Z Gastroenterol 2011; 49(7): 845-870
DOI: 10.1055/s-0031-1273362
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Normwerte in der Abdomensonografie – biliopankreatisches System und Milz

Reference Values in Abdominal Ultrasound – Biliopancreatic System and SpleenM. Sienz1 , A. Ignee1 , C. F. Dietrich1
  • 1Innere Medizin 2, Caritas Krankenhaus Bad Mergentheim
Further Information

Publication History

Manuskript eingetroffen: 16.2.2011

Manuskript akzeptiert: 6.4.2011

Publication Date:
15 July 2011 (online)

Zusammenfassung

Ziel: Normwerte in der B-Bild-Sonografie des Abdomens werden aufgrund der begrenzten Datenlage in der Literatur kontrovers diskutiert. Es erfolgt eine systematische Zusammenstellung bislang publizierter Daten bezüglich des biliopankreatischen Systems und der Milz. Methoden: Literatur-Recherche bez. Normwerten im Abdomen von 1970 – 2010 an gesunden Probanden. In Anlehnung an die Bestimmung von Referenzintervallen für Laborwerte werden Normwerte in der Regel mithilfe von 95 %-Referenzintervallen und den zugehörigen 90 %-Konfidenzintervallen bestimmt. Evaluiert wurden die Gallenblase, die Gallenblasenwand, die Gallengänge, das Pankreas und die Milz. Ergebnisse: 70 Studien konnten ausgewertet werden. Die Vergleichbarkeit der Daten ist eingeschränkt, da unterschiedliche Kollektive untersucht und verschiedene Messmethoden angewendet wurden. Insbesondere für das Gallenblasenvolumen unterscheiden sich die in der Literatur angegebenen Messwerte quantitativ erheblich. Zur Gallenblasengröße ist die Datenlage unzureichend. Für die Wanddicke der Gallenblase kann als Normwert ca. 3 mm angesehen werden. Die für den Ductus hepaticus communis bzw. Ductus hepatocholedochus ableitbaren Normwerte liegen in Abhängigkeit vom Messort und den untersuchten Kollektiven zwischen 5 und 9 mm. Die publizierten Messwerte für die Pankreasgröße differieren ebenfalls erheblich. Als obere Normgrenze für die Milzlänge ergibt sich aus den meisten Publikationen um 12 cm, bei jungen, großen athlethischen Männern bis 15 cm. Diskussion: Normwerte sind hilfreich für die Abgrenzung zahlreicher pathologischer Prozesse in den jeweiligen Organen.

Abstract

Objective: Reference values for B-mode abdominal ultrasound are controversially discussed due to the limited data in the literature. A systematic survey of the data published so far is presented for the biliopancreatic system and the spleen. Methods: A literature review of reference values in the abdomen from 1970 to 2010 in healthy subjects 18 years of age and older was carried out. According to the determination of reference intervals for laboratory values, reference values are generally determined using 95 %-reference intervals and their associated 90 %-confidence intervals. The gallbladder, gallbladder wall, bile ducts, pancreas and the spleen were evaluated. Results: 70 studies were analysed. The comparability of the data is limited, because different collectives were studied and diverse measuring techniques were used. In particular, gallbladder volume measurements reported in the literature differ substantially. Data for the size of the gallbladder are insufficient. Deducible reference values for the common hepatic duct or, respectively, the common bile duct lie between 5 and 9 mm in dependency on the measuring position and the collective analysed. The published measurement values for the size of the pancreas also vary considerably. In most of the publications the upper limit of normal for the length of the spleen amounts to around 12 cm, in young, athletic men up to 15 cm. Discussion: Normal values are helpful in delimiting numerous pathological changes in the respective organs.

