16 pasien. Dari kurva ROC, sensitivitas MRCP adalah 87,5% dan spesifisitas 62,5% dengan PPV 70% dan NPV 80%. Lima pasien menjalani prosedur Kasai dan mengungkapkan atresia bilier. MRCP sensitif namun tidak spesifik untuk mendiagnosis BA dan MRCP memiliki sensitivitas dan spesifisitas sedang untuk diagnosis BA.

Kata kunci: biliary atresia, magnetic resonance cholangiopancreatography, liver biopsy, diagnostic test.

Korespondensi: geendjk@gmail.com

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DOI: http://dx.doi.org/10.30651/jqm.v3i2.2131