Second harmonic imaging improves trans-abdominal ultrasound detection of biliary sludge in 'idiopathic' pancreatitis.
BACKGROUND
Recently, biliary sludge has been strongly correlated with 'idiopathic pancreatitis'. It is often diagnosed by trans-abdominal ultrasonography, despite the low sensitivity of this investigation. New scanners, using second harmonic imaging, may improve the quality of the echographic picture.


OBJECTIVE
To verify the impact of this methodology on the detection of biliary sludge in patients with 'idiopathic' pancreatitis.


METHODS
Fifty patients with 'idiopathic' pancreatitis observed over a 18-month period entered the study. Exclusion criteria were gall-bladder stones, polyps, clinical conditions related to biliary sludge development and haemolytic disorders. Patients were assessed blind by two operators using either conventional ultrasonography or second harmonic imaging. The parameters of diagnostic quality of both examinations were evaluated using, as the gold standard, microscopic examination of the gall-bladder content collected at endoscopy after cholecystokinin infusion.


RESULTS
An improvement in sensitivity, specificity, efficiency and negative predictive value was obtained by second harmonic imaging compared with conventional ultrasonography.


CONCLUSIONS
Second harmonic imaging, in our experience, is a reliable non-invasive tool for the diagnosis and follow-up of biliary sludge in the course of 'idiopathic' pancreatitis.
Ierardi
E
E
Gastroenterology Department, University of Foggia, Italy. e.ierardi@virgilio.it
Muscatiello
N
N
Nacchiero
M
M
Gentile
M
M
Margiotta
M
M
Marangi
S
S
De Francesco
V
V
Francavilla
R
R
Barone
M
M
Faleo
D
D
Panella
C
C
Francavilla
A
A
Cuomo
R
R
D000208:Acute Disease; D001646:Bile; D001659:Biliary Tract / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014465:Ultrasonics; D014463:Ultrasonography