Literatur

  • 1 Deutsche Gesellschaft für Ultraschall in der Medizin (DEGUM), Österreichische Gesellschaft für Ultraschall in der Medizin (ÖGUM) .Befundung und Nomenklatur bei Ultraschalluntersuchungen innerer Organe. Empfehlungen der Nomenklaturkommission der Sektion Innere Medizin der DEGUM und der ÖGUM. Berlin: Springer Verlag; 1994
  • 2 Sienz M, Ignee A, Dietrich C F. Reference values in abdominal ultrasound – liver and liver vessels.  Z Gastroenterol. 2010;  48 (9) 1141-1152
  • 3 Solberg H E. A guide to IFCC recommendations on reference values.  J Int Fed Clin Chem. 1993;  5 (4) 162-165
  • 4 Solberg H E. International Federation of Clinical Chemistry. Scientific committee, Clinical Section. Expert Panel on Theory of Reference Values and International Committee for Standardization in Haematology Standing Committee on Reference Values. Approved recommendation (1986) on the theory of reference values. Part 1. The concept of reference values.  Clin Chim Acta. 1987;  165 (1) 111-118
  • 5 Solberg H E. The theory of reference values Part 5. Statistical treatment of collected reference values. Determination of reference limits.  J Clin Chem Clin Biochem. 1983;  21 (11) 749-760
  • 6 Dietrich C F, Chichakli M, Hirche T O et al. Sonographic findings of the hepatobiliary-pancreatic system in adult patients with cystic fibrosis.  J Ultrasound Med. 2002;  21 (4) 409-416
  • 7 Capaccioli L, Stecco A, Vanzi E et al. Ultrasonographic study on the growth and dimensions of healthy children and adults organs.  Ital J Anat Embryol. 2000;  105 (1) 1-50
  • 8 Festi D, Frabboni R, Bazzoli F et al. Gallbladder motility in cholesterol gallstone disease. Effect of ursodeoxycholic acid administration and gallstone dissolution.  Gastroenterology. 1990;  99 (6) 1779-1785
  • 9 Saibene A, Pellicciotta G, Balconi G et al. Ultrasonographic evaluation of gallbladder volume and contractility in diabetic patients of different ages.  Diabete Metab. 1991;  17 (6) 530-533
  • 10 Palasciano G, Serio G, Portincasa P et al. Gallbladder volume in adults, and relationship to age, sex, body mass index, and gallstones: a sonographic population study.  Am J Gastroenterol. 1992;  87 (4) 493-497
  • 11 Chen J J, Changchien C S, Tai D I et al. Gallbladder volume in patients with common hepatic duct dilatation. An evaluation of Courvoisier’s sign using ultrasonography.  Scand J Gastroenterol. 1994;  29 (3) 284-288
  • 12 Portincasa P, Di Ciaula A, Baldassarre G et al. Gallbladder motor function in gallstone patients: sonographic and in vitro studies on the role of gallstones, smooth muscle function and gallbladder wall inflammation.  J Hepatol. 1994;  21 (3) 430-440
  • 13 Gourtsoyiannis N C, Damilakis J E, Charoulakis N Z et al. Relationship of gallbladder contour, fasting volume and emptying to body size indices in normal subjects and patients with gallstones.  Digestion. 1995;  56 (5) 395-399
  • 14 Chapman B A, Chapman T M, Frampton C M et al. Gallbladder volume: comparison of diabetics and controls.  Dig Dis Sci. 1998;  43 (2) 344-348
  • 15 Caroli-Bosc F X, Pugliese P, Peten E P et al. Gallbladder volume in adults and its relationship to age, sex, body mass index, body surface area and gallstones. An epidemiologic study in a nonselected population in France.  Digestion. 1999;  60 (4) 344-348
  • 16 Lock G, Kammerl M, Schlottmann K et al. Gallbladder motility in healthy volunteers: effects of age, gender, body mass index, and hair color.  Hepatogastroenterology. 2003;  50 (53) 1232-1235
  • 17 Guliter S, Yilmaz S, Karakan T. Evaluation of gallbladder volume and motility in non-insulin-dependent diabetes mellitus patients using real-time ultrasonography.  J Clin Gastroenterol. 2003;  37 (4) 288-291
  • 18 Kamerling I M, Van Haarst A D, De Kam M L et al. Gallbladder volume as a biomarker for the motilin effect in healthy volunteers and patients with functional dyspepsia.  Aliment Pharmacol Ther. 2004;  19 (7) 797-804
  • 19 Nazaroglu H, Akgul C, Bukte Y et al. Volume changes in the gallbladder in association with various radiologic examinations.  J Clin Ultrasound. 2005;  33 (5) 214-217
  • 20 Sari R, Balci M K, Coban E et al. Sonographic evaluation of gallbladder volume and ejection fraction in obese women without gallstones.  J Clin Ultrasound. 2003;  31 (7) 352-357
  • 21 Finberg H J, Birnholz J C. Ultrasound evaluation of the gallbladder wall.  Radiology. 1979;  133 (3 Pt 1) 693-698
