An evaluation of three-dimensional ultrasonography for the measurement of gallbladder volume

Association of biliary distention with a diagnosis of acute cholecystitis

BACKGROUND

Gallbladder distention has been described in radiology literature but its value on point-of-care ultrasound (PoCUS) performed by emergency physicians is unclear. We sought to determine the test characteristics of gallbladder distention on PoCUS for cholecystitis (acute or chronic), and secondarily whether distention was associated with an obstructing stone-in-neck (SIN), acute cholecystitis on subsequent pathology report, and longer cholecystectomy operative times.

METHODS

This was a dual-site retrospective cohort study of all Emergency Department (ED) patients that underwent diagnostic biliary PoCUS and were subsequently admitted from 11/1/2020 to 10/31/2022. Patients with pregnancy, liver failure, ascites, hepatobiliary cancer, prior cholecystectomy, or known cholecystitis were excluded. Gallbladder distention was defined as a width ≥4 cm or a length ≥10 cm. Saved ultrasound images were reviewed by three independent reviewers who obtained measurements during the review. Test characteristics, Cohen's kappa (κ), and strength of association between distention and our variables (acute cholecystitis on pathology report and SIN on PoCUS) were calculated using a Chi Square analysis, where intervention (cholecystectomy, percutaneous cholecystostomy, or intravenous antibiotics) was used as the reference standard for AC. A one-tail two sample t-test was calculated for mean operative times.

RESULTS

Of 280 admitted patients who underwent ED biliary PoCUS, 53 were excluded, and 227 were analyzed. Of the 227 patients, 113 (49.8%) had cholecystitis according to our reference standard, and 68 (30.0%) had distention on PoCUS: 32 distended by both width and length, 16 distended by width alone, and 20 distended by length alone. Agreement between investigators was substantial for width (κ 0.630) and length (κ 0.676). Distention was 85.09% (95% CI 77.20-91.07%) specific and 45.1% (95% CI 35.8-54.8%) sensitive for cholecystitis. There was an association between distention and SIN; odds ratio (OR) 2.76 (95% CI 1.54-4.97). Distention of both length and width was associated with acute over chronic cholecystitis; OR 4.32 (95% CI 1.42-13.14). Among patients with acute cholecystitis, mean operative times were 114 min in patients with distention and 89 min in patients without distention (p = 0.03).

CONCLUSION

Gallbladder distention on PoCUS was specific for cholecystitis (acute or chronic), and associated with SIN, acute cholecystitis on subsequent pathology report, and longer cholecystectomy operative times. Measurement of gallbladder dimensions as part of the assessment of cholecystitis may be advantageous.

Sonographic Evaluation of the Gallbladder in Adult Patients With Type 2 Diabetes Mellitus

Introduction and aim: Diabetes mellitus (DM) is one of the most common non-communicable diseases worldwide. Diabetics with autonomic neuropathy tend to have larger gallbladder (GB) with poor contraction after fatty meals predisposing them to gallstones and cholecystitis. This may be prevented and treated if detected early using ultrasound. This study sonographically evaluated the GB in adults with type 2 diabetes and compared the findings with a non-diabetic age and sex-matched control group.

Methods: In this case-control study, 120 patients with type 2 diabetes and 120 non-diabetic controls between the ages of 18 and 80 years at National Hospital Abuja had their GB evaluated after eight hours of overnight fast using B-mode ultrasound. The data were analyzed using IBM SPSS version 20.0 (Armonk, NY: IBM Corp.) and presented in tables.

Result: There were 60 males and 60 females with mean ages of 53.3 and 52 years for the cases and controls, respectively. The average fasting gallbladder volume (FGBV) in diabetics (34.51 + 3.16cm³) was higher than that of controls (27.17 + 1.25cm³). Eleven (9.2%) diabetics had gallstone (GS), while none was detected in controls. The GB wall thickness was significantly higher in diabetics than in the controls (0.28 ± 0.06 cm vs 0.25 ± 0.04 cm).

Conclusion: A significant proportion of type 2 diabetics had higher FGBV, GB wall thickness, and presence of gallstone compared to the non-diabetic controls. B-mode ultrasound is a very important non-invasive and accurate tool for detecting these changes early.

