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Purpose  To compare preoperative CT findings before liver transplantation between patients with Alagille syndrome (AGS) and those with end-stage biliary atresia (BA).    Materials and Methods  The institutional review board approved this retrospective study. Eleven children with AGS (median age, 19.0 ± 13.0 months; male to female ratio, 3:8) and 109 children with end-stage BA (median age, 17.9 ± 25.8 months; male to female ratio, 37:72) who underwent abdomen CT as candidates for liver transplant were included. CT images were reviewed focusing on hepatic parenchymal changes, vascular changes, presence of focal lesions, and signs of portal hypertension.    Results  Hepatic parenchymal changes were present in 27% (3/11) of AGS patients and 100% (109/109) of end-stage BA patients ( P  < .001). The hepatic artery diameter was significantly smaller (1.9 mm versus 3.6 mm,  P  = 008), whereas portal vein diameter was larger (6.8 mm versus 5.0 mm,  P  < .001) in patients with AGS compared with patients with end-stage BA. No focal lesion was seen in patients with AGS, whereas 44% (48/109) of patients with end-stage BA had intrahepatic biliary cysts (39%, 43/109) and hepatic tumors (8%, 9/109) ( P  = .008). Splenomegaly was commonly seen in both groups ( P  = .082), and ascites (9% [1/11] versus 50% [54/109],  P  = .010) and gastroesophageal varix (0% [0/11] versus 80% [87/109],  P  < .001) were less common in patients with AGS than in patients with end-stage BA.    Conclusion  Fibrotic or cirrhotic changes of the liver, presence of focal lesions, and relevant portal hypertension were less common in patients with AGS than in patients with end-stage BA.

Alagille Syndrome Candidates for Liver Transplantation: Differentiation from End-Stage Biliary Atresia Using Preoperative CT