MR-IMAGING OF BILIARY CYSTS IN CHILDREN WITH BILIARY ATRESIA - CLINICAL ASSOCIATIONS AND PATHOLOGICAL CORRELATION

OBJECTIVE. We used MR imaging to determine the prevalence of biliary c ysts in children with end-stage biliary atresia and evaluated the asso ciation of cysts with cholangitis, choleretic therapy, portoenterostom y, biochemical abnormalities, and MR findings of end-stage liver disea se. The MR features of these cysts were correlated with their gross an d histopathologic appearances. MATERIALS AND METHODS. We retrospective ly reviewed 48 MR studies, clinical history, and laboratory data of 44 consecutive children with biliary atresia. RESULTS. MR images showed cysts in eight patients (18%). Cysts were statistically (p<.04) more c ommon in patients who had a history of cholangitis, but were not assoc iated with choleretic therapy or portoenterostomy surgery. Cysts were not statistically correlated with abnormalities in hepatic biochemical function or MR features of end-stage liver disease. Four livers with cysts were available for histopathologic study. Cysts were filled with bile, and most had an epithelial lining, consistent with a biliary or igin. The epithelium was frequently ulcerated, accompanied by periport al extravasation of bile and inflammation. These findings suggest chro nic obstruction with microscopic perforation. CONCLUSION. Biliary cyst s are common in biliary atresia and may be related to previous episode s of cholangitis with attendant obstruction of biliary radicles. The p resence of these cysts did not correlate with hepatic function, portoe nterostomy surgery, or the extent of liver disease.