2301: Comet-tail artifacts and color Doppler twinkling artifacts from gallbladder wall: Clinical observations, specimen ultrasonography and pathologic correlation

Abstract

Objectives: To determine the relationship between comet-tail artifact and color Doppler twinkling artifact occurring from gallbladder wall. Methods: A prospective study was performed with 72 patients who had comet-tail artifacts arising from the gallbladder wall and 34 patients who didn’t have the artifacts on ultrasonography. Grayscale and color Doppler images were obtained. Investigators determined whether twinkling artifacts occur on comet-tail artifacts or not and whether twinkling artifacts occur from the place where comet-tail artifacts were not seen. Twenty-one patients underwent cholecystectomy. Sonographic and histopathologic evaluations were performed on the extracted gallbladders. Results: Total 242 comet-tail artifacts in 72 patients were evaluated. Color Doppler twinkling artifacts were seen on all comet-tail artifacts, either transiently or persistently. Seventeen twinkling artifacts were seen from intramural echogenic foci where comet-tail artifacts were not seen. On specimen sonography, all specimens showing twinkling artifacts (n = 8) had cholesterol crystal deposition in either adenomyoma (n = 3) or adenomyomatous hyperplasia (n = 5), whereas specimens that did not show twinkling artifacts (n = 13) did not have cholesterol crystal depositions in their wall, regardless of the presence of Rokitansky-Aschoff sinus. Conclusions: Color Doppler twinkling artifacts are closely related to comet-tail artifacts, and it may be a sensitive diagnostic feature indicating cholesterol crystal deposition within adenomyoma or adenomyomatous hyperplasia.