  • 22 Sanders R C. The significance of sonographic gallbladder wall thickening.  J Clin Ultrasound. 1980;  8 (2) 143-146
  • 23 Deitch E A. Utility and accuracy of ultrasonically measured gallbladder wall as a diagnostic criteria in biliary tract disease.  Dig Dis Sci. 1981;  26 (8) 686-693
  • 24 Alekse R. Diffuse thickening of the gallbladder wall detected by ultrasonography.  Mater Med Pol. 1991;  23 (3) 229-232
  • 25 Uggowitzer M, Kugler C, Schramayer G et al. Sonography of acute cholecystitis: comparison of color and power Doppler sonography in detecting a hypervascularized gallbladder wall.  Am J Roentgenol. 1997;  168 (3) 707-712
  • 26 El S E, Faris R, Grumbach K et al. Ultra sonographic measurements of the normal liver and spleen among Egyptians 10 – 50 years old.  J Egypt Public Health Assoc. 1997;  72 (3 – 4) 257-283
  • 27 Cooperberg P L. High-resolution real-time ultrasound in the evaluation of the normal and obstructed biliary tract.  Radiology. 1978;  129 (2) 477-480
  • 28 Parulekar S G. Ultrasound evaluation of common bile duct size.  Radiology. 1979;  133 (3 Pt 1) 703-707
  • 29 Graham M F, Cooperberg P L, Cohen M M et al. The size of the normal common hepatic duct following cholecystectomy: an ultrasonographic study.  Radiology. 1980;  135 (1) 137-139
  • 30 Dewbury K C. Visualization of normal biliary ducts with ultrasound.  Br J Radiol. 1980;  53 (632) 774-780
  • 31 Mueller P R, Ferrucci Jr J T, Simeone J F et al. Postcholecystectomy bile duct dilatation: myth or reality?.  Am J Roentgenol. 1981;  136 (2) 355-358
  • 32 Bruneton J N, Roux P, Fenart D et al. Ultrasound evaluation of common bile duct size in normal adult patients and following cholecystectomy. A report of 750 cases.  Eur J Radiol. 1981;  1 (2) 171-172
  • 33 Niederau C, Muller J, Sonnenberg A et al. Extrahepatic bile ducts in healthy subjects, in patients with cholelithiasis, and in postcholecystectomy patients: a prospective ultrasonic study.  J Clin Ultrasound. 1983;  11 (1) 23-27
  • 34 Kaude J V. The width of the common bile duct in relation to age and stone disease. An ultrasonographic study.  Eur J Radiol. 1983;  3 (2) 115-117
  • 35 Wu C C, Ho Y H, Chen C Y. Effect of aging on common bile duct diameter: a real-time ultrasonographic study.  J Clin Ultrasound. 1984;  12 (8) 473-478
  • 36 Wedmann B, Borsch G, Coenen C et al. Effect of cholecystectomy on common bile duct diameters: a longitudinal prospective ultrasonographic study.  J Clin Ultrasound. 1988;  16 (9) 619-624
  • 37 Heistermann P, Buchholz J, Strosche H et al. Changes of the ductus hepatocholedochus after gastric stimulant. Results of early functional sonography.  Surg Endosc. 1989;  3 (3) 134-136
  • 38 Brogna A, Bucceri A M, Catalano F et al. Common bile duct and sex, age and body mass index in normal humans: an ultrasonographic study.  Ital J Gastroenterol. 1991;  23 (3) 136-137
  • 39 Watkin D S, Haworth J M, Leaper D J et al. Assessment of the common bile duct before cholecystectomy using ultrasound and biochemical measurements: validation based on follow-up.  Ann R Coll Surg Engl. 1994;  76 (5) 317-319
  • 40 Feng B, Song Q. Does the common bile duct dilate after cholecystectomy? Sonographic evaluation in 234 patients.  Am J Roentgenol. 1995;  165 (4) 859-861
  • 41 Kaim A, Steinke K, Frank M et al. Diameter of the common bile duct in the elderly patient: measurement by ultrasound.  Eur Radiol. 1998;  8 (8) 1413-1415
  • 42 Majeed A W, Ross B, Johnson A G. The preoperatively normal bile duct does not dilate after cholecystectomy: results of a five year study.  Gut. 1999;  45 (5) 741-743
  • 43 Perret R S, Sloop G D, Borne J A. Common bile duct measurements in an elderly population.  J Ultrasound Med. 2000;  19 (11) 727-730
  • 44 Horrow M M, Horrow J C, Niakosari A et al. Is age associated with size of adult extrahepatic bile duct: sonographic study.  Radiology. 2001;  221 (2) 411-414
  • 45 Bachar G N, Cohen M, Belenky A et al. Effect of aging on the adult extrahepatic bile duct: a sonographic study.  J Ultrasound Med. 2003;  22 (9) 879-882
  • 46 Daradkeh S, Tarawneh E, Al-Hadidy A. Factors affecting common bile duct diameter.  Hepatogastroenterology. 2005;  52 (66) 1659-1661
  • 47 Prpic G L, Babic N, Marjan D et al. MR assessment of bile duct size in healthy individuals: comparison with US measurements.  Coll Antropol. 2007;  31 (2) 567-571
  • 48 Admassie D. Ultrasound assessment of common bile duct diameter in Tikur Anbessa Hospital, Addis Ababa, Ethiopia.  Ethiop Med J. 2008;  46 (4) 391-395
