Power Versus Conventional Color Doppler Sonographic Diagnosis Of Acute Cholecystitis: Comparison In The Depiction Of Mural Flow
Background: Gray-scale sonography is generally considered as a first-line diagnostic tool for patient with suspected acute cholecystitis. It is suggested by gallstones, Murphy's sign, thickening of the gallbladder wall and bile sludging, but the specificity of these sonographic findings are not as high as their sensitivity. Blood flow of the gallbladder wall is increased in acute inflammation. Objective: To evaluate the sensitivity and specificity of power Doppler sonography and compared with conventional color Doppler and gray-scale sonography in diagnosing patients with acute cholecystitis.
Type of the study: This was a cross sectional study.
Patients and methods: The study was conducted through the period from August 2014 to August 2015 on 80 patients with acute right upper quadrant abdominal pain and clinically suspected acute cholecystitis. Firstly, gray-scale sonography of the abdomen was performed. Next, color Doppler and power Doppler sonography of the gallblader wall was done to detect mural flow. Quantifying intramural vascularity was performed using Uggowitzer scoring system. Grading of vascularity ++ and +++ were suggestive of acute cholecystitis. Results of gray-scale and Doppler sonography were compared with post cholecystectomy histopathological results.
Results: The overall sensitivity of gray-scale sonography was 83% while the specificity ranges from 43% for the presence of calculi to 100% for the presence of pericholecystic fluid. Sensitivity of color Doppler sonography for acute cholecystitis was 21%, with a specificity of 86%. Sensitivity of power Doppler sonography for acute cholecystitis was 94%, with a lower specificity 72%.
Conclusion: Power Doppler sonography adds a significant amount of specificity to gray-scale sonography and sensitivity to conventional color Doppler sonography and may further improve confidence in diagnosing acute cholecystitis.
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