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He JJ, Xiong WL, Sun WQ, Pan QY, Xie LT, Jiang TA. Advances and current research status of early diagnosis for gallbladder cancer. Hepatobiliary Pancreat Dis Int 2025; 24:239-251. [PMID: 39393997 DOI: 10.1016/j.hbpd.2024.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 09/26/2024] [Indexed: 10/13/2024]
Abstract
Gallbladder cancer (GBC) is the most common malignant tumor in the biliary system, characterized by high malignancy, aggressiveness, and poor prognosis. Early diagnosis holds paramount importance in ameliorating therapeutic outcomes. Presently, the clinical diagnosis of GBC primarily relies on clinical-radiological-pathological approach. However, there remains a potential for missed diagnosis and misdiagnose in the realm of clinical practice. We firstly analyzed the blood-based biomarkers, such as carcinoembryonic antigen and carbohydrate antigen 19-9. Subsequently, we evaluated the diagnostic performance of various imaging modalities, including ultrasound (US), endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography/computed tomography (PET/CT) and pathological examination, emphasizing their strengths and limitations in detecting early-stage GBC. Furthermore, we explored the potential of emerging technologies, particularly artificial intelligence (AI) and liquid biopsy, to revolutionize GBC diagnosis. AI algorithms have demonstrated improved image analysis capabilities, while liquid biopsy offers the promise of non-invasive and real-time monitoring. However, the translation of these advancements into clinical practice necessitates further validation and standardization. The review highlighted the advantages and limitations of current diagnostic approaches and underscored the need for innovative strategies to enhance diagnostic accuracy of GBC. In addition, we emphasized the importance of multidisciplinary collaboration to improve early diagnosis of GBC and ultimately patient outcomes. This review endeavoured to impart fresh perspectives and insights into the early diagnosis of GBC.
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Affiliation(s)
- Jia-Jia He
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Department of Ultrasound Medicine, Beilun District People's Hospital, Ningbo 315800, China
| | - Wei-Lv Xiong
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Department of Ultrasound Medicine, Huzhou Central Hospital, Huzhou 313000, China
| | - Wei-Qi Sun
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Department of Ultrasound Medicine, The Second Affiliated Hospital, Jiaxing University, Jiaxing 314000, China
| | - Qun-Yan Pan
- Department of Ultrasound Medicine, Beilun District People's Hospital, Ningbo 315800, China
| | - Li-Ting Xie
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Tian-An Jiang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
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Fei X, Cheng Z, Zhu L, Han P, Li N, Jiao Z, Liang S, Jiang B, Li M, Li H, Lv W. A practical contrast-enhanced ultrasound risk prediction of gallbladder polyp: differentiation of adenoma from cholesterol polyp lesion. Abdom Radiol (NY) 2025; 50:747-756. [PMID: 39254706 DOI: 10.1007/s00261-024-04566-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 08/26/2024] [Accepted: 08/30/2024] [Indexed: 09/11/2024]
Affiliation(s)
- Xiang Fei
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhihao Cheng
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Lianhua Zhu
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Peng Han
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Nan Li
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ziyu Jiao
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shuyuan Liang
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Bo Jiang
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Miao Li
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hongtian Li
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China.
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.
| | - Wenping Lv
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
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Ruan L, Wu X, Peng G, Zhang J, Chen W. Application of contrast-enhanced ultrasonography for gallbladder squamous cell carcinoma: a case report. Front Oncol 2024; 14:1502226. [PMID: 39723365 PMCID: PMC11668673 DOI: 10.3389/fonc.2024.1502226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 11/25/2024] [Indexed: 12/28/2024] Open
Abstract
Preoperative diagnosis of Gallbladder squamous cell carcinoma (GBSCC) is difficult, and the contrast-enhanced ultrasound (CEUS) pattern has never been reported before. We present a case of GBSCC where CEUS revealed special findings that facilitated early diagnosis. CEUS demonstrated irregular peripheral ring-like enhancement during the arterial phase, with hypoenhancement in the late phases, and an irregular non-enhancing area persistently present in the center of the lesion.
