Assessing the Impact of Optimized Ultrasound Methods on Gallstone Detection in Obese Patients

Abstract

Gallstone disease is a common hepatobiliary disorder, and ultrasonography remains the first-line imaging modality for its diagnosis. However, diagnostic performance may be reduced in obese patients due to increased soft-tissue attenuation, suboptimal acoustic windows, and limited gallbladder visualization. Optimized ultrasound techniques may improve image quality and diagnostic yield in this high-risk population. Objective: To assess the impact of optimized ultrasound methods on gallstone detection in obese patients at a tertiary care hospital. Methods: This prospective comparative diagnostic accuracy study was conducted in the Department of Radiology, Jinnah Hospital, Abbottabad, Pakistan, from July to November 2024. A total of 97 consecutive obese adults with suspected gallstone disease or referred for hepatobiliary ultrasonography were enrolled. Each participant underwent two sequential examinations during the same visit: a routine standard ultrasound followed by an optimized ultrasound assessment that incorporated patient repositioning, use of multiple acoustic windows, machine settings adjusted for deeper penetration, tissue harmonic imaging where available, and graded compression. The primary outcome was the incremental detection yield of optimized ultrasound for gallstone identification. Secondary outcomes included technical adequacy, conclusive scan rate, repeat imaging requirement, and diagnostic performance against the final reference standard. Results: The mean age of participants was 44.8 ± 11.6 years, and 63 (64.9%) were women. Gallstones were detected in 68 patients (70.1%) by standard ultrasonography and in 82 patients (84.5%) by optimized ultrasonography, yielding an absolute increase of 14.4%. Satisfactory gallbladder visualization improved from 73.2% to 89.7%, while conclusive examinations increased from 68.0% to 86.6%. Repeat imaging requirement decreased from 21.6% to 8.2%. Compared with the reference standard, optimized ultrasonography demonstrated higher sensitivity (95.3% vs 79.1%) and overall diagnostic accuracy (93.8% vs 80.4%) than the standard method, while specificity remained similar. Conclusion: Optimized ultrasound methods significantly improved gallbladder visualization and gallstone detection in obese patients. These findings support the routine use of protocol-based ultrasound optimization in obese individuals undergoing evaluation for suspected gallstone disease in tertiary care settings.