title: Sonographic Appearance of the Gallbladder in the Allogeneic Hematopoietic Stem Cell Transplant Population.
abstract: OBJECTIVE
  To determine whether gallbladder sonographic findings in hematopoietic stem cell (HSC) transplant patients can distinguish among hepatobiliary complications of HSC transplants (graft-versus-host disease [GVHD] and veno-occlusive disease) and biliary events (cholecystitis, cholangitis, and choledocholithiasis).
  
  
  METHODS
  All HSC transplant patients who underwent gallbladder sonography from 2009 through 2012 were identified. Complications and sonographic findings were recorded.
  
  
  RESULTS
  Of 124 patients, 66 (53.2%) had an event: 33 (50.0%) had GVHD; 22 (33.3%) had veno-occlusive disease; 6 (9.0%) had a biliary event; 4 (6.0%) had veno-occlusive disease and GVHD; and 1 (1.5%) had veno-occlusive disease and a biliary event. Of all patients, 115 (92.7%) had 1 or more sonographic findings in the gallbladder, with sludge being most common in all groups. In patients with veno-occlusive disease, the second and third most common findings were pericholecystic fluid and wall thickening. In patients with GVHD, distension was the second most common. Patients with biliary events all had distension, and half had pericholecystic fluid. Patients with veno-occlusive disease were significantly more likely to have wall thickening than those with GVHD or no event (77.2% versus 36.3%; P= .005; and 77.2% versus 37.9%; P= .002) and more likely to have pericholecystic fluid than patients with GVHD (95.5% versus 45.5%; P = .0001), a biliary event (95.5% versus 50%; P = .02), or no event (95.5% versus 29.3%; P = .0001). The positive predictive value of any finding was low for all groups because findings were common in patients with no event.
  
  
  CONCLUSIONS
  Sonographic abnormalities of the gallbladder after HSC transplants are common in patients with and without HSC transplant complications and in those with biliary events. No sonographic finding is useful to distinguish among complications in HSC transplant patients.
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston Massachusetts USA.
authors.forename: Asha
authors.initials: A
authors.lastname: Sarma
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston Massachusetts USA.
authors.forename: Carol B
authors.initials: CB
authors.lastname: Benson
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston Massachusetts USA.
authors.forename: Vincent T
authors.initials: VT
authors.lastname: Ho
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston Massachusetts USA mfrates@partners.org.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Frates
mesh_terms: D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging; D005705:Gallbladder Diseases / Q000000981:diagnostic imaging*; D006086:Graft vs Host Disease / Q000000981:diagnostic imaging*; D018380:Hematopoietic Stem Cell Transplantation; D006504:Hepatic Veno-Occlusive Disease / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
keywords: gallbladder; gastrointestinal ultrasound; graft-versus-host disease; stem cell transplant; veno-occlusive disease