  • 49 Haber K, Freimanis A K, Asher W M. Demonstration and dimensional analysis of the normal pancreas with gray-scale echography.  Am J Roentgenol. 1976;  126 (3) 624-628
  • 50 Graaff C S, Taylor K J, simonds B D et al. Gray-scale echography of the pancreas. Re-evaluation of normal size.  Radiology. 1978;  129 (1) 157-161
  • 51 Afschrift de M, Mets T, Verdonk G. Real-time ultrasonography of the normal pancreas in young adults: advantage of the erect position.  Acta Clin Belg. 1979;  34 (1) 32-35
  • 52 Zimmermann W, Frank N, Weiss-Simon C et al. The normal pancreas. Demonstration in the sonogram in relation to age.  Fortschr Med. 1981;  99 (30) 1178-1182
  • 53 Kolmannskog F, Vatn M H, Swensen T et al. Computer tomography of the abdomen in patients with uncharacteristic abdominal disturbances.  Scand J Gastroenterol. 1983;  18 (2) 225-227
  • 54 Niederau C, Sonnenberg A, Muller J E et al. Sonographic measurements of the normal liver, spleen, pancreas, and portal vein.  Radiology. 1983;  149 (2) 537-540
  • 55 Pochhammer K F, Szekessy T, Frentzel-Beyme B et al. Craniocaudad extension of the head of the pancreas.  Digitale Bilddiagn. 1984;  4 (3) 118-120
  • 56 Ker C G, Tabata M, Sheen P C et al. Echographic measurement of normal Chinese pancreas.  Taiwan Yi Xue Hui Za Zhi. 1984;  83 (11) 1094-1104
  • 57 Silva M E, Vezozzo D P, Ursich M J et al. Ultrasonographic abnormalities of the pancreas in IDDM and NIDDM patients.  Diabetes Care. 1993;  16 (9) 1296-1297
  • 58 Weill F, Schraub A, Eisenscher A et al. Ultrasonography of the normal pancreas. Success rate and criteria for normality.  Radiology. 1977;  123 (2) 417-423
  • 59 Vossen C H. Ultrasonographic measurement of the pancreatic body. Its significance in measuring the normal pancreas.  Diagn Imaging Clin Med. 1986;  55 (6) 327-329
  • 60 Frank K, Linhart P, Kortsik C et al. Sonographic determination of spleen size: normal dimensions in adults with a healthy spleen.  Ultraschall in Med. 1986;  7 (3) 134-137
  • 61 Wermke W. Sonomorphometrische und Dopplersonographische Untersuchungen bei Chronischen Leberkrankheiten. Habilitation 1990
  • 62 Loftus W K, Chow L T, Metreweli C. Sonographic measurement of splenic length: correlation with measurement at autopsy.  J Clin Ultrasound. 1999;  27 (2) 71-74
  • 63 Messinezy M, Macdonald L M, Nunan T O et al. Spleen sizing by ultrasound in polycythaemia and thrombocythaemia: comparison with SPECT.  Br J Haematol. 1997;  98 (1) 103-107
  • 64 Yazdanpanah Y, Thomas A K, Kardorff R et al. Organometric investigations of the spleen and liver by ultrasound in Schistosoma mansoni endemic and nonendemic villages in Senegal.  Am J Trop Med Hyg. 1997;  57 (2) 245-249
  • 65 Dietrich C F, Zeuzem S, Caspary W F et al. Ultrasound lymph node imaging in the abdomen and retroperitoneum of healthy probands.  Ultraschall in Med. 1998;  19 (6) 265-269
  • 66 De Odorico I, Spaulding K A, Pretorius D H et al. Normal splenic volumes estimated using three-dimensional ultrasonography.  J Ultrasound Med. 1999;  18 (3) 231-236
  • 67 Li Y S, Kardorff R, Richter J et al. Ultrasound organometry: the importance of body height adjusted normal ranges in assessing liver and spleen parameters among Chinese subjects with Schistosoma japonicum infection.  Acta Trop. 2004;  92 (2) 133-138
  • 68 Spielmann A L, DeLong D M, Kliewer M A. Sonographic evaluation of spleen size in tall healthy athletes.  Am J Roentgenol. 2005;  184 (1) 45-49
  • 69 Hosey R G, Mattacola C G, Kriss V et al. Ultrasound assessment of spleen size in collegiate athletes.  Br J Sports Med. 2006;  40 (3) 251-254
  • 70 Mustapha Z, Tahir A, Tukur M et al. Sonographic determination of normal spleen size in an adult African population.  Eur J Radiol. 2010;  75 (1) e133-e135
  • 71 Koga T, Morikawa Y. Ultrasonographic determination of the splenic size and its clinical usefulness in various liver diseases.  Radiology. 1975;  115 (1) 157-161
  • 72 Pietri H, Boscaini M. Determination of a splenic volumetric index by ultrasonic scanning.  J Ultrasound Med. 1984;  3 (1) 19-23
  • 73 Ishibashi H, Higuchi N, Shimamura R et al. Sonographic assessment and grading of spleen size.  J Clin Ultrasound. 1991;  19 (1) 21-25
  • 74 Sheth S G, Mani S, Tamhankar H et al. Spleen size in health and disease: a sonographic assessment.  J Assoc Physicians India. 1995;  43 (3) 182-184
  • 75 Sonmez G, Ozturk E, Basekim C C et al. Effects of altitude on spleen volume: sonographic assessment.  J Clin Ultrasound. 2007;  35 (4) 182-185
