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

Abstract

BACKGROUND:This study aimed to evaluate the diagnostic value of gray-scale and power Doppler sonography for acute cholecystitis and show a correlation between sonographic and intraoperative findings, quantitively. METHODS:Forty chronic and forty acute cholecystitis patients were examined. Early laparoscopic cholecystectomy was performed for acute cholecystitis. Demographic characteristics, sonographic findings, and adhesion scores were analyzed. Data were collected prospectively (clinicaltrials.gov: NCT02156947). RESULTS:Wall thickness (≥3 mm) and vascularity increased in acute cholecystitis (p<0.01 and <0.01). Vascularity was found to be moderately correlated with adhesion (p<0.01, r=0.59) but it did not affect the difficulty of the operation by means of perforation, conversion rate, and operation time. In addition, wall thickness did not correlate with adhesion formation (p=0.36). Sensitivity and specifity of wall thickness and vascularity were found to be 96.9%, 72.7%, and 68%, 87.2%, respectively. When both diagnostic measurements were taken into account, sensitivity was calculated 69.7% and specificity reached up to 97.6%. CONCLUSION:Vascularity correlated with adhesion but failed to predict operation difficulty. Specificity of gray-scale sonography could be improved with power Doppler examination; however, desired diagnostic accuracy could not be obtained with only quantitive measurements of sonography.

Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos)

“…A study of the use of color Doppler sonography in acute cholecystitis found that although it was useful for the diagnosis of gallbladder adhesions, it was not predictive of the degree of surgical difficulty . In our search of the literature relevant to the color Doppler sonography, we were unable to identify any articles concerning the diagnosis of acute cholecystitis.…”

Is There a Role for Color Doppler Ultrasonography in Acute Cholecystitis?

“…Yamashita et al suggested that gallbladder wall flow positively correlates with the degree of inflammation in the acute setting, proposing this method for monitoring treatment success (17). Cetinkunar et al evaluated gallbladder wall vascularity using Power Doppler, and came to the conclusion that increased vascularity correlates with the presence of adhesions, but not with operation difficulty (5). More recently Loehfelm et al proposed that a peak systolic hepatic artery velocity of more than 100 cm/sec represents a significant aid in diagnosing acute cholecystitis (7).…”

“…Patients with equivocal findings were excluded from the analysis, in an attempt to counterbalance the non-availability of pathological confirmation of acute cholecystitis. Exclusion criteria also included the following comorbidities: choledocholithiasis (due to the fact that concurrent cholangitis may affect hepatic artery velocity, thus acting as a confounding factor); pancreatitis, congestive heart failure, liver cirrhosis, renal failure, hypoalbuminemia, and hepatitis (due to the fact that these conditions are known to cause gallbladder wall thickening thus being potential confounders) (5,6,9); arteriosclerosis, decreased intravascular volume due to severe dehydration, and hyperdynamic circulatory state due to high fever (because PI measurement is greatly affected by the condition of the arteries, the circulating blood volume and a hyperdynamic circulation state).…”

“…In the former condition wall thickening represents an inflammatory edema of the wall on the grounds of hyperemia, while in the latter it is caused by the formation of fibrous scar tissue in the chronic setting. Furthermore, several chronic conditions, such as heart failure and cirrhosis, have been correlated with gallbladder wall thickening (5,6). Last but not least, detection of a sonographic Murphy's sign, which is a key diagnostic finding, may be biased by analgesics administered to the patient (7).…”