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Cystic artery velocity as a predictor of acute cholecystitis

  • Hepatobiliary
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Abstract

Purpose

To evaluate angle-corrected peak systolic cystic artery velocity (CAv) as a predictor of acute cholecystitis among patients presenting to the emergency department (ED) with right upper quadrant (RUQ) pain.

Methods

In this IRB-approved and retrospective study, CAv was evaluated in 73 patients, 43 who underwent definitive treatment with cholecystectomy or percutaneous cholecystostomy and 30 control patients without clinical suspicion for cholecystitis. In addition to CAv, the following were reviewed by 3 radiologists: CBD diameter, cholelithiasis, impacted stone in the neck, sludge, gallbladder wall thickness > 3 mm, gallbladder transverse dimension ≥ 4 cm, longitudinal dimension ≥ 8 cm, tensile gallbladder fundus sign, pericholecystic fluid, pericholecystic echogenic fat, and sonographic Murphy sign.

Results

Of the 43 patients who underwent definitive treatment, 25 had acute cholecystitis (34%) and 18 (25%) had chronic cholecystitis. Average CAv measurements were 50 ± 16 cm/s (acute), 28 ± 8 cm/s (chronic), and 22 ± 8 cm/s (control; p < 0.0001). In univariate analysis, among patients who underwent definitive therapy, CAv ≥ 40 cm/s, gallbladder wall thickness, stone impaction, GB long dimension ≥ 8 cm, and elevated WBC were associated with acute cholecystitis (p < 0.05). In multivariate analysis, CAv ≥ 40 cm/s was the only statistically significant variable (p = 0.016). CAv ≥ 40 cm/s alone had a PPV of 94.7% and overall accuracy of 81.4% in diagnosing acute cholecystitis.

Conclusion

CAv ≥ 40 cm/s is highly associated with acute cholecystitis in patients presenting to the ED with RUQ pain.

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Authors and Affiliations

  1. Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Room H-1307, Stanford, CA, 94305, USA

    Marcelina G. Perez, Kristen N. Bird, Tie Liang, R. Brooke Jeffrey & Aya Kamaya

  2. Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA

    Justin R. Tse

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  1. Marcelina G. Perez
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  2. Justin R. Tse
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Correspondence to Aya Kamaya.

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Conflict of interest

Aya Kamaya: Book royalties from Elsevier. Marcelina G. Perez, Justin R. Tse, Kristen Bird, Tie Liang, and R. Brooke Jeffrey disclose that they have no conflicts of interest.

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Perez, M.G., Tse, J.R., Bird, K.N. et al. Cystic artery velocity as a predictor of acute cholecystitis. Abdom Radiol 46, 4720–4728 (2021). https://doi.org/10.1007/s00261-021-03020-z

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  • DOI: https://doi.org/10.1007/s00261-021-03020-z

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