The Use of Gadoxetic Acid–Enhanced MRI as a Diagnostic Tool in Cases of Biliary Atresia: A Two-Case Report

Early diagnosis of biliary atresia (BA) remains challenging, although timely recognition is critical for achieving favorable surgical outcomes. We present two infants in whom gadoxetic acid–enhanced MRI demonstrated imaging findings that supported early suspicion of BA. Two neonates with persistent cholestasis underwent routine laboratory evaluation, targeted ultrasonography, and hepatocyte-specific magnetic resonance imaging using gadoxetic acid. This contrast agent is actively taken up by functioning hepatocytes and is normally excreted into the biliary system during the delayed hepatobiliary phase, allowing functional assessment of bile formation and excretion. MRI findings, particularly biliary excretion on delayed images, were evaluated and correlated with intraoperative cholangiography. In both infants, hepatic parenchymal enhancement after contrast administration was preserved, indicating intact hepatocellular uptake. However, no biliary excretion was observed on delayed hepatobiliary-phase images. Intraoperative cholangiography confirmed biliary atresia in both cases. Although the diagnosis of biliary atresia is traditionally based on clinical findings, laboratory parameters, and ultrasonography, these approaches may remain inconclusive in some patients. Our findings suggest that gadoxetic acid–enhanced MRI, by demonstrating preserved hepatocellular uptake with absent biliary excretion, may serve as a useful adjunctive diagnostic tool and contribute to earlier and more confident identification of biliary atresia.

Keywords: Biliary atresia, cholestasis, gadoxetic acid, hepatobiliary MRI, Kasai, neonatal jaundice