Ultrasound Image Based Human Gallbladder 3D Modelling along with Volume and Stress Level Assessment

Purpose

Three-dimensional (3D) gallbladder (GB) geometrical models are essential to GB motor function evaluation and GB wall biomechanical property identification by employing finite element analysis (FEA) in GB disease diagnosis with ultrasound systems. Methods for establishing such 3D geometrical models based on static two-dimensional (2D) ultrasound images scanned along the long-axis/sagittal and short-axis/transverse cross-sections in routine GB disease diagnosis at the beginning of emptying phase have not been documented in the literature so far.

Methods

Based on two custom MATLAB codes composed, two images were segmented manually to secure two sets of the scattered points for the long- and short-axis GB cross-section edges; and the points were best fitted with a piecewise cubic spline function, and the short-axis cross-section edges were lofted along the long-axis to yield a 3D geometrical model, then GB volume of the model was figured out. The model was read into SolidWorks for real surface generation and involved in ABAQUS for FEA.

Results

3D geometrical models of seven typical GB samples were established. Their GB volumes are with 15.5% and − 4.4% mean errors in comparison with those estimated with the ellipsoid model and sum-of-cylinders method but can be correlated to the latter very well. The maximum first principal in-plane stress in the 3D models is higher than in the ellipsoid model by a factor of 1.76.

Conclusions

A numerical method was put forward here to create 3D GB geometrical models and can be applied to GB disease diagnosis and GB shape analysis with principal component method potentially in the future.

Three-Dimensional Sonography of Biliary Tract Disorders

In this pictorial essay, we review the 3-dimensional sonographic appearance of the normal gallbladder and biliary tree, as well as the appearance of congenital and acquired biliary tract disorders. Using examples, we demonstrate the advantage of 3-dimensional scanning compared with 2-dimensional sonography and, even in certain cases, magnetic resonance cholangiopancreatography.

Evaluation of gallbladder volume and contraction index with three-dimensional ultrasonography in healthy dogs

Three-dimensional (3D) ultrasonography has been shown to be an accurate and appropriate tool for measurement of gallbladder volume in humans. Therefore, we applied this novel technique for the first time to study fasting and postprandial gallbladder volume in 10 healthy dogs and compared the results with those of 2-dimensional (2D) ultrasonography. Fasting gallbladder volumes determined by 3D ultrasonography were significantly higher than corresponding volumes determined by 2D ultrasonography (P<0.01). Additionally, gallbladder volumes were significantly decreased in the postprandial state compared with the fasting state using 3D ultrasonography (P<0.001), but 2D ultrasonography showed no significant difference (P=0.189). The Gallbladder contraction index was higher in 3D ultrasonography than 2D ultrasonography; however, it did not reach statistical significance (P=0.25). In conclusion, 3D ultrasonography was able to measure gallbladder volume in healthy dogs in this study. It is suggested that 3D ultrasonography can be used to accurately estimate gallbladder volume and contractility.

Editorial review: pediatric 3D ultrasound

Three-dimensional ultrasound is an established diagnostic imaging technique in many specialties. However, in neonates, infants and children three-dimensional ultrasound still is underutilized, partially due to time constraints for post-processing and restricted availability, of devices as well as dedicated pediatric transducers. Also reimbursement issues still need to be addressed. This editorial review presents more or less established pediatric three-dimensional ultrasound applications with proven diagnostic benefit as well as potential future applications of three-dimensional/four-dimensional ultrasound in infants and children, aiming at enhancing research and promoting practical use of three-dimensional ultrasound in relevant pediatric conditions. Particularly, applications in neonatal neurosonography, ultrasound of the urogenital tract as well as some other small part and miscellaneous queries are highlighted. Additional other potential and future indications are discussed briefly, also mentioning restrictions and potential future developments. In summary, three-dimensional ultrasound holds some potential to widen sonographic diagnostic capabilities throughout childhood and hopefully will be increasingly investigated and introduced into clinical practice provided respective equipment and pediatric three-dimensional/four-dimensional ultrasound transducers become available.

