{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T04:45:01Z","timestamp":1788669901709,"version":"build-2803163510"},"reference-count":13,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T00:00:00Z","timestamp":1748822400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Ultrasound exams are commonly used to evaluate infants for biliary atresia. However, ultrasound findings may be inconclusive, and more invasive diagnostic testing is often required. We hypothesized that another ultrasound finding\u2014absence of the extrahepatic bile duct at the liver hilum (the \u201cduct at the hilum\u201d)\u2014could be useful.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Ultrasound exams were reviewed from infants undergoing evaluation for biliary atresia at Texas Children's Hospital during two periods. First, exams performed before 2021 were reviewed to develop a systematic approach to visualize the duct at the hilum. Second, exams performed during a subsequent 26\u2010month period were reviewed to assess the approach's diagnostic performance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A four\u2010step approach to visualize the duct at the hilum was developed, based on location, position, length, and absence of blood flow specifications. The approach was then performed on 64 infants with a median age of 25 days (range: 0\u2013170 days) and a median weight of 3.2\u2009kg (range: 1.0\u20136.3 kg). The approach identified all 12 patients with biliary atresia and excluded 49 out of 52 infants without biliary atresia, for a sensitivity of 1.00 (95% confidence interval [CI]: 0.70\u20131.00) and specificity of 0.94 (95% CI: 0.83\u20130.99). The approach could be performed in feeding infants and often in &lt;5\u2009min.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We present a systematic approach to visualize the duct at the hilum, which does not require fasting and may efficiently exclude infants who do not have biliary atresia. Future, multisite studies are needed to determine how the approach performs in larger populations and in different healthcare settings.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jpn3.70081","type":"journal-article","created":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T03:26:03Z","timestamp":1748834763000},"page":"204-211","source":"Crossref","is-referenced-by-count":8,"title":["An ultrasound approach to visualize the \u201cduct at the hilum\u201d in infants undergoing evaluation for biliary atresia"],"prefix":"10.1002","volume":"81","author":[{"given":"Ashley M.","family":"Upton","sequence":"first","affiliation":[{"name":"Department of Radiology Baylor College of Medicine and Texas Children's Hospital Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose A.","family":"Hernandez","sequence":"additional","affiliation":[{"name":"Department of Radiology Baylor College of Medicine and Texas Children's Hospital Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7208-0949","authenticated-orcid":false,"given":"Benjamin L.","family":"Shneider","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition Baylor College of Medicine and Texas Children's Hospital Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6307-4774","authenticated-orcid":false,"given":"Tebyan A.","family":"Rabbani","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Gastroenterology Hepatology, and Nutrition Stanford University Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sridevi","family":"Devaraj","sequence":"additional","affiliation":[{"name":"Department of Pathology Baylor College of Medicine and Texas Children's Hospital Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2654-5386","authenticated-orcid":false,"given":"Kalyani R.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Pathology Baylor College of Medicine and Texas Children's Hospital Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjeev A.","family":"Vasudevan","sequence":"additional","affiliation":[{"name":"Department of Surgery Baylor College of Medicine and Texas Children's Hospital Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam M.","family":"Vogel","sequence":"additional","affiliation":[{"name":"Department of Surgery Baylor College of Medicine and Texas Children's Hospital Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9964-2294","authenticated-orcid":false,"given":"Sanjiv","family":"Harpavat","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition Baylor College of Medicine and Texas Children's Hospital Houston Texas 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\u201cmaximum echogenicity\u201d at the right portal vein: biliary atresia versus Alagille syndrome","volume":"81","author":"Upton AM","year":"2025","journal-title":"J Pediatr Gastroenterol Nutr"}],"container-title":["Journal of Pediatric Gastroenterology and 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