title: Contrast-enhanced ultrasonography with Sonazoid for diagnosis of gangrenous cholecystitis.
abstract: OBJECTIVE
  This prospective study investigated the ability of contrast-enhanced ultrasonography (CEUS) with Sonazoid to diagnose gangrenous cholecystitis and determined the inter-observer agreement.
  
  
  METHODS
  From September 2012 to August 2014, 27 patients with acute cholecystitis underwent preoperative CEUS (registration number 1277). After Sonazoid injection, harmonic imaging of the gallbladder wall was performed, and the findings were recorded using movie clips. The signal intensity was classified as absence (uncomplicated) or presence of perfusion defects (gangrenous). The physician performing CEUS recorded the findings immediately after the examination. Another physician (blinded to the clinical information) then reviewed the movie clips and recorded the findings. The final diagnosis was determined by histological examination in all 27 patients.
  
  
  RESULTS
  The final diagnosis was gangrenous cholecystitis in 15 patients and uncomplicated cholecystitis in 12. On CEUS examination, perfusion defects were detected in 10 patients with gangrenous cholecystitis, giving a sensitivity of 66.7 %, specificity of 100 %, positive predictive value of 100 %, and negative predictive value of 70.6 %. On review of the movie clips, these values were 73.3, 100, 100, and 75.0 %, respectively. The inter-observer agreement between physicians was good (κ coefficient, 0.64).
  
  
  CONCLUSIONS
  CEUS with Sonazoid is a useful and reproducible modality for diagnosing gangrenous cholecystitis.
authors.affiliation: Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan. hiroicu0603@yahoo.co.jp.
authors.forename: Ryousuke
authors.initials: R
authors.lastname: Kawai
authors.affiliation: Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Hata
authors.affiliation: Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Manabe
authors.affiliation: Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
authors.affiliation: Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Iida
authors.affiliation: Department of Gastroenterology, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
authors.forename: Rui
authors.initials: R
authors.lastname: Nakatou
authors.affiliation: Department of Hepatology and Pancreatology, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
authors.forename: Nobuko
authors.initials: N
authors.lastname: Koyama
authors.affiliation: Department of Digestive Surgery, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Hirai
authors.affiliation: Department of Pathology, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Sadahira
mesh_terms: D000368:Aged; D041881:Cholecystitis, Acute / Q000000981:diagnostic imaging* / Q000601:surgery; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D005290:Ferric Compounds; D005704:Gallbladder / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005734:Gangrene / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007501:Iron; D008297:Male; D015588:Observer Variation; D010087:Oxides; D011300:Preoperative Care; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*; D014741:Video Recording / Q000379:methods
chemical_list: D003287:Contrast Media; D005290:Ferric Compounds; D010087:Oxides; C069727:Sonazoid; D007501:Iron
keywords: Contrast-enhanced ultrasonography; Gangrenous cholecystitis; Preoperative diagnosis