Utility and accuracy of ultrasonically measured gallbladder wall as a diagnostic criteria in biliary tract disease.

Biliary tract sonography has achieved wide acceptance as a screening test for chronic calculous disease. However, the clinical usefulness of biliary sonography is limited by the inability of this test to identify patients with acalculous cholecystitis or to separate patients with calculous cholecystitis from those with asymptomatic calculi. A prospective blinded study of 106 patients undergoing cholecystectomy was performed to determine if, cholecystosonography could visualize the gallbladder wall accurately and to evaluate gallbladder wall thickening as a predictor of disease. Of these patients, 88 had a sonographically visible gallbladder wall and in 95% of the patients the ultrasonic and direct surgical measurements of the gallbladder wall agreed within 1 mm. To determine the sonographic size range of gallbladder wall thickness in the normal population, the width of the gallbladder wall in the fasting state was measured in 100 patients without biliary tract disease. One percent of the normal population had thickened gallbladder walls, in contrast to 96% of the patients with acute calculous or acalculous cholecystitis. Gallbladder wall thickness appears to be an accurate noninvasive technique for diagnosing patients with acute calculous and acalculous cholecystitis in the absence of other entities which thicken the gallbladder wall such as ascites and hypoproteinemic states.