Diffuse gallbladder wall thickening on computed tomography in patients with liver cirrhosis: correlation with clinical and laboratory variables. J Comput Assist Tomogr. 2011;35:535-538. [PMID: 21926844 DOI: 10.1097/rct.0b013e31822d2ade]

Associations of gallbladder and gallstone parameters with clinical outcomes in patients with cirrhosis

BACKGROUND

Morphologic changes in the gallbladder and gallstones are common in cirrhotic patients, but their associations with outcomes of cirrhotic patients are unclear.

METHODS

We retrospectively enrolled 206 cirrhotic patients and measured their gallbladder length and width, gallbladder wall thickness, presence of gallstones, and gallstones' length and width in axial contrast-enhanced computed tomography (CT) images. X-tile software was utilized to calculate the optimal cutoff values of these parameters for evaluating survival and hepatic decompensation events in the cirrhosis group. Their associations with survival were explored by Cox regression analyses and Kaplan-Meier curve analyses. Their associations with hepatic decompensation events were evaluated by competing risk analyses and Nelson-Aalen cumulative risk curve analyses where death was a competing event.

RESULTS

Cirrhotic patients with gallbladder length < 72 mm had a significantly higher cumulative survival rate than those with a length of ≥ 72 mm (P = 0.049 by log-rank test), but gallbladder width, gallbladder wall thickness, presence of gallstones, and gallstones' length and width were not significantly associated with survival (P = 0.10, P = 0.14, P = 0.97, P = 0.73, and P = 0.73 by log-rank tests, respectively). Cirrhotic patients with gallbladder wall thickness < 3.4 mm had a significantly lower cumulative rate of hepatic decompensation events than those with a wall thickness of ≥ 3.4 mm (P = 0.02 by Gray's test), but gallbladder length and width, presence of gallstones, and gallstones' length and width were not significantly associated with hepatic decompensation events (P = 0.15, P = 0.15, P = 0.54, P = 0.76, and P = 0.54 by Gray's tests, respectively).

CONCLUSION

Changes in gallbladder length and gallbladder wall thickness, rather than gallstone parameters, may be in parallel with the long-term outcomes of cirrhotic patients.

Pathological gallbladder wall thickening is associated with advanced chronic liver disease and independent of serum albumin

PURPOSE

Increased gallbladder wall thickness (GBWT) is a common finding. Reported causes include advanced chronic liver disease (ACLD), ascites and hypalbuminemia. GBWT is a marker for the prediction of esophageal varices. It remains unclear which of these factors is the decisive driver of GBWT. We aim to investigate whether there is a predominant factor associated with the GBWT.

METHODS

We enrolled 258 patients with ascites, hypalbuminemia and/or ACLD and 98 healthy volunteers that underwent abdominal ultrasound. Differences of mean GBWT in subgroups of patients with ACLD, ascites, and/or hypalbuminemia were analyzed. Correlation between various parameters and GBWT were calculated using multiple regression analysis.

RESULTS

GBWT in patients with ACLD + ascites + hypalbuminemia (n = 59; 5.70 ± 2.05 mm) was pathologically increased compared to patients with hypalbuminemia + ascites without ACLD (n = 36; 2.14 ± 0.66 mm; p < .001) and to patients with only hypalbuminemia (n = 76; 2.02 ± 0.80 mm; p < .001). GBWT of patients with ACLD + hypalbuminemia (n = 30; 3.42 ± 1.52 mm) and with ACLD and normal albumin level were not different (n = 46; 3.10 ± 1.62 mm; p > .999). Significant correlation was seen between GBWT and ACLD (r = .53; p < .001) and ascites (r = .51; p < .001) but not albumin level (r = .04; p = .510).

CONCLUSION

We demonstrate that ACLD is predominantly associated with GBWT. In contrast to the current literature, serum albumin level appears not to be associated with pathological GBWT.

Benign gallbladder diseases: Imaging techniques and tips for differentiating with malignant gallbladder diseases

Benign gallbladder diseases usually present with intraluminal lesions and localized or diffuse wall thickening. Intraluminal lesions of the gallbladder include gallstones, cholesterol polyps, adenomas, or sludge and polypoid type of gallbladder cancer must subsequently be excluded. Polyp size, stalk width, and enhancement intensity on contrast-enhanced ultrasound and degree of diffusion restriction may help differentiate cholesterol polyps and adenomas from gallbladder cancer. Localized gallbladder wall thickening is largely due to segmental or focal gallbladder adenomyomatosis, although infiltrative cancer may present similarly. Identification of Rokitansky-Aschoff sinuses is pivotal in diagnosing adenomyomatosis. The layered pattern, degree of enhancement, and integrity of the wall are imaging clues that help discriminate innocuous thickening from gallbladder cancer. High-resolution ultrasound is especially useful for analyzing the layering of gallbladder wall. A diffusely thickened wall is frequently seen in inflammatory processes of the gallbladder. Nevertheless, it is important to check for coexistent cancer in instances of acute cholecystitis. Ultrasound used alone is limited in evaluating complicated cholecystitis and often requires complementary computed tomography. In chronic cholecystitis, preservation of a two-layered wall and weak wall enhancement are diagnostic clues for excluding malignancy. Magnetic resonance imaging in conjunction with diffusion-weighted imaging helps to differentiate xathogranulomatous cholecystitis from gallbladder cancer by identifying the presence of fat and degree of diffusion restriction. Such distinctions require a familiarity with typical imaging features of various gallbladder diseases and an understanding of the roles that assorted imaging modalities play in gallbladder evaluations.

