Ultrasonographic diagnosis of biliary atresia based on a decision-making tree model

So Mi Lee, Jung Eun Cheon, Young Hun Choi, Woo Sun Kim, Hyun Hye Cho, In One Kim, Sun Kyoung You

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Objective: To assess the diagnostic value of various ultrasound (US) findings and to make a decision-tree model for US diagnosis of biliary atresia (BA). Materials and Methods: From March 2008 to January 2014, the following US findings were retrospectively evaluated in 100 infants with cholestatic jaundice (BA, n = 46; non-BA, n = 54): length and morphology of the gallbladder, triangular cord thickness, hepatic artery and portal vein diameters, and visualization of the common bile duct. Logistic regression analyses were performed to determine the features that would be useful in predicting BA. Conditional inference tree analysis was used to generate a decision-making tree for classifying patients into the BA or non-BA groups. Results: Multivariate logistic regression analysis showed that abnormal gallbladder morphology and greater triangular cord thickness were significant predictors of BA (p = 0.003 and 0.001; adjusted odds ratio: 345.6 and 65.6, respectively). In the decision-making tree using conditional inference tree analysis, gallbladder morphology and triangular cord thickness (optimal cutoff value of triangular cord thickness, 3.4 mm) were also selected as significant discriminators for differential diagnosis of BA, and gallbladder morphology was the first discriminator. The diagnostic performance of the decision-making tree was excellent, with sensitivity of 100% (46/46), specificity of 94.4% (51/54), and overall accuracy of 97% (97/100). Conclusion: Abnormal gallbladder morphology and greater triangular cord thickness (> 3.4 mm) were the most useful predictors of BA on US. We suggest that the gallbladder morphology should be evaluated first and that triangular cord thickness should be evaluated subsequently in cases with normal gallbladder morphology.

Original languageEnglish
Pages (from-to)1364-1372
Number of pages9
JournalKorean Journal of Radiology
Issue number6
StatePublished - Nov 2015

Bibliographical note

Publisher Copyright:
© 2015 The Korean Society of Radiology.


  • Biliary atresia
  • Decision trees
  • Neonatal jaundice
  • US


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