Ko Ara, Lee Eun Sun, Park Hyun Jeong, Park Sung Bin, Kim Hee Sung, Choi Byung Ihn
Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
Department of Pathology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
Ultrasonography. 2020 Oct;39(4):384-393. doi: 10.14366/usg.19060. Epub 2020 Mar 23.
The purpose of this study was to evaluate whether shear wave elastography (SWE) and the shear wave dispersion slope (SWD) obtained from 2-dimensional shear wave imaging (2D-SWI) of the gallbladder (GB) bed of the liver could be helpful in the diagnosis of acute cholecystitis.
We included 44 patients referred for abdominal ultrasonography (US) under the impression of acute cholecystitis from April 2018 to March 2019. Patients with chronic liver disease were excluded from this study. In addition to routine upper abdominal US, we performed 2D-SWI including liver stiffness measurements by SWE and SWD, which reflects tissue viscosity. 2D-SWI was performed at the GB bed of the liver through the right intercostal approach at least 3 times with different frames. We assessed typical US findings and the added value of 2D-SWI in diagnosing acute cholecystitis. Histopathologic results of surgical specimens were used as the standard of reference. If a surgical specimen was unavailable, a bile fluid test or clinical follow-up for more than 3 months served as the reference standard.
The optimal cutoff values for SWE and SWD were 8 kPa and 10.9 (m/sec)/kHz, respectively. In the univariate analysis, SWE, GB distension, and sludge were predictive factors of acute cholecystitis. In the multivariate analysis, categorized SWE was the only significant predictor (P<0.01). By using 2D-SWI, the diagnostic performance of two readers did not significantly increase, although the inter-reader agreement improved (k=0.654-0.778).
2D-SWI of the GB bed of the liver could be helpful for diagnosing acute cholecystitis.
本研究旨在评估从肝脏胆囊床二维剪切波成像（2D-SWI）获得的剪切波弹性成像（SWE）和剪切波频散斜率（SWD）是否有助于急性胆囊炎的诊断。
我们纳入了2018年4月至2019年3月期间因疑似急性胆囊炎而接受腹部超声检查（US）的44例患者。本研究排除了患有慢性肝病的患者。除了常规上腹部超声检查外，我们还进行了2D-SWI，包括通过SWE和SWD测量肝脏硬度，SWD反映组织粘度。通过右肋间途径在肝脏胆囊床至少进行3次不同帧的2D-SWI检查。我们评估了典型的超声检查结果以及2D-SWI在诊断急性胆囊炎中的附加价值。手术标本的组织病理学结果用作参考标准。如果没有手术标本，则胆汁液检查或超过3个月的临床随访用作参考标准。
SWE和SWD的最佳截断值分别为8 kPa和10.9（m/sec）/kHz。在单变量分析中，SWE、胆囊扩张和胆汁淤积是急性胆囊炎的预测因素。在多变量分析中，分类后的SWE是唯一显著的预测因素（P<0.01）。通过使用2D-SWI，尽管阅片者间的一致性有所提高（k=0.654-0.778），但两位阅片者的诊断性能并未显著提高。
肝脏胆囊床的2D-SWI有助于诊断急性胆囊炎。
