Objectives To establish a semi-quantitative hepatic subcapsular flow (HSF) score using color Doppler ultrasonography (CDUS) and evaluate the performance of both the HSF score and hepatic capsular retraction (HCR) sign for identifying biliary atresia (BA), while simultaneously correlating with liver fibrosis. Materials and methods This study prospectively recruited 170 infants (35 BA and 135 non-BA; 124 males and 46 females) with a median age of 50 days (interquartile range 35–71). Multimodal ultrasound (grayscale ultrasound, CDUS, elastography) was utilized to evaluate the HSF score, HCR sign, and established markers (triangular cord [TC] sign, gallbladder, porta hepatis lymph nodes [PHLNs]). Diagnostic performance of individual and combined indicators was evaluated using the receiver operating characteristic curve (ROC). Additionally, correlations were analyzed between HSF score, HCR sign, and serum and histopathological liver fibrosis indicators. Results The HSF score (cutoff ≥2) demonstrated an area under the ROC curve (AUC) of 0.950, superior to the cutoff ≥1 (p = 0.036) and higher (though not significantly) than established markers (all p > 0.05). The HCR sign had a lower AUC than other markers (all p < 0.05) but had high specificity within the studied cohort. It was also associated with higher liver stiffness measurement and fibrosis stage (p < 0.001, p = 0.001). Conclusion The liver capsule in BA infants undergoes significant morphological changes, which can be assessed using the HSF score and HCR sign. The HSF score provides reliable diagnostic performance for BA. The HCR sign, as a supplementary diagnostic marker, shows high specificity and correlates with the severity of liver fibrosis. These two indicators may support the diagnosis of BA and fibrosis assessment. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> Can novel ultrasonographic signs—HSF score and HCR sign—improve the non-invasive diagnosis of BA and fibrosis assessment in cholestatic infants? <Emphasis Type="BoldItalic">Findings</Emphasis> The HSF score demonstrated excellent diagnostic performance, while the HCR sign offered high specificity and was associated with liver fibrosis. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> The HSF score is reliable for diagnosing BA, and the HCR sign serves as a high-specificity marker correlated with the severity of liver fibrosis, thus aiding in early diagnosis and fibrosis assessment. Graphical Abstract

Prospective evaluation of the semi-quantitative hepatic subcapsular flow score and hepatic capsular retraction sign in the diagnosis of biliary atresia

期刊论文
发表日期：

2026年3月15日

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Wen Ling,
Fengying Ye,
Qiumei Wu,
Mingkun Liu,
Zhen Huang,
Zong-jie Weng

摘要

Objectives

To establish a semi-quantitative hepatic subcapsular flow (HSF) score using color Doppler ultrasonography (CDUS) and evaluate the performance of both the HSF score and hepatic capsular retraction (HCR) sign for identifying biliary atresia (BA), while simultaneously correlating with liver fibrosis.

Materials and methods

This study prospectively recruited 170 infants (35 BA and 135 non-BA; 124 males and 46 females) with a median age of 50 days (interquartile range 35–71). Multimodal ultrasound (grayscale ultrasound, CDUS, elastography) was utilized to evaluate the HSF score, HCR sign, and established markers (triangular cord [TC] sign, gallbladder, porta hepatis lymph nodes [PHLNs]). Diagnostic performance of individual and combined indicators was evaluated using the receiver operating characteristic curve (ROC). Additionally, correlations were analyzed between HSF score, HCR sign, and serum and histopathological liver fibrosis indicators.

Results

The HSF score (cutoff ≥2) demonstrated an area under the ROC curve (AUC) of 0.950, superior to the cutoff ≥1 (p = 0.036) and higher (though not significantly) than established markers (all p > 0.05). The HCR sign had a lower AUC than other markers (all p < 0.05) but had high specificity within the studied cohort. It was also associated with higher liver stiffness measurement and fibrosis stage (p < 0.001, p = 0.001).

Conclusion

The liver capsule in BA infants undergoes significant morphological changes, which can be assessed using the HSF score and HCR sign. The HSF score provides reliable diagnostic performance for BA. The HCR sign, as a supplementary diagnostic marker, shows high specificity and correlates with the severity of liver fibrosis. These two indicators may support the diagnosis of BA and fibrosis assessment.

Key Points

Question Can novel ultrasonographic signs—HSF score and HCR sign—improve the non-invasive diagnosis of BA and fibrosis assessment in cholestatic infants?

Findings The HSF score demonstrated excellent diagnostic performance, while the HCR sign offered high specificity and was associated with liver fibrosis.

Clinical relevance The HSF score is reliable for diagnosing BA, and the HCR sign serves as a high-specificity marker correlated with the severity of liver fibrosis, thus aiding in early diagnosis and fibrosis assessment.

Graphical Abstract