A new semi-automated method for fetal volume measurements with three-dimensional ultrasound: preliminary results

OBJECTIVE

Complications in pregnancy are suggested to be the result of intrauterine conditions in the first trimester of pregnancy. Three-dimensional ultrasound volume measurements might give more information, compared with two-dimensional measurements. Commonly available methods for volume measurements are not suited for daily practice. This is a report of preliminary results of a promising, more practical semi-automated method for volume calculations with three-dimensional ultrasound.

METHOD

Volume datasets of 16 objects (10.2-41.5 cm(3) ) were obtained. Euclidean shortening flow and Perona and Malik were used as image enhancement techniques. The image gradient was calculated. The points of interest were detected by the iso-intensity and the edge-detection technique. Volume measurements with Volume Computer-aided AnaLysis (VOCAL) are used as a reference. A volume dataset of a first trimester fetus was acquired to test this method in vivo.

RESULTS

The mathematical calculations with iso-intensity (Perona and Malik: average= -1.57 cm(3) , SD=4.05; and Euclidean shortening flow: average= -1.38 cm(3) , SD=2.47) showed results comparable with the VOCAL method (average= +1.28 cm(3) , SD=2.07). We also succeeded in detecting all voxels in the whole contour of a 12-week fetus.

CONCLUSION

Mathematical volume calculations are possible with the semi-automated method. We were able to apply this new method on a first trimester fetus. This new method is promising for future use in the daily practice.

Potential role of 3DUS in infants and children

The objective of this review is to discuss basic technical aspects as well as potential pediatric applications of three-dimensional ultrasound (3DUS). Different 3DUS-techniques are already commercially available. Most commonly, a transducer-integrated motor drives a scan-head to acquire a volumetric dataset, which is then reconstructed and viewed using various post-processing techniques. It has been proved feasible to apply 3DUS with pediatric transducers in typical pediatric investigations. Based on our own experiences and on review of the literature, 3DUS can be successfully used in infants and children for brain, spine, cardiac, urinary tract (particularly assessment of hydronephrosis, and virtual cystoscopy), and female genital (e.g., for assessment of uterine malformations) US, and for various other applications, particularly in small parts. Power Doppler data can be integrated, allowing 3DUS-angiography. Thus, 3DUS promises to become a useful adjunct for imaging children, particularly as it enhances ultrasound by offering additional, previously inaccessible planes, rendering options and surface assessments. 3DUS should be increasingly exploited, thus hopefully helping reduce the need for more invasive or burdening (e.g., ionizing radiation) investigations in children.

Comparison of sonography and scintigraphy in the evaluation of gallbladder functional studies with cholecystokinin

OBJECTIVE

Both sonography and scintigraphy have been used to evaluate gallbladder function with the use of sincalide (cholecystokinin [CCK]). However, the reported ejection fractions (EFs) for the two modalities are not the same. The techniques measure slightly different parameters. This study directly compared both techniques performed simultaneously on the same participants.

METHODS

Twenty healthy volunteers were evaluated with sonography and scintigraphy to estimate the gallbladder EF simultaneously. The gallbladder EF was calculated at 5-minute intervals for 1 hour.

RESULTS

The mean EFs +/- SD were 66.3% +/- 20% and 49% +/- 29% for sonography and scintigraphy, respectively. The mean times to the peak EF were 38 +/- 12 and 33 +/- 9 minutes for sonography and scintigraphy. An average time of 34 minutes was noted after radiopharmaceutical injection before CCK administration for the scintigraphic studies. The earliest time to the peak EF for sonography was 15 minutes, and the latest time to the peak EF was 60 minutes (mode, 40 minutes); for scintigraphy, the earliest and latest times were 15 and 50 minutes (mode, 30 minutes), respectively. One participant could not be evaluated secondary to nonfilling of the gallbladder on scintigraphy. There was wider variability of the gall-bladder EF with scintigraphy than sonography.

CONCLUSIONS

Scintigraphy estimated a lower EF than sonography, had wider EF variability than sonography, and required additional time (>30 minutes more) to complete the study. Scintigraphy could not be performed in 5% of the participants because of nonfilling of the gallbladder. The use of sonography to estimate the gallbladder EF is less time-consuming and less costly. With these techniques, the range of normal gallbladder EFs should be adjusted for the technique used.

