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The utility of hepatic artery velocity in diagnosing patients with acute cholecystitis

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Abstract

Purpose

To test the diagnostic performance of elevated peak systolic hepatic arterial velocity (HAv) in the diagnosis of acute cholecystitis.

Methods

229 patients with an ultrasound (US) performed for right upper quadrant (RUQ) pain were retrospectively reviewed. 35 had cholecystectomy within 10 days 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.

Results

21 patients had acute cholecystitis and 14 had chronic cholecystitis by pathology. For patients who went to cholecystectomy, HAv ≥100 cm/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 ≥100 cm/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.

Conclusion

HAv ≥100 cm/s is a useful objective parameter that may improve the performance of US in the diagnosis of acute cholecystitis.

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Authors and Affiliations

  1. Department of Radiology, University of California, Davis Medical Center, Suite 3100, 4860 Y Street, Sacramento, CA, 95817, USA

    Thomas W. Loehfelm

  2. Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA

    Justin R. Tse, R. Brooke Jeffrey & Aya Kamaya

Authors
  1. Thomas W. Loehfelm
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  2. Justin R. Tse
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  3. R. Brooke Jeffrey
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  4. Aya Kamaya
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Correspondence to Thomas W. Loehfelm.

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Funding

No internal or external grant funds supported this work.

Conflict of interest

Aya Kamaya receives royalties from Elsevier. The remaining authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards on the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Loehfelm, T.W., Tse, J.R., Jeffrey, R.B. et al. The utility of hepatic artery velocity in diagnosing patients with acute cholecystitis. Abdom Radiol 43, 1159–1167 (2018). https://doi.org/10.1007/s00261-017-1288-z

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  • DOI: https://doi.org/10.1007/s00261-017-1288-z

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