Power Doppler ultrasound of gallbladder wall vascularization in inflammation: clinical implications

Abstract

We investigated the role of Power Doppler US in the diagnosis and follow-up of cholecystitis. We reviewed the examinations of 21 surgical patients aged 27-48 years with US findings of cholecystitis. We performed B-mode and then Power Doppler US. Wall thickness and US structure, the presence/absence of stones, and US Murphy's sign were assessed at B-mode US, whereas only the presence/absence of wall vascularization was studied with Power Doppler. B-mode and Power Doppler changes post treatment were also investigated. Ultrasound showed wall thickening in all patients. In addition, positive Murphy's sign and/or gallbladder stones were seen in 6 patients each at B-mode US and wall vascularization in 7 patients with Power Doppler. Acute cholecystitis was diagnosed in these patients. The other 14 patients presenting wall thickening but no vascularization and negative US Murphy's sign were diagnosed as having chronic cholecystitis; 10 of them had gallbladder stones. Two of seven acute cholecystitis patients were operated on in the acute stage for the onset of complications and histologic findings confirmed the US diagnosis. As for the remaining patients, histology diagnosed chronic cholecystitis in 17, whereas wall thickening was not inflammatory in 2 cases. All the cases with early wall vascularization were eventually diagnosed as cholecystitis. Power Doppler US permits confirmation of the diagnosis of acute cholecystitis and distinguishing of chronic disease, which helps in planning of surgery.

Does ultrasongraphy predict intraoperative findings at cholecystectomy? An institutional review

“…The most predictive individual US signs for AC are a positive sonographic Murphy sign, thickened gallblad der wall and cholelithiasis, which is consistent with the literature. 18,19 Independently, a positive sonographic Murphy sign is highly predictive of AC. These signs should be considered as major criteria for sonographic diagnosis of AC.…”

“…Major US criteria used in our institution to diagnose AC are the combination of cho lelithiasis (especially an immobile calculus), wall thick ening (> 3 mm) and a positive sonographic Murphy sign. 18,19 Minor indicators include pericholecystic fluid and gallbladder distension. These criteria are locally agreed upon among the US radiologist staff as there are no universally accepted US diagnostic criteria.…”

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

“…[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.…”

“…[18] On the other hand, with the use of power Doppler sonography, a significant diagnostic superiority was put forward in previous reports. [5,17] However, the quantitive measurement of GB wall vascularity and its association with pathologically proven acute cholecystitis has been reported by only one study. [5] To the best of our knowledge, this is the first prospective comparative study aiming to evaluate the association between preoperative sonographic (gray-scale and power Doppler) findings and intraoperative adhesion grade, quantitively.…”

Akutno vnetje žolčnika – zgodnja operacija ali poskus konzervativnega zdravljenja?

“…Pri akutnem holecistitisu UZ običajno pokaže tekočino ob žolčniku, povečan in napet žolčnik z zadebeljeno, razslojeno in heperemično steno ter morda kamne v žolčniku. Rentgensko slikanje trebuha lahko pokaže radiopačne žolčne kamne pri 10 % bolnikov z akutnim holecistitisom in zrak v steni žolčnika pri emfizemskem holecistitisu (17).…”