Three-dimensional magnetic resonance cholangiopancreatography for the diagnosis of biliary atresia in infants and neonates

PLoS One. 2014 Feb 5;9(2):e88268. doi: 10.1371/journal.pone.0088268. eCollection 2014.


Background and objective: Magnetic resonance cholangiopancreatography (MRCP) is widely accepted for visualization of the biliary system. However, the sensitivity and specificity of MRCP for the diagnosis of biliary atresia (BA) are still not fully elucidated. This study aimed to investigate the diagnostic value of three-dimensional MRCP (3D-MRCP) for BA in a large cohort of cholestatic infants and neonates.

Methods: One hundred ninety patients with infant jaundice underwent 3D-MRCP and one or more of the following: (1) intraoperative cholangiography, (2) laparoscopic exploration and pathological examination, or/and (3) clinical therapy. Statistical analyses were performed to determine the diagnostic accuracy of 3D-MRCP for BA.

Results: Our study demonstrated that 158 of 190 patients were interpreted as having BA by 3D-MRCP; of those, 103 patients were confirmed as having BA, whereas 55 patients did not have BA. Of the 32 patients interpreted as non-BA cases by 3D-MRCP, one patient was misdiagnosed. The diagnostic accuracy for 3D-MRCP was 70.53% (134 of 190), the sensitivity was 99.04% (103 of 104), the specificity was 36.05% (31 of 86), the negative predictive value was 96.88% (31 of 32), the positive predictive value was 65.19% (103 of 158), the positive likelihood ratio was 2.7473, the negative likelihood ratio was 0.0267, and the Youden index was 0.3509.

Conclusions: The sensitivity of 3D-MRCP in diagnosing BA was excellent, but the specificity was not as high as described in previous reports. 3D-MRCP can be an effective screening method but should be combined with other modalities to identify BA and distinguish it from other causes of infant jaundice.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bile Ducts / pathology
  • Biliary Atresia / diagnosis*
  • Biliary Atresia / pathology
  • Cholangiopancreatography, Magnetic Resonance*
  • Cohort Studies
  • Female
  • Humans
  • Imaging, Three-Dimensional
  • Infant
  • Infant, Newborn
  • Male
  • Sensitivity and Specificity

Grants and funding

This study was supported by Grants from the National Natural Science Foundation of China (No. 81171387;, Natural Science Foundation Project of Chongqing (CQ CSTC, No. CSTC, 2011BB5130; and Project Foundation of Chongqing Municipal Education Committee (KJ080313; The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.