title: Use of color Doppler ultrasonography in the diagnosis of anomalous connection in pancreatobiliary disease.
abstract: OBJECTIVE
  To estimate the detectability of anomalous connection in pancreatobiliary disease (ACPBD) cases, measuring gallbladder wall blood flow (GWBF).
  
  
  METHODS
  In the retrospective study, we enrolled 42 subjects with gallbladder wall thickening. GWBF velocity was determined as an average value of the peak velocity of color signals on the gallbladder wall, three times in each case. Based on the findings on endoscopic ultrasonography (EUS) or endoscopic retrograde cholangiopancreatography (ERCP), the 42 subjects were divided into 11 cases with ACPBD and 31 cases without ACPBD. In the prospective study, the subjects were 92 cases with gallbladder wall thickening. Using the cut-off level of the flow velocity obtained in the retrospective study, the usefulness of measuring GWBF velocity in diagnosing ACPBD was evaluated.
  
  
  RESULTS
  In the retrospective study, imaging of GWBF was obtained in 40 of the 42 subjects. The mean GWBF velocity of the ACPBD cases was 29.4+/-3.9 cm/s (mean+/-SD), which was significantly different (P<0.0001; 95% CI 5.48-13.2) from that of the without ACPBD cases (20.1+/-5.9 cm/s). Based on this result, we prepared a receiver operating characteristic curve, and the cut-off level appropriate for diagnosing ACPBD was estimated to be 25 cm/s. In the prospective study, GWBF was detected in 86 of the 92 subjects. Based on the EUS or ERCP findings, the 92 subjects were divided into 15 cases with ACPBD and 77 cases without ACPBD. When a cut-off level of 25 cm/s was employed, ACPBD could be diagnosed with a sensitivity of 87.0% (13/15) and a specificity of 87.3% (62/71).
  
  
  CONCLUSIONS
  Measurement of GWBF velocity, which is less invasive and provides objective values, is very useful for diagnosing ACPBD prior to the development of malignant tumors in cases with gallbladder wall thickening.
authors.affiliation: Department of Endoscopy, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8550, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kawashima
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Hirooka
authors.forename: Akihiro
authors.initials: A
authors.lastname: Itoh
authors.forename: Senju
authors.initials: S
authors.lastname: Hashimoto
authors.forename: Terutomo
authors.initials: T
authors.lastname: Itoh
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hara
authors.forename: Akira
authors.initials: A
authors.lastname: Kanamori
authors.forename: Naoki
authors.initials: N
authors.lastname: Ohmiya
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Niwa
authors.forename: Hidemi
authors.initials: H
authors.lastname: Goto
mesh_terms: D005260:Female; D005704:Gallbladder / Q000098:blood supply* / Q000473:pathology; D005706:Gallbladder Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color
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