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Ahmed AS, Ahmed SS, Mohamed S, Salman NE, Humidan AAM, Ibrahim RF, Salim RS, Mohamed Elamir AA, Hakim EM. Advancements in Cholelithiasis Diagnosis: A Systematic Review of Machine Learning Applications in Imaging Analysis. Cureus 2024; 16:e66453. [PMID: 39247002 PMCID: PMC11380526 DOI: 10.7759/cureus.66453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2024] [Indexed: 09/10/2024] Open
Abstract
Gallstone disease is a common condition affecting a substantial number of individuals globally. The risk factors for gallstones include obesity, rapid weight loss, diabetes, and genetic predisposition. Gallstones can lead to serious complications such as calculous cholecystitis, cholangitis, biliary pancreatitis, and an increased risk for gallbladder (GB) cancer. Abdominal ultrasound (US) is the primary diagnostic method due to its affordability and high sensitivity, while computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) offer higher sensitivity and specificity. This review assesses the diagnostic accuracy of machine learning (ML) technologies in detecting gallstones. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting systematic reviews and meta-analyses. An electronic search was conducted in PubMed, Cochrane Library, Scopus, and Embase, covering literature up to April 2024, focusing on human studies, and including all relevant keywords. Various Boolean operators and Medical Subject Heading (MeSH) terms were used. Additionally, reference lists were manually screened. The review included all study designs and performance indicators but excluded studies not involving artificial intelligence (AI)/ML algorithms, non-imaging diagnostic modalities, microscopic images, other diseases, editorials, commentaries, reviews, and studies with incomplete data. Data extraction covered study characteristics, imaging modalities, ML architectures, training/testing/validation, performance metrics, reference standards, and reported advantages and drawbacks of the diagnostic models. The electronic search yielded 1,002 records, of which 34 underwent full-text screening, resulting in the inclusion of seven studies. An additional study identified through citation searching brought the total to eight articles. Most studies employed a retrospective cross-sectional design, except for one prospective study. Imaging modalities included ultrasonography (four studies), computed tomography (three studies), and magnetic resonance cholangiopancreatography (one study). Patient numbers ranged from 60 to 2,386, and image numbers ranged from 60 to 17,560 images included in the training, validation, and testing of the diagnostic models. All studies utilized neural networks, predominantly convolutional neural networks (CNNs). Expert radiologists served as the reference standard for image labelling, and model performances were compared against human doctors or other algorithms. Performance indicators such as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were commonly used. In conclusion, while the reviewed machine learning models show promising performance in diagnosing gallstones, significant work remains to be done to ensure their reliability and generalizability across diverse clinical settings. The potential for these models to improve diagnostic accuracy and efficiency is evident, but the careful consideration of their limitations and rigorous validation are essential steps toward their successful integration into clinical practice.
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Affiliation(s)
| | - Sharwany S Ahmed
- Faculty of Medicine, University of Khartoum, Khartoum, SDN
- Faculty of Postgraduate Studies, National University - Sudan, Khartoum, SDN
| | - Shakir Mohamed
- Faculty of Medicine, University of Khartoum, Khartoum, SDN
| | - Noureia E Salman
- Department of Pediatric Surgery, El-Sahel Teaching Hospital, Cairo, EGY
| | | | | | - Rammah S Salim
- Faculty of Medicine, University of Khartoum, Khartoum, SDN
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Karahan D, Şahin İ. Evaluation of hepatosteatosis and gallstone disease in patients with chronic kidney disease. Hemodial Int 2024; 28:343-350. [PMID: 38558287 DOI: 10.1111/hdi.13151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION The prevalence rates of hepatosteatosis and gallstones are increasing owing to the multifactorial causes of chronic kidney disease, and the prevalence may change with the availability of different forms of renal replacement therapy. We aimed to determine the incidence or prevalence rates of hepatosteatosis, cholelithiasis, and acute cholecystitis in patients with chronic kidney disease and compare them between renal replacement therapy modalities. METHODS A total of 270 patients (90 with chronic kidney disease stages III-V, 90 undergoing peritoneal dialysis, and 90 undergoing hemodialysis) were included and categorized into the pre-dialysis, hemodialysis, and peritoneal dialysis groups. The patients were questioned about previous gallbladder surgeries and chronic diseases. The results of abdominal ultrasonography, tomography, and magnetic resonance imaging were retrospectively evaluated with respect to the findings on the hepatobiliary system. Hepatosteatosis and cholelithiasis were diagnosed by expert radiologists on the basis of abdominal ultrasonography, tomography, and magnetic resonance imaging findings. The prevalence rates of hepatosteatosis, cholelithiasis, and other liver findings were compared between the groups. FINDINGS Hepatosteatosis and cholelithiasis were detected in 16.7% and 21.5% of the 270 cases, respectively. Hepatosteatosis was present in 17.8%, 25.6%, and 6.7% of patients in the pre-dialysis, hemodialysis, and peritoneal dialysis groups, respectively. The prevalence of hepatosteatosis was significantly higher in patients undergoing hemodialysis than in patients undergoing peritoneal dialysis (p = 0.002). However, no statistically significant difference was found between the peritoneal dialysis and pre-dialysis groups or between the hemodialysis and pre-dialysis groups (p >0.05). The prevalence rates of cholelithiasis were 15.6%, 28.9%, and 20.0%, in the pre-dialysis, hemodialysis, and peritoneal dialysis groups, respectively, and there were no statistically significant differences among the groups. The incidence of acute cholecystitis was significantly higher in the hemodialysis group than in the pre-dialysis group (p = 0.006). DISCUSSION Our study showed that the hepatobiliary system is frequently affected in chronic kidney disease and that the findings may differ depending on the renal replacement therapy modality.
