Periportal thickening on magnetic resonance imaging for hepatic fibrosis in infantile cholestasis

Figure 1 Example of measuring of periportal thickening on magnetic resonance imaging. Pancreaticobiliary magnetic resonance imaging of a 3-mo-old girl diagnosed as biliary atresia. A: On T1-weighted axial image, the maximal thickness of periportal signal change was measured on right main portal vein where its greatest thickness was 5.5 mm; B: On T2-weighted sagittal image, the maximal thickness of periportal signal change was 6.1 mm. Therefore, the larger of the two, which was measured on T2-weighted sagittal image, was defined as periportal thickening of this patient.

Figure 2 Representative images of periportal thickening for each hepatic fibrosis grade. The maximal thickness (double arrow in each figure) of periportal signal intensity change was measured. A: 2.7 mm on axial T2-weighted image in a 7-d-old girl with non-biliary atresia (non-biliary atresia, choledochal cyst) and hepatic fibrosis grade 1 (F1); B: 4.2 mm on T2-weighted axial image in a 2-mo-old girl with BA and F2; C: 5.5 mm on T1-weighted axial image in a 3-mo-old girl with biliary atresia and F3; D: 5.4 mm on T2-weighted axial image in a 2-mo-old girl with non-biliary atresia (metabolic disease) and F4.

Figure 3 Comparisons of receiver operating characteristic curves. The comparisons of area under the curve (AUC) for diagnosing A: Clinically significant fibrosis (F2-F4); B: Advance fibrosis (F3-F4); C: Cirrhosis (F4) with periportal thickening (PT, green line), normalized spleen size ratio (SR, orange line), and aspartate aminotransferase to platelet ratio index (APRI, blue line). The AUC of PT for diagnosing clinically significant fibrosis was higher than that of SR or APRI. However, the AUCs were not different for differentiating advanced fibrosis. For diagnosing cirrhosis, SR had higher AUC value than PT. APRI: Aspartate aminotransferase to platelet ratio index; SR: Normalized spleen size ratio; PT: Periportal thickening.