Color velocity imaging and power Doppler sonography of the gallbladder wall: a new look at sonographic diagnosis of acute cholecystitis.

Abstract

tamedin gray-scaleB-mode image scanlinesto determineblood flow velocity.We prospec tively determinedif color velocity imaging and power Doppler sonographycan be usedto differentiateacutefrom chroniccholecystitis. We analyzedthe potentialrole of usingthese two color imaging techniques as an adjunct to conventional gray-scale sonography to differen tiate acutefrom chroniccholecystitis. SUBJECTSAND METHODS. Onehundred twenty-nine patients withacuterightupperquadrant pain or clinically suspected cholecystitis underwent color velocity imaging and power Doppler sonography of the gallbladder as an adjunct to gray-scale sonography. Mor phologiccriteriawere analyzedon gray-scalesonography, andthepresenceof flow within the gallbladder wall was assessedwith color velocity imaging and power Doppler sonography. Imaging findingswere comparedwith pathologicfindingsin the 50 patientswho underwent cholecystectomy and with clinical and biologic findingsin the 79 patientswho did not un dergo cholecystectomy. RESULTS.Twenty-two patients hadsurgically provenacutecholecystitis, 28 patients hadsurgicallyprovenchroniccholecystitis, and79 patientshadnogallbladderdisease. Sensitivity, specificity,accuracy,positivepredictivevalue, and negativepredictivevalue of gray-scale sonography for revealing acute cholecystitis were 86%, 99%, 92%, 87%, and 97%, respec tively.Sensitivity, specificity, accuracy, positivepredictivevalue,andnegativepredictivevalue of color velocity imaging and power Doppler sonographyfor revealingacutecholecystitis were 95%, 100%, 99%, 100%, and 99%, respectively.

Evaluation of power Doppler sonography in acute cholecystitis to predict intraoperative findings: Prospective clinical study

“…[11] Furthermore, distortion of the anatomy by severe inflammation and related fibrous adhesions increase the risk of bleeding and bile duct injury. [4] These findings may lead the surgeon to convert LC to an open cholecystectomy. In our patients, intraoperative bleeding or bile duct injury were not encountered.…”

“…[2,3,16] Increased wall thickness (≥3 mm), being the only quantitive measurement of gray-scale sonography, has demonstrated a 44% positive predictive value for the diagnosis of acute cholecystitis. [4] In order to exclude other causes of wall thickness and measure the direct effect of underlying pathophysiology of acute cholecystitis, GB wall vascularity has been extensively evaluated in the literature with the use of color and power Doppler sonography. [4,5,17,18] Paulson et al have stated that color Doppler sonography for the diagnosis of acute cholecystitis Is nonspecific as thickening of the wall.…”

“…[4] In order to exclude other causes of wall thickness and measure the direct effect of underlying pathophysiology of acute cholecystitis, GB wall vascularity has been extensively evaluated in the literature with the use of color and power Doppler sonography. [4,5,17,18] Paulson et al have stated that color Doppler sonography for the diagnosis of acute cholecystitis Is nonspecific as thickening of the wall. [18] On the other hand, with the use of power Doppler sonography, a significant diagnostic superiority was put forward in previous reports.…”

“…[3] In acute cholecystitis, GB wall thickness is caused by increased vascularity of the GB wall but in chronic cholecystitis it is caused by fibrosis. [4] On the other hand, a number of conditions can cause GB wall thickness, such as pancreatitis, hepatitis, cirrhosis, and congestive heart failure. In order to increase the specificity of the diagnosis, determining the vascularity of the GB wall with Doppler sonography showed valuable diagnostic benefits in previous reports and diagnostic superiority was obtained especially with power Doppler sonography.…”

“…In order to increase the specificity of the diagnosis, determining the vascularity of the GB wall with Doppler sonography showed valuable diagnostic benefits in previous reports and diagnostic superiority was obtained especially with power Doppler sonography. [4,5] Despite higher diagnostic capability of power Doppler sonography for the discrimination of acute cholecystitis from the chronic form, the real challenge is to determine the association between sonographic findings and predicting the difficulty of dissection and to help physician to make a clear decision for performing or not performing an emergent operation. So as to evaluate the diagnostic and prognostic value of gray-scale and power Doppler sonography for acute cholecystitis, it was our aim to show a correlation between…”