Ultrasonic features,causes of misdiagnosis and missed diagnosis,and preventive measures in patients with fatty liver and gallbladder stones

ZHANG Xuankai

doi:10.3969/j.issn.1002-3429.2025.22.002

Abstract：Objective To analyze the ultrasonic features of patients with fatty liver and gallbladder stones,the causes of misdiagnosis and missed diagnosis,as well as the preventive measures.Methods A total of 128 patients with fatty liver suspected of being accompanied by gallbladder stones who were admitted from January 2023 to December 2024 were selected and all underwent color Doppler ultrasound examination.Taking the surgical and pathological results as the gold standard,the diagnostic value of ultrasound for fatty liver complicated with gallbladder stones was evaluated.The ultrasonic features,causes of misdiagnosis and missed diagnosis,and preventive measures of patients with fatty liver and gallbladder stones were analyzed.Results Among 128 patients with fatty liver suspected of having gallbladder stones,114 were diagnosed by surgical pathology as having gallbladder stones.Compared with the surgical and pathological results,the consistency coefficient of the Kappa test for ultrasound diagnosis of fatty liver with gallbladder stones was 0.779,with a sensitivity of 99.12％,a specificity of 71.43％,and an accuracy rate of 96.09％.Among 114 patients with fatty liver and gallbladder stones,113 cases were correctly diagnosed by ultrasound.Among ultrasonic features,the proportion of typical gallbladder stones was the highest,at 61.06％,and the proportion of sludge-like gallbladder stones was the lowest,at 8.85％.Compared with female patients and those under 40 years old,the detection rate of gallbladder stones by ultrasound was higher in male patients and those aged 40 years or above(P＜0.05).A total of 4 patients(3.12％)were misdiagnosed and 1 patient(0.78％)was missed in the diagnosis of fatty liver with gallbladder stones by ultrasound.The 4 patients misdiagnosed by ultrasound as having fatty liver with gallbladder stones were respectively diagnosed with gallbladder polyps,cholestasis,cholecystitis and gallbladder atrophy.Duration of misdiagnosis was(17.69±2.51)d.One patient with fatty liver and gallbladder stones was misdiagnosed as having simple fatty liver.Conclusion Ultrasound has a relatively high accuracy rate in the diagnosis of fatty liver with gallbladder stones.However,for several atypical gallbladder stones,there are still certain misdiagnoses and missed diagnoses.Misdiagnoses and missed diagnoses are mainly related to the patient's abnormal lesions,body type,drug use history and the experience of the scanner.It is recommended that physicians make a comprehensive judgment based on the patient's medical history and ultrasonic features.In the meantime,mastering the examination techniques and characteristics of sonographic images proficiently is of great significance for reducing the rates of misdiagnosis and missed diagnosis.