  • 76 Stiff P J, Bensinger W, Abidi M H et al. Clinical and ultrasonic evaluation of spleen size during peripheral blood progenitor cell mobilization by filgrastim: results of an open-label trial in normal donors.  Biol Blood Marrow Transplant. 2009;  15 (7) 827-834
  • 77 Festi D, Frabboni R, Bazzoli F et al. Gallbladder motility in cholesterol gallstone disease. Effect of ursodeoxycholic acid administration and gallstone dissolution.  Gastroenterology. 1990;  99 (6) 1779-1785
  • 78 Caroli-Bosc F X, Pugliese P, Peten E P et al. Gallbladder volume in adults and its relationship to age, sex, body mass index, body surface area and gallstones. An epidemiologic study in a nonselected population in France.  Digestion. 1999;  60 (4) 344-348
  • 79 Everson G T, Braverman D Z, Johnson M L et al. A critical evaluation of real-time ultrasonography for the study of gallbladder volume and contraction.  Gastroenterology. 1980;  79 (1) 40-46
  • 80 Rajan M, Wali J P, Sharma M P et al. Ultrasonographic assessment of gall bladder kinetics in the elderly.  Indian J Gastroenterol. 2000;  19 (4) 158-160
  • 81 Hansen W E, Maurer H. (A simple grid for measurement of gallbladder size by real-time ultrasound (author’s transl)).  Z Gastroenterol. 1981;  19 (10) 663-666
  • 82 Wedmann B, Schmidt G, Wegener M et al. Effects of age and gender on fat-induced gallbladder contraction and gastric emptying of a caloric liquid meal: a sonographic study.  Am J Gastroenterol. 1991;  86 (12) 1765-1770
  • 83 Vezina W C, Paradis R L, Grace D M et al. Increased volume and decreased emptying of the gallbladder in large (morbidly obese, tall normal, and muscular normal) people.  Gastroenterology. 1990;  98 (4) 1000-1007
  • 84 Xynos E, Haroulakis N, Petrakis I et al. Effect of the menstrual cycle on gallbladder fasting volume and postprandial emptying in nulliparous young females.  Invest Radiol. 1997;  32 (6) 330-334
  • 85 Pansini F, Campobasso C, Giorgetti L et al. Influence of oral contraceptives on fasting gallbladder volume.  Gynecol Endocrinol. 1993;  7 (4) 267-271
  • 86 Everson G T, McKinley C, Lawson M et al. Gallbladder function in the human female: effect of the ovulatory cycle, pregnancy, and contraceptive steroids.  Gastroenterology. 1982;  82 (4) 711-719
  • 87 Braverman D Z, Johnson M L, Kern Jr F. Effects of pregnancy and contraceptive steroids on gallbladder function.  N Engl J Med. 1980;  302 (7) 362-364
  • 88 Dodds W J, Groh W J, Darweesh R M et al. Sonographic measurement of gallbladder volume.  Am J Roentgenol. 1985;  145 (5) 1009-1011
  • 89 Stolk M F, Erpecum K J, Berge Henegouwen van G P et al. Gallbladder volume and contraction measured by sum-of-cylinders method compared with ellipsoid and area-length methods.  Acta Radiol. 1990;  31 (6) 591-596
  • 90 Damiao A O, Sipahi A M, Vezozzo D P et al. Reproducibility of the ultrasound method for measurement of gallbladder volume.  Rev Hosp Clin Fac Med Sao Paulo. 1996;  51 (5) 151-153
  • 91 Yoon H J, Kim P N, Kim A Y et al. Three-dimensional sonographic evaluation of gallbladder contractility: comparison with cholescintigraphy.  J Clin Ultrasound. 2006;  34 (3) 123-127
  • 92 Hashimoto van S, Goto H, Hirooka Y et al. An evaluation of three-dimensional ultrasonography for the measurement of gallbladder volume.  Am J Gastroenterol. 1999;  94 (12) 3492-3496
  • 93 Dietrich C F, Braden B. Sonographic assessments of gastrointestinal and biliary functions.  Best Pract Res Clin Gastroenterol. 2009;  23 (3) 353-367
  • 94 Kratzer W, Walcher T, Arnold F et al. Gallstone prevalence and risk factors for gallstone disease in an urban population of children and adolescents.  Z Gastroenterol. 2010;  48 (6) 683-687
  • 95 Kratzer W, Haenle M M, Mason R A et al. Prevalence of cholelithiasis in patients with chronic inflammatory bowel disease.  World J Gastroenterol. 2005;  11 (39) 6170-6175
  • 96 Kratzer W, Fritz V, Mason R A et al. Factors affecting liver size: a sonographic survey of 2080 subjects.  J Ultrasound Med. 2003;  22 (11) 1155-1161
  • 97 Kratzer W, Kron M, Hay B et al. (Prevalence of cholecystolithiasis in South Germany – an ultrasound study of 2,498 persons of a rural population).  Z Gastroenterol. 1999;  37 (12) 1157-1162
  • 98 Kratzer W, Mason R A, Kachele V. Prevalence of gallstones in sonographic surveys worldwide.  J Clin Ultrasound. 1999;  27 (1) 1-7
