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MDCT of biliary cysts in children with biliary atresia: clinical associations and pathologic correlations

Esra Meltem Kayahan Ulu1, Fuldem Yıldırım Dönmez1, Nihan Haberal2, Elif Durukan3, Ahmet Öztürk1, Ahmet Bayrak1, Mehmet Coşkun1

1From the Departments of Radiology, Başkent University School of Medicine, Ankara, Turkey 2From the Departments of Pathology, Başkent University School of Medicine, Ankara, Turkey 3From the Departments of Public Health, Başkent University School of Medicine, Ankara, Turkey

Keywords: • biliary system, abnormalities • diagnostic imaging • cysts

PURPOSE To evaluate the association of biliary cyst formation with cholangitis, portoenterostomy, biochemical abnormalities, using multidetector computed tomography (MDCT) and pathologic findings of end-stage liver disease. MATERIALS AND METHODS We retrospectively reviewed the 42 MCDT studies, clinical history and laboratory findings of 36 children with biliary atresia. RESULTS Biliary cysts were detected in 58% of the patients on MDCT images. The cysts were not associated with cholangitis, portoenterostomy surgery, or biochemical abnormality. Hepatic artery anomaly was also common in our series (25%) and more common in patients with biliary cysts which was statistically significant (P < 0.05). Eighteen livers were available for pathologic examination. The only statistically significant finding between the patients with and without biliary cysts were biliary epithelial damage and inflammatory reaction around the cysts which were common in the patients with biliary cysts (P < 0.05). CONCLUSION The damage to the bile duct epithelium and inflammatory reaction around the biliary epithelium support the theory of obstruction and bile leaks in the etiogenesis of biliary cysts. This is the first report of the association between hepatic artery variations and the biliary cysts; this may be important in pretransplant evaluation.

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