Gallbladder wall thickness combined with acoustic radiation force impulse imaging, portal vein width and biochemical parameters for assessing liver fibrosis caused by hepatitis

AIM: To investigate the relationship between the thickness of the gallbladder wall and the progress and severity of hepatic fibrosis, in order to provide a reference for clinical diagnosis and treatment of hepatic fibrosis.

METHODS: A retrospective analysis was performed of 76 patients with different stages of liver fibrosis who underwent acoustic radiation force impulse imaging from March 2014 to March 2015 at the First Hospital of Lanzhou University. All patients had a history of liver disease, typical clinical manifestations and laboratory tests. The patients with a history of gallbladder disease were excluded. The thickness of the gallbladder wall, liver elasticity index, width of portal vein, the presence of ascites, serum albumin, serum bilirubin, and prothrombin time were statistically analyzed.

RESULTS: Grade of hepatic fibrosis was significantly positively correlated with gllbladder wall thickness, liver elasticity index, portal vein width, serum albumin and ascites volume (P < 0.05). Gallbladder wall thickness was significantly positively associated with elasticity index, portal width and ascites volume (P < 0.05), but negatively associated with serum albumin (P < 0.05).

CONCLUSION: Combined use of thickness of the gallbladder wall, elasticity index, portal width, serum albumin and ascites can improve the assessment of the progress and severity of fibrosis. Gallbladder wall thickness may be used as independent indicator to assess liver fibrosis.

Histopathological gallbladder morphometric measurements in geriatric patients with symptomatic chronic cholecystitis

INTRODUCTION

Cholecystectomy for symptomatic cholecystitis is one of the common surgical procedures in the geriatric patients. Increased gallbladder wall thickness is expected due to acute cholecystitis and in some other clinical conditions. Routine histopathological evaluation of cholecystectomy materials are required to confirm the diagnosis and document other pathologies. The aim of this study was to evaluate age-related histopathological gallbladder morphometric measurements.

METHODS

A retrospective chart review of 371 cholecystectomy materials was performed. Two groups were designed according to age (<65 and ≥65 years old, respectively). Age and gender analyses for histopathological gallbladder length, diameter and wall thickness were performed. In addition, pathologically confirmed acute inflammation rates were evaluated in this case-control study.

RESULTS

Gallbladder morphometric measurements and pathologically confirmed acute inflammation rates were similar in males and females. Histopathological gallbladder diameter was higher with acute inflammatory changes, but no differences were observed in gallbladder length and wall thickness. Gallbladder wall thickness and pathologically confirmed acute inflammation rates were not comparable between the control and geriatric patients (2.8 ± 1.3 vs 2.6 ± 1.2 mm, and 30/281 (10.7 %) vs 10/74 (13.5 %), respectively, p > 0.05). However, higher gallbladder length and diameter were observed in geriatric group.

CONCLUSION

Age is an independent factor on histopathological gallbladder length and diameter, but not for gallbladder wall thickness. In addition, pathologically confirmed acute inflammation rate is not higher in geriatric patients. Clinical significance of these findings merits further investigation.

Extrabiliary Pathology Identified by Right Upper Quadrant Abdominal Ultrasound in Emergency Department Patients

BACKGROUND

The effectiveness of point of care (POC) right upper quadrant ultrasound (RUQ US) in the diagnosis of biliary disease has been well studied. Extrabiliary pathology that might remain undetected in the course of typical, focused POC RUQ US has not been directly examined.

OBJECTIVES

Our objective was to determine the prevalence and clinical significance of extrabiliary findings (EBFs) seen on radiology-performed, comprehensive RUQ US.

METHODS

We conducted a retrospective review of all adult patients undergoing radiology-performed RUQ US in the emergency department (ED) between January 2007 and April 2012. Ultrasound findings and contemporaneous laboratory values were collected. EBFs were identified and further classified by clinical significance.

RESULTS

A total of 1579 charts were included, demonstrating a total of 1030 EBFs, with 747 (47.3% [95% confidence interval {CI}, 44.8-49.8%]) patients demonstrating ≥ 1 EBF. Of these EBFs, 184 were classified as clinically significant (CSEBFs) and 150 (9.5% [95% CI, 8.1-11.0%]) patients had ≥ 1 CSEBF. A total of 50 unspecified masses were seen in 47 (3.0% [95% CI, 2.1-3.8%]) patients, with 8 (0.5%) representing a previously undiagnosed malignancy.

CONCLUSION

CSEBFs were seen in < 10% of ED patients undergoing comprehensive RUQ US. Nonspecific masses were seen in 3% of patients, but < 1% of patients were found to have a new malignancy.

MR imaging of the biliary system

Although ultrasound, computed tomography, and cholescintigraphy play essential roles in the evaluation of suspected biliary abnormalities, magnetic resonance (MR) imaging and MR cholangiopancreatography can be used to evaluate inconclusive findings and provide a comprehensive noninvasive assessment of the biliary tract and gallbladder. This article reviews standard MR and MR cholangiopancreatography techniques, clinical applications, and pitfalls. Normal biliary anatomy and variants are discussed, particularly as they pertain to preoperative planning. A spectrum of benign and malignant biliary processes is reviewed, emphasizing MR findings that aid in characterization.