  • 99 Kim M Y, Baik S K, Choi Y J et al. Endoscopic sonographic evaluation of the thickened gallbladder wall in patients with acute hepatitis.  J Clin Ultrasound. 2003;  31 (5) 245-249
  • 100 Zissin R, Osadchy A, Shapiro-Feinberg M et al. CT of a thickened-wall gall bladder.  Br J Radiol. 2003;  76 (902) 137-143
  • 101 Hunt D R, Scott A J. Changes in bile duct diameter after cholecystectomy: a 5-year prospective study.  Gastroenterology. 1989;  97 (6) 1485-1488
  • 102 Wachsberg R H. Respiratory variation of extrahepatic bile duct diameter during ultrasonography.  J Ultrasound Med. 1994;  13 (8) 617-621
  • 103 Yarmenitis S D. Ultrasound of the gallbladder and the biliary tree.  Eur Radiol. 2002;  12 (2) 270-282
  • 104 Glaser J, Stienecker K. Pancreas and aging: a study using ultrasonography.  Gerontology. 2000;  46 (2) 93-96
  • 105 Rajan E, Clain J E, Levy M J et al. Age-related changes in the pancreas identified by EUS: a prospective evaluation.  Gastrointest Endosc. 2005;  61 (3) 401-406
  • 106 Loftus W K, Metreweli C. Normal splenic size in a Chinese population.  J Ultrasound Med. 1997;  16 (5) 345-347
  • 107 Wermke W. Sonomorphometrische und Dopplersonographische Untersuchungen bei Chronischen Leberkrankheiten. 1990
  • 108 Maymon R, Strauss S, Vaknin Z et al. Normal sonographic values of maternal spleen size throughout pregnancy.  Ultrasound Med Biol. 2006;  32 (12) 1827-1831
  • 109 Nakanishi T, Ogawa H, Kawamura T et al. Comparison of convex and linear transducers for sonographic assessment of the liver, spleen, and pancreas.  Am J Roentgenol. 1984;  143 (5) 1110-1112
  • 110 Kaneko J, Sugawara Y, Matsui Y et al. Spleen size of live donors for liver transplantation.  Surg Radiol Anat. 2008;  30 (6) 515-518
  • 111 Nuernberg D, Ignee A, Dietrich C F. Ultrasound in gastroenterology – liver and spleen.  Z Gastroenterol. 2006;  44 (9) 991-1000
  • 112 Wedemeyer J, Gratz K F, Soudah B et al. Splenosis – important differential diagnosis in splenectomized patients presenting with abdominal masses of unknown origin.  Z Gastroenterol. 2005;  43 (11) 1225-1229
  • 113 Nuernberg D, Braden B, Ignee A et al. Functional ultrasound in gastroenterology.  Z Gastroenterol. 2008;  46 (9) 883-896
  • 114 Olokoba A B, Bojuwoye B J, Olokoba L B et al. The relationship between gallstone disease and gall bladder volume.  Niger J Clin Pract. 2008;  11 (2) 89-93
  • 115 Pauletzki J, Cicala M, Holl J et al. Correlation between gall bladder fasting volume and postprandial emptying in patients with gall stones and healthy controls.  Gut. 1993;  34 (10) 1443-1447
  • 116 Kishk S M, Darweesh R M, Dodds W J et al. Sonographic evaluation of resting gallbladder volume and postprandial emptying in patients with gallstones.  Am J Roentgenol. 1987;  148 (5) 875-879
  • 117 Jazrawi R P, Pazzi P, Petroni M L et al. Postprandial gallbladder motor function: refilling and turnover of bile in health and in cholelithiasis.  Gastroenterology. 1995;  109 (2) 582-591
  • 118 Erpecum K J, Berge Henegouwen van G P, Stolk M F et al. Fasting gallbladder volume, postprandial emptying and cholecystokinin release in gallstone patients and normal subjects.  J Hepatol. 1992;  14 (2 – 3) 194-202
  • 119 Cicala van M, Guarino M P, Vavassori P et al. Ultrasonographic assessment of gallbladder bile exchanges in healthy subjects and in gallstone patients.  Ultrasound Med Biol. 2001;  27 (11) 1445-1450
  • 120 Eberle F, Pfeilsticker D, Rettenmaier G. The size of the gallbladder in acute viral hepatitis.  Ultraschall in Med. 1984;  5 (3) 108-110
  • 121 Toni R, Bolondi L, Gaiani S et al. Accessory ultrasonographic findings in chronic liver disease: diameter of splenic and hepatic arteries, fasting gallbladder volume, and course of left portal vein.  J Clin Ultrasound. 1985;  13 (9) 611-618
  • 122 Agarwal A K, Miglani S, Singla S et al. Ultrasonographic evaluation of gallbladder volume in diabetics.  J Assoc Physicians India. 2004;  52 962-965
  • 123 Keshavarzian A, Dunne M, Iber F L. Gallbladder volume and emptying in insulin-requiring male diabetics.  Dig Dis Sci. 1987;  32 (8) 824-828
  • 124 Crade M, Taylor K J, Viscomi G N. Need for care in assessing gallbladder wall thickening.  Am J Roentgenol. 1980;  135 (2) 423-424
  • 125 Summers S M, Scruggs W, Menchine M D et al. A prospective evaluation of emergency department bedside ultrasonography for the detection of acute cholecystitis.  Ann Emerg Med. 2010;  56 (2) 114-122