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Affiliation(s)
- Doğu Karahan
- Department of Internal Medicine, Malatya Turgut Özal University School of Medicine, Malatya, Turkey
| | - İdris Şahin
- Department of Nephrology, İnonu University School of Medicine, Malatya, Turkey
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Xia Z, Liu Y, Sun S, Shan E, Liu Y. The value of preoperative neutrophil/lymphocyte ratio in predicting the severity of cholecystolithiasis with cholecystitis in elderly patients. BMC Surg 2023; 23:360. [PMID: 38012600 PMCID: PMC10683304 DOI: 10.1186/s12893-023-02267-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND This study aims to assess the effectiveness of neutrophil/lymphocyte ratio (NLR) and C-reactive protein (CRP) in diagnosing cholecystolithiasis with cholecystitis in elderly patients. Additionally, the study seeks to determine the predictive value of preoperative NLR in determining the severity of the condition in this population. METHODS This study is a retrospective cohort study, including 160 elderly patients with cholecystolithiasis with cholecystitis (45 cases of simple cholecystitis, 58 cases of suppurative cholecystitis, 57 cases of gangrenous cholecystitis) and 60 cases of normal gallbladder histology. The study collected clinical data of the patients detected the preoperative CRP content, neutrophil, and lymphocyte levels through blood routine tests, and calculated the NLR value. The diagnostic value of NLR and CRP was determined by using the Receiver Operating Characteristic Curve (ROC), and the optimal value of preoperative NLR related to the severity of elderly patients with cholecystolithiasis with cholecystitis was identified. RESULTS This study found that for elderly patients with cholecystolithiasis with cholecystitis, preoperative NLR and CRP levels can be used to distinguish the condition. The critical value for NLR was found to be 2.995 (95% CI, 0.9465-0.9853; P < 0.001) with an area under the ROC curve of 0.9659, while the critical value for CRP was 13.05 (95% CI, 0.9284-0.9830; P < 0.001) with an area under the ROC curve of 0.9557. Both NLR and CRP were found to have equivalent diagnostic abilities. Additionally, the study found that there were significant differences in neutrophil and lymphocyte levels in elderly patients with different severity levels, with NLR increasing as severity increased (P < 0.001). The study identified cut-off values for preoperative NLR that could distinguish Simple cholecystitis and Purulent cholecystitis, as well as Purulent cholecystitis and Gangrenous cholecystitis in elderly patients with cholecystolithiasis, with respective AUCs of 0.8441 (95% CI: 0.7642-0.9239; P < 0.001) and 0.7886(95% CI: 0.7050-0.8721, P < 0.001), sensitivities of 91.38% and 87.72%, and specificities of 73.33% and 63.79%. CONCLUSIONS Preoperative NLR and CRP values can serve as indicators to detect cholecystolithiasis with cholecystitis in elderly patients. Additionally, NLR has been recognized as a potential tool to differentiate the severity of cholecystolithiasis with cholecystitis in the elderly population.
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Affiliation(s)
- Zeliang Xia
- Department of General Surgery, The Second Affiliated Hospital of Bengbu Medical College, Anhui, Bengbu, 233004, PR China
| | - Yanyu Liu
- Department of Intensive Care Unit, The First Affiliated Hospital of Bengbu Medical College, Anhui, Bengbu, 233004, PR China
| | - Siyu Sun
- Department of Pharmacy, The Second Affiliated Hospital of Bengbu Medical College, Anhui, Bengbu, 233004, PR China
| | - Erbo Shan
- Department of General Surgery, The Second Affiliated Hospital of Bengbu Medical College, Anhui, Bengbu, 233004, PR China
| | - Yanhao Liu
- Department of Clinical Trial Research Center, The First Affiliated Hospital of Bengbu Medical College, Anhui, Bengbu, 233004, PR China.
