Neonatal cholestasis, if left untreated, can advance into liver cirrhosis and end stage liver disease in infancy due to chronic hepatocyte and biliary tree injury. Few cases also warrant liver transplantation. Hence, it is crucial to conduct a non-invasive investigation of hepatic fibrosis in infants with cholestasis for a prompt diagnosis.

The current retrospective study evaluated the advantages of periportal thickening (PT) determined by liver magnetic resonance imaging (MRI) for the examination of hepatic fibrosis in infants with cholestasis including biliary atresia (BA).

The trial enrolled infants less than 6 months of age who underwent liver MRI and biopsy for the assessment of infantile cholestasis. MRI was used to analyze PT and spleen size. Serologic assessment measured aspartate transaminase to platelet ratio index (APRI). METAVIR grading system was utilized to evaluate the grade of histopathologic fibrosis. Correlation and diagnostic performance of PT, normalized spleen size ratio (SR), and APRI for diagnosing hepatic fibrosis were performed by receiver-operating characteristic (ROC) curve analysis.

The outcome showed that a total of 110 out of 155 patients with mean age of 57.6 ± 34.4 d were diagnosed with BA. Positive correlations were found between fibrosis grade and PT and SR. The area under the ROC curve was 0.899 for PT, which was higher than 0.741 for SR and 0.712 for APRI while diagnosing significant fibrosis (METAVIR grade F2-F4). Additionally, the area under the ROC curve was the highest with SR as 0.790 for identification of cirrhosis (F4).

To conclude, liver MRI findings of PT and SR represent a potent tool to diagnose clinically significant hepatic fibrosis (F2 and higher) in infants with cholestasis including BA.

Source: Lee MH, Shin HJ, Yoon H, Han SJ, Koh H, Lee MJ. Periportal thickening on magnetic resonance imaging for hepatic fibrosis in infantile cholestasis. World J Gastroenterol. 2020;26(21):2821-2830.