Evaluation der sonographisch bestimmten Gallenblasenwanddicke als nicht-invasiver Marker für das Vorliegen eines Leberparenchymumbaus
by Rawan Masri
Date of Examination:2025-01-20
Date of issue:2024-11-28
Advisor:Prof. Dr. Ahmad Amanzada
Referee:Prof. Dr. Ahmad Amanzada
Referee:PD Dr. Thomas Lorf
Persistent Address:
http://dx.doi.org/10.53846/goediss-10901
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Abstract
English
Liver cirrhosis is the final stage of various chronic liver diseases. Causes include chronic alcohol consumption, untreated chronic viral or autoimmune hepatitis, metabolic disorders, and medication, alongside cases with unclear etiology. Due to the high mortality of liver cirrhosis, early detection of liver parenchymal changes is critical for enabling targeted interventions that can slow down or even halt progression towards cirrhosis in some chronic liver diseases. While histological examination of liver tissue remains the gold standard for the detection of parenchymal changes, its invasive nature and potential for lethal complications have encouraged the development of non-invasive diagnostic techniques, including transient elastography and shear wave elastography. Additionally, laboratory-derived scoring systems provide a reliable non-invasive means of estimating the degree of parenchymal changes. In this study, we evaluated whether gallbladder wall thickening is associated with sonographic and histological signs of liver parenchymal changes or cirrhosis. Furthermore, we examined whether gallbladder wall thickening correlates with liver pathology scores such as FIB-4, APRI, MELD, and Child-Pugh. We conducted a retrospective monocentric cross-sectional evaluation of 505 patients with chronic hepatitis and suspected or confirmed liver cirrhosis. Of these, 145 patients had a histological biopsy result within two years before or after an abdominal ultrasound examination. Patients were divided into subgroups with and without sonographic signs of liver parenchymal changes. Additionally, patients with available histological results were categorized as having confirmed liver cirrhosis (Stage 4 according to Desmet and Scheuer) or not having cirrhosis (Stages 0 to 3 according to Desmet and Scheuer), to compare them regarding sonographically measured gallbladder wall thickness, laboratory parameters, and derived scores. We identified an association between measured gallbladder wall thickness and the presence of sonographic liver parenchymal changes or histological liver cirrhosis. For the first time, a threshold value of gallbladder wall thickness for the detection of sonographic or histological liver parenchymal changes was calculated. In other studies, a cutoff value for relevant gallbladder wall thickening between 3 and 4 mm was established. In contrast, using ROC curve analysis and the Youden index, we calculated a threshold value for the presence of liver parenchymal changes. A gallbladder wall thickness of ≥3.3 mm was associated with sonographic signs of liver parenchymal changes. Furthermore, a gallbladder wall thickness of ≥3.3 mm was associated with histologically confirmed liver cirrhosis in Stage 4 according to Desmet and Scheuer. Patients with sonographic signs of liver parenchymal changes had significantly more often a histologically detectable cirrhosis in Stage 4 according to Desmet and Scheuer. Furthermore, we established a positive correlation between gallbladder wall thickness and the APRI and FIB-4 scores. Both scores are validated, non-invasive, and simple to calculate, and can predict the likelihood of liver cirrhosis without the need for histology. By combining measurements of gallbladder wall thickness ≥3.325 mm with APRI >2 or FIB-4 score >3.325, a better discrimination of patient groups with sonographic and histological liver parenchymal changes was achieved compared to considering individual parameters. The accuracy of gallbladder wall thickness in detecting liver parenchymal changes or liver cirrhosis was higher in patients with sonographic signs of liver parenchymal changes than in patients with histologically confirmed liver cirrhosis. We also found correlations between gallbladder wall thickness and liver and spleen sizes, gallbladder width, portal vein diameter, and other biochemical parameters. Additionally, positive correlations between gallbladder wall thickness and the MELD score and Child-Pugh stage were demonstrated. Overall, the results suggest that sonographic measurement of gallbladder wall thickness in combination with other non-invasive parameters provides a useful contribution to the assessment of liver parenchymal changes. Accordingly, routine sonographic measurement of gallbladder wall thickness and further calculations of scores like APRI, FIB-4, MELD, and Child-Pugh stage could be a useful measure for early detection of liver parenchymal changes in patients with chronic liver diseases. This could help avoid severe complications from liver cirrhosis and provide time to initiate appropriate interventions.
Keywords: Sonography; liver cirrhosis; gall bladder; wall thickness
