MR cholangiography in the evaluation of neonatal cholestasis

PURPOSE: To evaluate the usefulness of magnetic resonance (MR) cholangiogra phy in excluding biliary atresia as the cause of neonatal cholestasis. MATERIALS AND METHODS: MR cholangiography was performed on 10 control and 1 6 jaundiced neonates and infants aged 3 days to 5 months. Diagnosis of bili ary atresia (n = 6) was confirmed with surgery and liver biopsy, with or wi thout surgical cholangiography. Diagnosis of neonatal hepatitis (n = 9) was confirmed with clinical follow-up until jaundice resolved. In one infant, paucity of intrahepatic ducts was diagnosed at liver biopsy. MR cholangiogr aphy was performed with respiratory-triggered, heavily T2-weighted turbo sp in-echo and optional inversion-recovery turbo spin-echo sequences. Diagnosi s of biliary atresia was based on nonvisualization of either the common bil e duct or common hepatic duct. Cholescintigraphy with technetium 99m disofe nin was performed in all 16 jaundiced patients. RESULTS: In the 10 controls, the nine patients with neonatal hepatitis, and the one infant with paucity of intrahepatic ducts, MR cholangiography clea rly depicted the gallbladder and common hepatic and common bile ducts. MR c holangiography was 100% accurate in excluding biliary atresia as the cause of neonatal cholestasis, while Tc-99m disofenin cholescintigraphic findings were false-positive in four of 10 patients with nonobstructive cholestasis . CONCLUSION: MR cholangiography can be used to depict the major biliary stru ctures of neonates and small infants and to exclude biliary atresia as the cause of neonatal cholestasis by allowing visualization of the biliary trac t.