  • 126 Ralls P W, Colletti P M, Lapin S A et al. Real-time sonography in suspected acute cholecystitis. Prospective evaluation of primary and secondary signs.  Radiology. 1985;  155 (3) 767-771
  • 127 Breda Vriesman A C, Engelbrecht M R, Smithuis R H et al. Diffuse gallbladder wall thickening: differential diagnosis.  Am J Roentgenol. 2007;  188 (2) 495-501
  • 128 Suk K T, Kim C H, Baik S K et al. Gallbladder wall thickening in patients with acute hepatitis.  J Clin Ultrasound. 2009;  37 (3) 144-148
  • 129 Ralls P W, Quinn M F, Juttner H U et al. Gallbladder wall thickening: patients without intrinsic gallbladder disease.  Am J Roentgenol. 1981;  137 (1) 65-68
  • 130 Kelbel van C, Borner N, Weilemann L S. (Ultrasound scanning of thickening of the gallbladder wall and its diagnostic significance in critical care patients).  Ultraschall in Med. 1988;  9 (3) 106-110
  • 131 Laudanna A A, Ferreyra N P, Cerri G G et al. Thickening of the gallbladder wall in alcoholic hepatitis verified by ultrasonographic examination. Its clinical implications.  Scand J Gastroenterol. 1987;  22 (5) 521-524
  • 132 Wegener M, Borsch G, Schneider J et al. Gallbladder wall thickening: a frequent finding in various nonbiliary disorders – a prospective ultrasonographic study.  J Clin Ultrasound. 1987;  15 (5) 307-312
  • 133 Talarico H P, Rubens D. Gallbladder wall thickening in acute pyelonephritis.  J Clin Ultrasound. 1990;  18 (8) 653-657
  • 134 Kim Y O, Chun K A, Choi J Y et al. Sonographic evaluation of gallbladder-wall thickening in hemorrhagic fever with renal syndrome: prediction of disease severity.  J Clin Ultrasound. 2001;  29 (5) 286-289
  • 135 Yamada K, Yamada H. Gallbladder wall thickening in mononucleosis syndromes.  J Clin Ultrasound. 2001;  29 (6) 322-325
  • 136 Donovan J E, Leech S L, Zucker R A et al. Really underage drinkers: alcohol use among elementary students.  Alcohol Clin Exp Res. 2004;  28 (2) 341-349
  • 137 Brogna A, Bucceri A M, Catalano F et al. Ultrasound demonstration of gallbladder wall thickening as a method to differentiate cirrhotic ascites from other ascites.  Invest Radiol. 1996;  31 (2) 80-83
  • 138 Hunt D R, Reiter L, Scott A J. Pre-operative ultrasound measurement of bile duct diameter: basis for selective cholangiography.  Aust N Z J Surg. 1990;  60 (3) 189-192
  • 139 Prat F, Meduri B, Ducot B et al. Prediction of common bile duct stones by noninvasive tests.  Ann Surg. 1999;  229 (3) 362-368
  • 140 Welbourn C R, Haworth J M, Leaper D J et al. Prospective evaluation of ultrasonography and liver function tests for preoperative assessment of the bile duct.  Br J Surg. 1995;  82 (10) 1371-1373
  • 141 Trondsen E, Edwin B, Reiertsen O et al. Prediction of common bile duct stones prior to cholecystectomy: a prospective validation of a discriminant analysis function.  Arch Surg. 1998;  133 (2) 162-166
  • 142 Sgourakis G, Dedemadi G, Stamatelopoulos A et al. Predictors of common bile duct lithiasis in laparoscopic era.  World J Gastroenterol. 2005;  11 (21) 3267-3272
  • 143 Ortega D, Burns P N, Hope S D et al. Tissue harmonic imaging: is it a benefit for bile duct sonography?.  Am J Roentgenol. 2001;  176 (3) 653-659
  • 144 Ripolles T, Ramirez-Fuentes C, Martinez-Perez M J et al. Tissue harmonic sonography in the diagnosis of common bile duct stones: a comparison with endoscopic retrograde cholangiography.  J Clin Ultrasound. 2009;  37 (9) 501-506
  • 145 Simeone J F, Butch R J, Mueller P R et al. The bile ducts after a fatty meal: further sonographic observations.  Radiology. 1985;  154 (3) 763-768
  • 146 Jones T B, Dubuisson R L, Hughes J J et al. Abrupt termination of the common bile duct: a sign of malignancy identified by high-resolution real-time sonography.  J Ultrasound Med. 1983;  2 (8) 345-348
  • 147 Niederau C, Sonnenberg A, Mueller J. Comparison of the extrahepatic bile duct size measured by ultrasound and by different radiographic methods.  Gastroenterology. 1984;  87 (3) 615-621
  • 148 Wachsberg R H, Kim K H, Sundaram K. Sonographic versus endoscopic retrograde cholangiographic measurements of the bile duct revisited: importance of the transverse diameter.  Am J Roentgenol. 1998;  170 (3) 669-674
  • 149 Alzaid A, Aideyan O, Nawaz S. The size of the pancreas in diabetes mellitus.  Diabet Med. 1993;  10 (8) 759-763
  • 150 El-Hodhod M A, Nassar M F, Hetta O A et al. Pancreatic size in protein energy malnutrition: a predictor of nutritional recovery.  Eur J Clin Nutr. 2005;  59 (4) 467-473