Sonographic assessments of gastrointestinal and biliary functions

Ultrasound has been established as a routine work-up imaging method in abdominal diseases. It assesses the morphology of intra-abdominal organs and depicts the normal and pathological anatomy of the gastrointestinal tract as well as of the biliopancreatic system. Ultrasound is the method of choice for visualisation of motion sequences since it is, in contrast to other imaging methods, a real-time method. The non-invasiveness and the repeatability of the method are important advantages when performing investigations of functional processes. Therefore, ultrasound is most suited for functional studies. Up to now, functional ultrasound and its potential have been undervalued. Functional ultrasound provides a widely available method to increase our understanding of functional processes and motility. The authors review the options of functional ultrasound and discuss its practical relevance.

Three-dimensional ultrasonography-based virtual cystoscopy of the pediatric urinary bladder: a preliminary report on feasibility and potential value

OBJECTIVE

The purpose of this study was to validate the feasibility and potential of 3-dimensional ultrasonography (3DUS)-based virtual cystoscopy in the pediatric urinary bladder.

METHODS

Twenty patients (age range, newborn-14 years) underwent urinary tract ultrasonography and 3DUS of the urinary bladder. From this data set, virtual cystoscopy was reconstructed for visualization of the inner bladder surface. Three-dimensional ultrasonography was compared with 2-dimensional ultrasonographic (2DUS) findings, voiding cystourethrography (VCUG) results, and reports from cystoscopy or surgery when available.

RESULTS

Three-dimensional ultrasonography was feasible in all patients. Data quality was sufficient for virtual cystoscopy without major motion artifacts. The 3DUS results matched all other findings; particularly, 3DUS superiorly visualized the ureteral ostium and the bladder neck configuration; in 5 patients, 3DUS depicted pathologically shaped ostia not detected by 2DUS. This correlated with the presence of vesicoureteral reflux on VCUG. Performing virtual cystoscopy added 1 minute to the investigation time (range, 0.5-2 minutes) and 3 minutes for postprocessing and viewing (range, 2-5 minutes).

CONCLUSIONS

Three-dimensional ultrasonography-based virtual cystoscopy is feasible in the pediatric urinary bladder without sedation. It reveals surface information not accessible by 2DUS, improving detection of pathologic conditions such as atypically shaped ureteral ostia. Three-dimensional ultrasonography-based cystoscopy may become a valuable adjunct to 2DUS of the pediatric urinary tract, improving selection criteria for further imaging such as VCUG, and potentially may help reduce the need for endoscopic cystoscopy. However, these preliminary results still have to be confirmed in prospective studies with larger patient numbers.

Evaluation of Body Surface Area as a Determinant of Cholecystodynamics Due to Orally Administered Standardized Skimmed Milk

The author studied the relationship between body surface area and both the gallbladder contraction index and gallbladder emptying rate. Using the ellipsoid formula, gallbladder volumes were sonographically measured in the preprandial state and 20 minutes after a standardized fatty meal in 62 subjects. Gallbladder contraction indices and emptying rates were calculated. The body surface area of 61 subjects who followed the study design was computed from their height and weight measurements. Parametric tests also were carried out, revealing that there were no significant correlations between body surface area and gallbladder contraction index and gallbladder emptying rate. Dosing in cholecystodynamic studies may be limited by lack of correlation between gallbladder emptying rate and body surface area.

Sonographic Assessment of Gallbladder Motility in the Ibo Population of Nigeria: A Feasibility Study

Gallbladder motility is affected in some gallbladder diseases. Reference values for normal gallbladder motility have not been established. The aim of this study is to establish multiple regression equations and reference values for predicting gallbladder motility in adult Nigerians. Forty healthy volunteers underwent serial sonographic scanning of the gallbladder between January and June 2005. Gallbladder volumes were calculated by ellipsoid approximation, and the 20th-minute gallbladder emptying rate (GBER) and gallbladder contraction index (GBCI) were computed. Anthropometric variables were equally measured. Multiple linear regression equations were derived using GBCI and GBER as dependent variables with age and body mass index as independent variables. The standard deviations for GBER were 0.429 and 0.457 in men and women, respectively, whereas the standard deviations for GBCI were 16.81 and 18.81 for men and women, respectively.

