Abstract
To test the diagnostic performance of elevated peak systolic hepatic arterial velocity (HAv) in the diagnosis of acute cholecystitis. 229 patients with an ultrasound (US) performed for right upper quadrant (RUQ) pain were retrospectively reviewed. 35 had cholecystectomy within 10days of ultrasound and were included as test subjects. 47 had normal US and serology and were included as controls. Each test patient US was reviewed for the presence of gallstones, gallbladder distention, sludge, echogenic pericholecystic fat, pericholecystic fluid, gallbladder wall thickening, gallbladder wall hyperemia, and reported sonographic Murphy sign. Demographic, clinical, and hepatic artery parameters at time of original imaging were recorded. Acute cholecystitis at pathology was the primary outcome variable. 21 patients had acute cholecystitis and 14 had chronic cholecystitis by pathology. For patients who went to cholecystectomy, HAv ≥100cm/s to diagnose acute cholecystitis was more accurate (69%) than the original radiology report (63%), the presence of gallstones (51%), and sonographic Murphy sign (50%). Statistically significant predictors of acute cholecystitis included HAv ≥100cm/s (p=0.008), older age (p=0.012), and elevated WBC (p=0.002), while gallstones (p=0.077), hepatic artery resistive index (HARI) (p=0.199), gallbladder distension (p=0.252), sludge (p=0.147), echogenic fat (p=0.184), pericholecystic fluid (p=0.357), wall thickening (p=0.434), hyperemia (p=0.999), and sonographic Murphy sign (p=0.765) were not significantly correlated with acute cholecystitis compared to chronic cholecystitis. HAv ≥100cm/s is a useful objective parameter that may improve the performance of US in the diagnosis of acute cholecystitis.
Published Version
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