ABSTRACT
Neonatal cholestasis still presents a diagnostic challenge, both from the anatomical and etiologic points of view. Distinguishing intrahepatic from extrahepatic causes of cholestasis is of paramount importance since the latter may be treated by surgery but prognosis depends on the age at which operation is performed. Many tests have been proposed to help in differentiating these two entities, among which are the abdominal ultrasonography [US], magnetic resonance cholangiography [MR cholangiography] and liver biopsy. The aim of this work is to evaluate the usefulness of these methods in the differential diagnosis of neonatal cholestasis. Fifty three patients with neonatal cholestasis were evaluated prospectively through history taking, laboratory investigations, abdominal ultrasound, MR cholangiography in 10 patients, and needle liver biopsy. The collected data were compared to that of the final diagnosis. The final diagnosis was reached through the operative findings, the histodiagnosis of the excised specimens or the clinical course of the disease. Thirty patients were found to have extrahepatic cholestasis [all with biliary atresia] and 23 patients with intrahepatic cholestasis. Sensitivity was 80% for ultrasonography and 90% for liver biopsy in diagnosing extrahepatic cholestasis. Specificity was 83% for ultrasonography and 100% for liver biopsy. Accuracy was 81% for ultrasonography and 94.3% for liver biopsy. Accuracy was 92.4% when both tests were considered together. Biliary atresia was suspected in 5/10 patients by MR cholangiography, but one of them was having sclerosing cholangitis, while another one showed atresia involving only one part of the extrahepatic bile duct [EHBD]. Based on these findings we strongly recommend ultrasonography with definite criteria as the initial investigation tool in the management of neonatal cholestasis, associated with liver biopsy. The use of MR cholangiography in diagnosis of biliary atresia has certain limitations according to its type