刑部 恵介¹, 堀口 祐爾¹, 今井 英夫¹, 坂本 宏司¹, 鈴木 智博¹, 久保 裕史¹, 上松 正尚¹, 竹内 文康¹, 中村 祐子¹, 林 隆男¹, 浅野 正裕¹, 西川 徹², 久志 有子², 中野 浩¹

Keisuke OSAKABE¹, Yuji HORIGUCHI¹, Hideo IMAI¹, Hiroshi SAKAMOTO¹, Tomohiro SUZUKI¹, Hiroshi KUBO¹, Masanao UEMATSU¹, Fumiyasu TAKEUCHI¹, Yuko NAKAMURA¹, Takao HAYASHI¹, Masahiro ASANO¹, Toru NISHIKAWA², Yuko KUSHI², Hiroshi NAKANO¹

¹藤田保健衛生大学医学部消化器内科, ²藤田保健衛生大学病院臨床検査研究部

¹Department of Gastroenterology, Fujita Health University School of Medicine, ²Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine

キーワード : Cholecystic vein, Drainage pattern, Gallbladder, Power Doppler

Power Doppler imaging (PDI) is a new technique that enhances detection of low-velocity blood flow. We used this modality to assess gallbladder vasculature, especially drainage pattern and flow analysis of the cholecystic vein. The power Doppler equipment used in this study was the Acuson Sequoia 512 system (Mountain View, California). Subjects were 27 patients with acute cholecystitis, 9 with gallbladder polyps, 7 with adenomyomatosis, 6 with gallstones, 2 with gallbladder cancer, 8 with liver cirrhosis, 7 with fatty liver, 4 with portal occlusion resulting from tumor thrombus, and 2 with anomalous arrangement of the pancreaticobiliary ductal system. Ninety vessels in 72 individuals were evaluated with PDI. Continuous wave-form signals (cystic veins) were delineated at the body of the gallbladder in 67% of 72 cases (90 vessels); at the fundus in 22%. Vessels communicating with the cystic vein (drainage vessel) were then analyzed in 78 veins. The drainage vessel was assessed to be a portal branch of segment 5 of the liver (P5) in 59%, a middle hepatic vein (MHV) in 38%, and the PV trunk in 3%. The cystic vein from the body drained into the P5 in 74%; the fundus drained into the MHV in 75%. On fast Fourier transformation analysis of the cystic venous flow, estimated maximal velocity (Vmax) was relatively high in patients with acute cholecystitis, gallbladder cancer and portal occlusion. Interestingly, the focal spared area in the fatty liver appeared to be perfused with cystic veins, in addition to having reduced portal blood flow. We conclude that power Doppler imaging may hold promise for assessing drainage pattern of the cystic vein.