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Added value of point shear-wave elastography in the diagnosis of acute cholecystitis

  • Ultrasound
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate the added value of point shear-wave elastography (pSWE) in the diagnostic performance of conventional US for diagnosis of acute cholecystitis.

Methods

B-mode and colour Doppler US and pSWE were performed prospectively in 216 patients with clinically suspected acute cholecystitis. The morphology and mural vascularity of the gallbladder and median shear wave velocity (SWV) of the right liver were evaluated. Two observers independently reviewed conventional US images and subsequently reviewed combined conventional US and pSWE images.

Results

Mean SWVs of the acute cholecystitis group (n = 91) were significantly higher than those of the control group (n = 85) in the right liver within 2 cm lateral to the gallbladder (1.56 versus 1.03 m/s, 1.39 versus 1.04 m/s, P < 0.0001) with a cut-off value of 1.29 or 1.16 m/s. The area under the receiver operating characteristic curve of both observers in the diagnosis of acute cholecystitis improved significantly from 0.790 and 0.777 to 0.963 and 0.962, respectively, after additional review of pSWE images (P < 0.0001). Diagnostic accuracy, sensitivity, specificity, positive and negative predictive values of combined image sets were higher than those of conventional US images alone.

Conclusion

Adding pSWE to conventional US improves the diagnosis of acute cholecystitis when compared with conventional US alone.

Key Points

• In acute cholecystitis, stiffness of the right liver increases adjacent to the gallbladder.

• The cut-off value for diagnosing acute cholecystitis was 1.29 or 1.16 m/s.

• Adding pSWE to conventional US improves the diagnosis of acute cholecystitis.

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Abbreviations

US:

Ultrasound

GB:

Gallbladder

pSWE:

Point shear-wave elastography

SWV:

Shear wave velocity

LS:

Liver stiffness

ROC:

Receiver operating characteristic

PPV:

Positive predictive value

NPV:

Negative predictive value

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Acknowledgments

The scientific guarantor of this publication is Dae Seob Choi. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic study, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Radiology, Gyeongsang National University School of medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea

    Ji Eun Kim, Dae Seob Choi, Kyungsoo Bae & Jae Min Cho

  2. Department of Surgery, Gyeongsang National University School of medicine, Jinju, Republic of Korea

    Chi Young Jeong

  3. Department of Internal medicine, Gyeongsang National University School of medicine, Jinju, Republic of Korea

    Hyun Ok Kim

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  1. Ji Eun Kim
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Correspondence to Dae Seob Choi.

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Table 1

Definition of four-point scale used in the first and second reading session (DOC 31 kb)

Appendix

Appendix

In the acute cholecystitis group, 80 patients were referred from the emergency room and 11 were referred from the clinic. In the control group, 50 and 35 patients were referred from the emergency room and clinic, respectively. The median duration between the onset of signs and US was 2 days (range, 1-14 days) and 3 days (range, 1-90 days) in the acute cholecystitis group and control group, respectively. The final clinical outcomes of acute cholecystitis patients (n = 91) were determined by laparoscopic cholecystectomy and histopathology analysis (n = 74) or by percutaneous drainage of pus from the GB (n = 17) according to the surgeon’s decision regarding the underlying conditions or diseases of patients. The median interval between the US and surgery was 1 day (range, 0-3 days). Twenty-four patients had surgery on the same day that the US was performed, 21 patients after 1 day, 20 patients after 2 days, and in 9 cases cholecystectomy was performed 3 days after US. The diagnoses of 91 patients with acute cholecystitis were as follows: acute calculous cholecystitis (n = 68), acute acalculous cholecystitis (n = 23), acute gangrenous cholecystitis (n = 13), and combined xanthogranulomatous cholecystitis (n = 1). Among the control patients (n = 85), 45 patients who underwent laparoscopic cholecystectomy on the same day that the US was performed were diagnosed with chronic cholecystitis. The other control patients were diagnosed by laboratory and CT findings at the admission and clinical follow-up for at least 6 months after admission. The diagnoses of these 40 patients were as follows: acute pancreatitis (n = 24), acute pyelonephritis (n = 5), acute diverticulitis (n = 3), pregnancy (n = 2), hepatobiliary malignancy (n = 4), and undefined diagnosis (n = 2).

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Kim, J.E., Choi, D.S., Bae, K. et al. Added value of point shear-wave elastography in the diagnosis of acute cholecystitis. Eur Radiol 27, 1517–1526 (2017). https://doi.org/10.1007/s00330-016-4509-x

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  • DOI: https://doi.org/10.1007/s00330-016-4509-x

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