Progress of endoscopic ultrasonography and intraductal ultrasonography in the diagnosis of malignant biliary diseases

In recent years, ultrasound technology has made remarkable strides, and the application of these latest advances to endoscopic ultrasonography (EUS) and intraductal ultrasonography (IDUS) is crucially important. EUS equipped with electronic scanners (both radial and convex types) has been developed, and now EUS with the function of tissue harmonic imaging (THI) and color/power Doppler is applicable clinically. THI facilitates the acquisition of ultrasound images clearer than those of fundamental imaging, and color/power Doppler sonography demonstrates the precise hemodynamics with the use of a contrast agent. In addition, the progress of image processing technology has realized three-dimensional (3D) images in EUS and IDUS. Reconstruction of 3D images enables us to diagnose more objectively. Here we describe the roles of these new ultrasound technologies in the diagnosis of biliary malignancies.

Three-dimensional sonographic evaluation of gallbladder contractility: comparison with cholescintigraphy

PURPOSE

To compare three-dimensional sonography (3D US) with quantitative cholescintigraphy for assessing gallbladder contractility.

METHODS

Gallbladder radioactivity was assessed in 35 patients with suspected gallbladder disease using a gamma camera 5, 30, 60, and 90 minutes after technetium 99m (Tc-99m) DISIDA injection and 30 and 60 minutes after ingestion of a high-fat meal. Immediate gallbladder images were obtained via 3D US. Gallbladder radioactivity at 120 minutes after injection of Tc-99m DISIDA was defined as 100%, and gallbladder contractility was calculated. Gallbladder volume on 3D US was calculated using a dedicated software. Pearson correlation analysis and simple linear regression analysis were used.

RESULTS

The mean gallbladder volume on 3D US was 25.3 ml after fasting and 6.6 ml after a high-fat meal. The mean gallbladder contractility index was 77.7% on cholescintigraphy (range, 18-99) and 73.4 on 3D US (range, 16.7-97.3). A linear correlation between cholescintigraphy and 3D US contractility indices was observed. The r value on Pearson analysis was 0.92 and R(2) of the coefficient of determination was 0.85. The difference in measured contractility between the 2 methods ranged from +21.5% to -15.0% (mean +/- SD, 4.4 +/- 8.7%).

CONCLUSIONS

3D US is a reliable and easy method for clinical measurement of the volume of the gallbladder and its contractility.

Choledochal cysts in children: evaluation with three-dimensional sonography

In this report, we describe the application of 3-dimensional (3D) sonography for diagnosing choledochal cysts in 3 girls who were 18 months, 2 years, and 11 years old. The 3D images that were obtained during the sonographic examination revealed that all 3 patients had a type I choledochal cyst and also demonstrated dilatation of the biliary tracts. The 3 patients then underwent surgical excision of their cysts, cholecystectomy, and hepaticojejunostomy. Besides its other clinical applications, 3D sonography promises to be a valuable adjunct to conventional 2-dimensional imaging for the evaluation of choledochal cysts in pediatric patients.

Estimation of liver tumor volume using a three-dimensional ultrasound volumetric system

The usefulness of a new three-dimensional ultrasound (3DUS) volumetric system developed recently was validated in volume measurement of liver tumor in the present study. The system was used to estimate the volumes of 22 regular phantoms, 25 irregular phantoms and 37 liver tumors from 33 patients. The results showed that the consumed time of measurement with the system ranged from 1 to 15 min, depending on different rotation angles. The measured volumes at different rotation angles all significantly correlated with the true volumes and there were no significant differences among measured volumes at different angles. The measurement error of 3DUS was 0.3% +/- 3.3% in regular phantoms, -0.4% +/- 3.7% in irregular phantoms and 0.9% +/- 11.3% in liver tumors, respectively, as compared with -5.3 +/- 9.4%, 13.6 +/- 28.0% and 15.3 +/- 37.3% for two-dimensional ultrasound, respectively (all p < 0.05). The volume estimation with 3DUS also had significant intraobserver and interobserver reproducibility both in vitro and in vivo. It can be concluded that the new system that we used can greatly reduce the consumed time and manual labor for volume measurement with high accuracy and reproducibility. 3DUS volumetry using the new system is more acceptable and valuable in clinical practice and is expected to be useful for evaluation of the efficacy of tumor therapy in situ in patients with hepatic tumors.