  • 151 Cuntz U, Frank G, Lehnert P et al. Interrelationships between the size of the pancreas and the weight of patients with eating disorders.  Int J Eat Disord. 2000;  27 (3) 297-303
  • 152 Feigelson J, Pecau Y, Poquet M et al. Imaging changes in the pancreas in cystic fibrosis: a retrospective evaluation of 55 cases seen over a period of 9 years.  J Pediatr Gastroenterol Nutr. 2000;  30 (2) 145-151
  • 153 Schneider K, Harms K, Fendel H. The increased echogenicity of the pancreas in infants and children: the white pancreas.  Eur J Pediatr. 1987;  146 (5) 508-511
  • 154 Jenssen C, Dietrich C F. Endoscopic ultrasound in chronic pancreatitis.  Z Gastroenterol. 2005;  43 (8) 737-749
  • 155 Lee J S, Kim S H, Jun D W et al. Clinical implications of fatty pancreas: correlations between fatty pancreas and metabolic syndrome.  World J Gastroenterol. 2009;  15 (15) 1869-1875
  • 156 Picardi M, Martinelli V, Ciancia R et al. Measurement of spleen volume by ultrasound scanning in patients with thrombocytosis: a prospective study.  Blood. 2002;  99 (11) 4228-4230
  • 157 Tassiopoulos T, Rombos Y, Konstantopoulos K et al. Spleen size in beta-thalassaemia heterozygotes.  Haematologia. 1995;  26 (4) 205-209
  • 158 Siniluoto T, Paivansalo M, Alavaikko M. Ultrasonography of spleen and liver in staging Hodgkin’s disease.  Eur J Radiol. 1991;  13 (3) 181-186
  • 159 Goerg C, Schwerk W B, Goerg K et al. Sonographic patterns of the affected spleen in malignant lymphoma.  J Clin Ultrasound. 1990;  18 (7) 569-574
  • 160 Siler J, Hunter T B, Weiss J et al. Increased echogenicity of the spleen in benign and malignant disease.  Am J Roentgenol. 1980;  134 (5) 1011-1014
  • 161 Tarantino G, Conca P, Tarantino M et al. Does spleen volume play a role in patients with HCV-related chronic hepatitis?.  Int J Immunopathol Pharmacol. 2009;  22 (4) 1009-1017
  • 162 Ditchfield M R, Gibson R N, Donlan J D et al. Duplex Doppler ultrasound signs of portal hypertension: relative diagnostic value of examination of paraumbilical vein, portal vein and spleen.  Australas Radiol. 1992;  36 (2) 102-105
  • 163 Strohm W D, Uher B. Correlation between hepatic vein pressure and diameter of portal vein and spleen as determined by ultrasound tomography in patients with liver disease (author’s transl).  Z Gastroenterol. 1979;  17 (10) 695-703
  • 164 O’Donohue J, Ng C, Catnach S et al. Diagnostic value of Doppler assessment of the hepatic and portal vessels and ultrasound of the spleen in liver disease.  Eur J Gastroenterol Hepatol. 2004;  16 (2) 147-155
  • 165 Berzigotti A, Zappoli P, Magalotti D et al. Spleen enlargement on follow-up evaluation: a noninvasive predictor of complications of portal hypertension in cirrhosis.  Clin Gastroenterol Hepatol. 2008;  6 (10) 1129-1134
  • 166 Testa R, Testa E, Giannini E et al. Noninvasive ratio indexes to evaluate fibrosis staging in chronic hepatitis C: role of platelet count/spleen diameter ratio index.  J Intern Med. 2006;  260 (2) 142-150
  • 167 Barrera F, Riquelme A, Soza A et al. Platelet count/spleen diameter ratio for non-invasive prediction of high risk esophageal varices in cirrhotic patients.  Ann Hepatol. 2009;  8 (4) 325-330
  • 168 Barikbin R, Hekmatnia A, Omidifar N et al. Prediction severity of esophageal varices: a new cutoff point for Platelet count/ spleen diameter ratio.  Minerva Gastroenterol Dietol. 2010;  56 (1) 1-6
  • 169 Cioni G, Tincani E, D’Alimonte P et al. Relevance of reduced portal flow velocity, low platelet count and enlarged spleen diameter in the non-invasive diagnosis of compensated liver cirrhosis.  Eur J Med. 1993;  2 (7) 408-410
  • 170 Ishibashi H, Okumura Y, Higuchi N et al. Differentiation of mononucleosis from hepatitis by sonographic measurement of spleen size.  J Clin Ultrasound. 1987;  15 (5) 313-316
  • 171 Chauhan R, Kapoor V, Vohra P A et al. The ‘small spleen’ in malaria.  J Assoc Physicians India. 1996;  44 (7) 483-485
  • 172 Dietrich C F, Brunner V, Seifert H et al. Intestinal B-mode sonography in patients with endemic sprue. Intestinal sonography in endemic sprue.  Ultraschall in Med. 1999;  20 (6) 242-247
  • 173 Gorg C, Eichkorn M, Zugmaier G. The small spleen: sonographic patterns of functional hyposplenia or asplenia.  J Clin Ultrasound. 2003;  31 (3) 152-155

Prof. Christoph F. Dietrich

Innere Medizin 2, Caritas Krankenhaus Bad Mergentheim

Uhlandstr. 7

97980 Bad Mergentheim

Phone:  ++ 49/79 31/58 22 01

Fax:  ++ 49/79 31/58 22 90

Email: christoph.dietrich@ckbm.de

    >