Uggowitzer M, Kugler C, Schramayer G, Kammerhuber F, Gröll R, Hausegger K A, Ratschek M, Quehenberger F
Department of Radiology, University of Graz, Austria.
AJR Am J Roentgenol. 1997 Mar;168(3):707-12. doi: 10.2214/ajr.168.3.9057520.
We evaluated the sensitivity and specificity of power Doppler sonography compared with conventional color Doppler sonography and gray-scale sonography in diagnosing patients with acute cholecystitis.
Seventy-six patients with right upper quadrant pain and 72 healthy volunteers underwent gray-scale sonography, conventional color Doppler sonography, and power Doppler sonography of the gallbladder. The vascularity of the gallbladder wall was scored on a scale of 0 to +3. Histology revealed acute cholecystitis in 55 patients. Histologic specimens and clinical workups showed that the remaining 21 patients suffered from other diseases.
Sensitive sonographic features such as the positive Murphy's sign (in 96% of patients with acute cholecystitis), calculi (95%), and a thickened gallbladder wall (73%) lacked specificity (71%, 38%, 67%, respectively) for diagnosing acute cholecystitis. In our study, the sensitivity of power Doppler sonography was 95% compared with 33% for color Doppler sonography in revealing a hypervascularized gallbladder wall. Power Doppler sonography revealed hyperemia within a nonthickened gallbladder wall in four patients with surgically proven acute cholecystitis. Specificity of power Doppler sonography was 86% compared with 95% for conventional color Doppler sonography. False-positive results with power Doppler sonography were caused by pancreatitis, duodenal ulcer, and gallbladder carcinoma. Interobserver variability seemed to play no significant role. No intramural hypervascularity was detected in the volunteer group. In four (4%) of 89 symptomatic patients we could not use power Doppler sonography because of the patients noncompliance. Mean values of the resistive index assessed within intramural vessels of the gallbladder showed no significant differences (p < .001) between patients with acute cholecystitis (0.73) and patients with other diseases (0.71).
Although the sensitivity of power Doppler sonography in diagnosing acute cholecystitis was similar to that of gray-scale sonography, the specificity of power Doppler sonography was significantly higher, which may substantially improve diagnostic confidence. However, the high susceptibility of power Doppler sonography to motion artifacts makes appropriate adjustment of technical parameters much more relevant than with other sonographic imaging. The resistive index within intramural vessels has no clinical use in the diagnosis of acute cholecystitis.
我们评估了能量多普勒超声与传统彩色多普勒超声及灰阶超声相比，在诊断急性胆囊炎患者时的敏感性和特异性。
76例右上腹疼痛患者和72名健康志愿者接受了胆囊的灰阶超声、传统彩色多普勒超声及能量多普勒超声检查。胆囊壁血管分布按0至 +3级评分。组织学检查显示55例患者患有急性胆囊炎。组织学标本和临床检查表明，其余21例患者患有其他疾病。
敏感的超声特征，如墨菲氏征阳性（96%的急性胆囊炎患者）、结石（95%）和胆囊壁增厚（73%），对诊断急性胆囊炎缺乏特异性（分别为71%、38%、67%）。在我们的研究中，能量多普勒超声在显示胆囊壁血管增多方面的敏感性为95%，而彩色多普勒超声为33%。能量多普勒超声在4例经手术证实为急性胆囊炎的患者中显示非增厚胆囊壁内有充血。能量多普勒超声的特异性为86%，而传统彩色多普勒超声为95%。能量多普勒超声的假阳性结果由胰腺炎、十二指肠溃疡和胆囊癌引起。观察者间的差异似乎没有显著作用。在志愿者组中未检测到壁内血管增多。在89例有症状的患者中，有4例（4%）因患者不配合而无法使用能量多普勒超声。在胆囊壁内血管中评估的阻力指数平均值在急性胆囊炎患者（0.73）和其他疾病患者（0.71）之间无显著差异（p <.001）。
尽管能量多普勒超声在诊断急性胆囊炎时的敏感性与灰阶超声相似，但其特异性显著更高，这可能会大大提高诊断信心。然而，能量多普勒超声对运动伪像的高敏感性使得技术参数的适当调整比其他超声成像更为重要。壁内血管的阻力指数在急性胆囊炎的诊断中无临床应用价值。
