MAGNETIC-RESONANCE CHOLANGIOGRAPHY FOR EVALUATION OF CHOLESTATIC JAUNDICE IN NEONATES AND INFANTS

Distinguishing extrahepatic biliary atresia from other causes of chole stasis in neonates and infants is important because surgical intervent ion before 2 months of age allows for long-term survival. The purpose of this prospective study was to evaluate the usefulness of magnetic r esonance (MR) cholangiography in differentiating biliary atresia from other causes of cholestatic jaundice in neonates and infants. Nine ani cteric infants (control group) aged 10 to 224 days (mean +/- SD, 8 +/- 65 days) and 15 neonates and infants with cholestatic jaundice, aged 22 to 142 days (mean I SD, 71 +/- 37) underwent MR cholangiography. Th e final diagnosis of extrabiliary atresia (6 patients) was based on la parotomy findings (4 patients) or autopsy (2 patients), while neonatal hepatitis (9 patients) was diagnosed according to the liver biopsy fi ndings and clinical recovery during follow-up. Percutaneous liver biop sies were performed in all 15 patients. Results showed that the gall b ladder and common bile duct (CBD) could be visualized using MR cholang iography in all patients in the control group. Non Nonvisualization of the CBD (6/6 patients) and demonstration of a small gall bladder (6/6 patients) characterized MR cholangiography findings in patients with biliary atresia. MR cholangiography failed to depict the CBD in one in fant with hepatitis. We conclude that demonstration of the CBD by MR c holangiography in neonates and infants with cholestasis can be used to exclude the diagnosis of biliary atresia. In patients,vith cholestati c jaundice considered for exploratory laparotomy, preoperative MR chol angiography is recommended to avoid unnecessary surgery.