Comparison of three- and two-dimensional sonography in diagnosis of gallbladder diseases: preliminary experience

OBJECTIVE

To compare three-dimensional sonography with two-dimensional sonography for diagnosis of gallbladder diseases.

METHODS

Sixty-three patients with gallbladder diseases were examined with two- and three-dimensional sonography. The morphologic features presented on both modalities were analyzed, and the diagnostic accuracies of both modalities were evaluated and compared.

RESULTS

Both two- and three-dimensional sonography facilitated correct diagnosis in all patients with gallstones. Three-dimensional sonography had no influence on the diagnosis of gallstones compared with two-dimensional sonography. Three-dimensional sonography showed the granular surfaces in 18 (81.8%) of 22 cases of polypoid lesions and the pedunculated fundus in 19 (86.4%) of 22, whereas two-dimensional sonography displayed them in 10 (45.5%) and 3 (13.6%) of 22, respectively (P < .05 and .001). Three- and two-dimensional sonography made correct differential diagnoses between non-neoplastic and neoplastic polyps in 20 (90.9%) and 12 (54.5%) of 22, respectively (P < .05). In gallbladder carcinoma, both three- and two-dimensional sonography accurately showed all the associated gallstones and intrahepatic bile duct dilatation. Two-dimensional sonography could not correctly define the locations of the lesions in 2 (28.6%) and tumor extension in 1 (14.3%) of 7 cases with pathologically proved gallbladder cancer, whereas three-dimensional sonography improved the diagnosis in these cases.

CONCLUSIONS

Three-dimensional sonography adds no advantages for diagnosis of gallstones compared with two-dimensional sonography, but it is better than two-dimensional sonography for differential diagnosis of gallbladder polyps and may improve the localization and staging for gallbladder carcinoma; however, additional studies are needed for further determination.

Ultrasonographic assessment of gallbladder bile exchanges in healthy subjects and in gallstone patients

Impaired gallbladder motility may contribute to gallstone pathogenesis by providing time for nucleation and aggregation of cholesterol crystals. Simultaneous scintigraphic-ultrasonographic techniques have been proposed to assess alternating phases of gallbladder emptying and filling. To evaluate patterns of gallbladder motility and of postprandial bile flow by means of a single ultrasonographic technique, 12 healthy volunteers and 20 gallstone patients underwent minute-by-minute gallbladder ultrasonography for 3 h postprandially. Mathematical analysis of volume measurements was used to estimate hepatic and cholecystic bile flux through the gallbladder. Compared to controls, gallstone patients showed greater amounts of unexchanged cholecystic-to-hepatic bile (11% vs. 1%, p <.001) and most of them showed impaired gallbladder washout efficacy. Utrasonographic values of bile exchanges were similar to those derived from scintigraphic-sonographic studies in comparable groups of subjects. This study provides new ultrasonographic variables, which better express gallbladder bile retention in gallstone patients and strongly discriminate gallstone patients from controls.

Real-time sonography for screening of gallbladder dysfunction in children with type 1 diabetes mellitus

The aim of this study was to evaluate the occurrence of gallbladder dysfunction in children with type 1 diabetes mellitus using real-time ultrasonography. The study population consisted of 20 diabetic children (11 male, 9 female; age 11.7+/-2.8 years; diabetes duration 0.5-7 years) with clinically negative neuropathy findings and 15 healthy controls (11 male, 4 female; age 10.5+/-3.7 years). Three-dimensional measurements of the gallbladder were made before and 15, 30, 45, 60 min after intake of diet chocolate. Gallbladder volumes were calculated by the ellipsoid formula. Fasting gallbladder volume of diabetic children (16.9+/-9.5 ml) was significantly greater than that of the controls (10.6+/-5.3 ml; p=0.017). Ejection fraction and maximal contraction showed no significant difference between the two groups. Diabetic patients with multiple microvascular complications had diminished gallbladder motility. There was a negative correlation between BMI and maximal contraction (p<0.05). Nerve conduction velocity was diminished in 45% of the diabetic patients. In conclusion, gallbladder function is preserved in pediatric type 1 diabetic patients with a disease duration less then 10 years, but dilated gallbladder at rest may be an early sign of gastrointestinal autonomic neuropathy and a risk factor for gallstone formation.