Diagnosis of acute cholecystitis in patients with liver cirrhosis: waveform analysis of the cystic artery by color Doppler imaging.
OBJECTIVE
The aim of this study was to investigate the possibility of diagnosing acute cholecystitis in patients with liver cirrhosis using color Doppler imaging to demonstrate the hemodynamics.


METHODS
Color Doppler imaging was used to analyze the waveform of the cystic artery in 28 cirrhotic subjects with thickened gallbladder walls and 56 normal controls. The cirrhotic group was further divided into the cholecystitis group, containing 6 cirrhotic patients with acute cholecystitis, and the liver cirrhosis group, containing 22 cirrhotic patients without acute cholecystitis.


RESULTS
Maximum velocity (Vmax) was significantly higher in the cholecystitis group (31.6 ± 23.0 cm/s) than in the normal controls (16.1 ± 5.9 cm/s) (P < 0.01). The resistance index (RI) was higher in the liver cirrhosis group (0.84 ± 0.04) than in either the normal controls (0.70 ± 0.06) (P < 0.01) or the cholecystitis group (0.72 ± 0.09) (P < 0.01). Sensitivity and specificity were 100% when the diagnostic criteria of acute cholecystitis were a maximum velocity of more than 40 cm/s, a resistance index of more than 0.75, or both.


CONCLUSIONS
A pulsatile signal with a maximum velocity of more than 40 cm/s, a resistance index lower than 0.75, or both indicated the presence of acute cholecystitis in patients with liver cirrhosis and a thickened gallbladder wall.
Department of Clinical Pathology, Kobe City General Hospital, 4-6 Minatojima Nakamachi, Chuo-ku, Kobe, 650-0046, Japan. fa_tochio@ybb.ne.jp.
Hitoshi
H
Tochio
Division of Gastroenterology, Kobe City General Hospital, Kobe, Japan.
Shin-Ichi
S
Nishiuma
Division of Gastroenterology, Kobe City General Hospital, Kobe, Japan.
Yoshihiro
Y
Okabe
Division of Gastroenterology, Kobe City General Hospital, Kobe, Japan.
Akio
A
Orino
Department of Internal Medicine, Kinki University School of Medicine, Osaka, Japan.
Masatoshi
M
Kudo
Acute cholecystitis; Color Doppler imaging; Liver cirrhosis; Resistance index; Vmax