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Joukar F, Ashoobi MT, Alizadeh A, Zeinali T, Faraji N, Tabatabaii M, Mansour-Ghanaei R, Naghipour M, Mansour-Ghanaei F. The association between the volume of the gallbladder based on sonographic findings and demographical data in the PERSIAN Guilan cohort study (PGCS). BMC Res Notes 2023; 16:310. [PMID: 37924103 PMCID: PMC10623732 DOI: 10.1186/s13104-023-06582-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Ultrasound is an important method to determine the volume of the gallbladder and check its structure. Considering the variation in the size and volume of the gallbladder in disease and physiological conditions, determining the volume of the gallbladder is clinically valuable. This study was carried out to evaluate the gallbladder volume and its association with patients' demographic data in the Prospective Epidemiological Research Studies of Iranian Adults (PERSIAN) Guilan cohort study (PGCS) population. METHODS In this cross-sectional study, 957 individuals aged 35-70 participated in determining the gallbladder volume by a radiologist based on the ultrasound method. The demographical data were collected using a questionnaire. After fasting for 12 h, the ultrasound was performed with an Ultrasonic device (Sonix SP series) with a 3.5 to 5 MHz probe. RESULTS The total frequency of gallbladder lesions was 2.2%. The results showed a significant association between marriage and gender with the presence or absence of lesions in the studied participants (P < 0.05). Also, significant differences were reported between the volume of gallbladder and gender, body mass index (BMI), social and economic status (SES), metabolic equivalent of task (MET), history of cardiovascular disease (CVD), and hypertension (P < 0.05). The results of a linear regression represented a significant association between gender, BMI, MET, and CVD and the mean volume of the gallbladder (P < 0.05). However, there was no significant association between the presence or absence of a lesion and the individuals' average gallbladder volume (P > 0.05). CONCLUSION According to our results, gender, BMI, MET, and CVD were significantly associated with gallbladder volume.
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Affiliation(s)
- Farahnaz Joukar
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Taghi Ashoobi
- Department of Surgery, School of Medicine Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Ahmad Alizadeh
- Department of Radiology, School of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Tahereh Zeinali
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Niloofar Faraji
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammadjavad Tabatabaii
- Department of Radiology, School of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Roya Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammadreza Naghipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
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Chen H, Wang B, Yang J, Wang C. IT COULD BE WORSE: A RARE CASE OF SPONTANEOUS CHOLEDOCHODUODENAL FISTULA WITH SUCCESSFUL DRAINAGE TO RELIEVE ACUTE SEVERE CHOLANGITIS. Gastroenterol Nurs 2023; 46:63-66. [PMID: 36706143 DOI: 10.1097/sga.0000000000000712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/08/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- Hong Chen
- Hong Chen, MS, is from the Department of Clinical Pharmacy, the 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei, China
- Biao Wang, MD, is from the Department of Endocrinology, Hospital of County Ningjin, Xingtai, Hebei, China
- Jie Yang, MD, is from the Outpatient Department, the Xicheng 4th Rest Center for Retired Cadres of Beijing Garrison Area of PLA, Beijing, China
- Chunhua Wang, MD, is from the Department of Gastroenterology, the 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei, China
| | - Biao Wang
- Hong Chen, MS, is from the Department of Clinical Pharmacy, the 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei, China
- Biao Wang, MD, is from the Department of Endocrinology, Hospital of County Ningjin, Xingtai, Hebei, China
- Jie Yang, MD, is from the Outpatient Department, the Xicheng 4th Rest Center for Retired Cadres of Beijing Garrison Area of PLA, Beijing, China
- Chunhua Wang, MD, is from the Department of Gastroenterology, the 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei, China
| | - Jie Yang
- Hong Chen, MS, is from the Department of Clinical Pharmacy, the 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei, China
- Biao Wang, MD, is from the Department of Endocrinology, Hospital of County Ningjin, Xingtai, Hebei, China
- Jie Yang, MD, is from the Outpatient Department, the Xicheng 4th Rest Center for Retired Cadres of Beijing Garrison Area of PLA, Beijing, China
- Chunhua Wang, MD, is from the Department of Gastroenterology, the 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei, China
| | - Chunhua Wang
- Hong Chen, MS, is from the Department of Clinical Pharmacy, the 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei, China
- Biao Wang, MD, is from the Department of Endocrinology, Hospital of County Ningjin, Xingtai, Hebei, China
- Jie Yang, MD, is from the Outpatient Department, the Xicheng 4th Rest Center for Retired Cadres of Beijing Garrison Area of PLA, Beijing, China
- Chunhua Wang, MD, is from the Department of Gastroenterology, the 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei, China
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Gallstone ileus in a middle-aged male with an atypical history: a case report. ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/10.29413/abs.2022-7.2.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Currently, gallstone ileus is an unusual complication of cholelithiasis (0.3–3.0 %) and a rare cause of mechanical bowel obstruction (0.1–4.0 %). The rarity of the condition makes it impossible to plan the large prospective randomized clinical trials, so the analysis of case reports is significant for decision making in the management of gallstone ileus. We report a case of gallstone ileus in a middle-aged male who had a history of surgery for duodenal ulcer perforation in past. A combination of peptic ulcer disease and cholelithiasis is based on a reduced gastrointestinal hormones secretion. Clinical specialists need to consider information about the greater frequency and asymptomatic clinical course of gallstone disease against a background of duodenal ulcer. Duodenal ulcer scar and bulbar deformity may promote to the cholecystoduodenal fistula formation. In the presence of an acute bowel obstruction symptoms and the absence of gallbladder instrumental examination results, it is possible to recommend the prior gastroduodenoscopy for the pre-operative pneumobilia detection. The optimal surgical approaches for acute gallstone ileus are still controversial.
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