Analysis of blood flow signals in ultrasonic Doppler study on the Ip-like small polypoid lesions of gallbladder

• Published in: Tando Vol. 10; no. 5; pp. 379 - 389
• Main Authors: YAMADA, Shigeki, YAMANAKA, Takeo, FUTAMURA, Mitsugi, OHSAWA, Hiroyuki, OHTA, Masahiro
• Format: Journal Article
• Language: Japanese
• Published: Japan Biliary Association 1996
• Subjects: acceleration time index; Ip型早期胆嚢癌; resistance index; 胆嚢小隆起性病変; 超音波ドプラ法
• ISSN: 0914-0077; 1883-6879
• DOI: 10.11210/tando1987.10.5_379

The fast Fourier transformation (FFT) waveforms of blood flow signals obtained with the ultrasonic and endoscopic ultrasonic Doppler methods (UD and EUD) were analyzed in order to differentiate malignant from benign in the Ip-like polypoid lesions of gallbladder. The subjects were 274 patients with Ip-like polypoid lesions of gallbladder, all of which cases were studied by US, and EUD was performed in 101 cases. Maximal and minimal velocity (Vmax, Vmin), acceleration time (AT) and periodic time (PT) were measured with the detected pulsatile flow wave signals (PW), and flow velocity was measured as Vmax from continuous flow wave signals (CW). Resistance index (RI) was calculated as the value of the difference between Vmax and Vmin divided by Vmax; acceleration time index (ATI) was defined as the value of AT divided by PT. The ability of Vmax, RI, and ATI indices to provide a satisfactory basis for judging malignancy was investigated. Doppler flow signals were detected in 34 cases of 274 (12.4%); the detection rate was 4.4% (12/274) by UD alone, but 28.7% (29/101) by EUD alone, which could contribute to improve detectability of flow signals. Pathological diagnosis was determined in 29 cases; a case of carcinoma,2 of adenoma,4 of non-neoplastic polyp with predominance of epithelial hyperplasia or fibrosis, and 22 of typical cholesterol polyp. Doppler flow signal could be detected in all of neoplastic and non-neoplastic polyp, but only 7 cases of typical cholesterol polyps. The Vmax of 6 cm/s or over was detected in 7 cases which include 2 cases of neoplastic polyp (carcinoma, adenoma). PW was detected in 7 cases including a carcinoma. Thus, on the cases with PW or the Vmax of 6 cm/s or over, cholecystectomy or close follow-up study should be considered because of possibility for carcinoma or adenoma. The relationship between RI, ATI and pathological diagnosis was investigated on the 7 cases with PW. It was seemed that the value of RI and ATI tend to be higher in carcinoma, compared with the other benign lesions, and it was suggested that RI and ATI would be, useful for differential diagnosis between carcinoma and benign polypoid lesion of gallbladder.