COLOR DOPPLER SONOGRAPHY OF THE CYSTIC ARTERY - COMPARISON OF NORMAL CONTROLS AND PATIENTS WITH ACUTE CHOLECYSTITIS

Color Doppler sonography was used to evaluate the length and distribut ion of the cystic artery in the gall-bladder wall in 115 normal adults and in 54 patients with surgically proved cholecystitis. All patients were scanned with a 5 MHz curved array transducer optimized for low v olume color sensitivity. A specific attempt was made to visualize the cystic artery throughout its course. Spectral Doppler waveforms were o btained to document arterial flow. The length of the cystic artery vis ualized was analyzed as a quartile percentage length of the anterior g allbladder wall. The distribution of the cystic artery flow also was a nalyzed in specific quartiles. Of 54 patients with acute cholecystitis , 26% had cystic artery length greater than half of the anterior gallb ladder wall, compared with 2% of 115 normal controls (P < 0.001); 19% of patients with cholecystitis had flow in the distal (fundal) quartil e, compared to 0% of normal controls (P < 0.0001). Although the presen ce or absence of flow in the gallbladder is not a reliable finding to establish the diagnosis of acute cholecystitis, length of cystic arter y visualized is a potentially useful criterion to suggest the diagnosi s of acute cholecystitis, especially in cases in which flow in the dis tal fundal quartile of the gallbladder. The usefulness of color Dopple r sonography in acute cholecystitis is limited owing to the fact that it is insensitive, and many patients with cholecystitis have no detect able flow or have normal flow patterns.