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Affiliation(s)
- Liqin Ruan
- Department of Hepatobiliary Surgery, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang No.1 People’s Hospital Jiujiang, Jiujiang, Jiangxi, China
| | - Xiaoyong Wu
- Department of Hepatobiliary Surgery, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang No.1 People’s Hospital Jiujiang, Jiujiang, Jiangxi, China
| | - Guiping Peng
- Department of Ultrasound, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang No.1 People’s Hospital Jiujiang, Jiujiang, Jiangxi, China
| | - Jing Zhang
- Laboratory of Pathology, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang No.1 People’s Hospital Jiujiang, Jiujiang, Jiangxi, China
| | - Weili Chen
- Department of Hepatobiliary Surgery, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang No.1 People’s Hospital Jiujiang, Jiujiang, Jiangxi, China
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Patel R, Tse JR, Shen L, Bingham DB, Kamaya A. Improving Diagnosis of Acute Cholecystitis with US: New Paradigms. Radiographics 2024; 44:e240032. [PMID: 39541246 DOI: 10.1148/rg.240032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
Acute cholecystitis is an inflammatory condition of the gallbladder typically incited by mechanical obstruction. Accurate diagnosis of this common clinical condition is challenging due to variable imaging appearances as well as overlapping clinical manifestations with biliary colic, acute hepatitis, pancreatitis, and cholangiopathies. In acute cholecystitis, increased dilatation and high intraluminal pressures lead to gallbladder inflammation and may progress to gangrenous changes, focal wall necrosis, and subsequent perforation. In acute calculous cholecystitis, gallstones are the cause of obstruction and are often impacted in the gallbladder neck or cystic duct, leading to gallbladder inflammation. In acalculous cholecystitis, patients are typically critically ill, often with hypotensive episodes and prolonged gallbladder stasis, which lead to obstruction, gallbladder ischemia, and inflammation. Helpful sonographic findings of acute cholecystitis include a dilated gallbladder; increased intraluminal pressures in the gallbladder, resulting in a bulging fundus (tensile fundus sign); intraluminal sludge in the setting of right upper quadrant pain; wall hyperemia, which may be quantified by elevated cystic artery velocities or hepatic artery velocities; mucosal ischemic changes, characterized by loss of mucosal echogenicity; pericholecystic inflammation, characterized by hyperechoic pericholecystic fat; and mucosal discontinuity. Extruded complex fluid next to a wall defect is definitive for gallbladder wall perforation, and further evaluation with CT or MRI allows evaluation of the full extent of perforation and other potential complications. The sonographic Murphy sign, while helpful if positive, is relatively insensitive for accurate diagnosis of acute cholecystitis. Thus, overreliance on the sonographic Murphy sign results in surprisingly low diagnostic accuracy in practice.
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Affiliation(s)
- Richa Patel
- From the Departments of Radiology (R.P., J.R.T., L.S., A.K.) and Pathology (D.B.B.), Stanford University, 300 Pasteur Dr, Palo Alto, CA 94304
| | - Justin R Tse
- From the Departments of Radiology (R.P., J.R.T., L.S., A.K.) and Pathology (D.B.B.), Stanford University, 300 Pasteur Dr, Palo Alto, CA 94304
| | - Luyao Shen
- From the Departments of Radiology (R.P., J.R.T., L.S., A.K.) and Pathology (D.B.B.), Stanford University, 300 Pasteur Dr, Palo Alto, CA 94304
| | - David B Bingham
- From the Departments of Radiology (R.P., J.R.T., L.S., A.K.) and Pathology (D.B.B.), Stanford University, 300 Pasteur Dr, Palo Alto, CA 94304
| | - Aya Kamaya
- From the Departments of Radiology (R.P., J.R.T., L.S., A.K.) and Pathology (D.B.B.), Stanford University, 300 Pasteur Dr, Palo Alto, CA 94304
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Wang R, Lv L, Li L. Diagnostic performance of the gallbladder reporting and data system combined with color doppler flow imaging for gallbladder cancer in the Asian population. Front Oncol 2024; 14:1367351. [PMID: 38686188 PMCID: PMC11056497 DOI: 10.3389/fonc.2024.1367351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/27/2024] [Indexed: 05/02/2024] Open
Abstract
Purpose Evaluating the performance of the Gallbladder Reporting and Data System (GB-RADS) combined with Color Doppler Flow Imaging (CDFI) for the diagnosis of gallbladder wall thickening disease in an Asian population. Methods In this study, the lesions were classified and the actual incidence rate of malignant tumors was calculated for each GB-RADS category, following the guidelines provided by GB-RADS. To evaluate the diagnostic performance of GB-RADS and GB-RADS combined with CDFI, we plotted Receiver Operator Characteristic (ROC) curves. The sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and accuracy (AC) were also calculated. Inter-observer agreement (IRA) between the two observers was assessed using Kappa values. Results The incidence of malignancy risk for GB-RADS 2, 3, 4, and 5 was 9%, 12.5%, 72.2%, and 100%. The AUC for GB-RADS was 0.855 (95% CI: 0.800-0.900), with a sensitivity of 82.5%, a specificity of 84.6%, and an accuracy of 83.8%. The AUC of GB-RADS combined with CDFI was 0.965 (95% CI: 0.930-0.985), with a sensitivity of 96.2%, a specificity of 94.6%, and an accuracy of 95.2%. The AUC, sensitivity, specificity, and accuracy of GB-RADS combined with CDFI for diagnosing gallbladder malignancy were higher than those of GB-RADS alone, and the differences were statistically significant (all P < 0.05). The IRA was excellent between the two observers (Kappa = 0.870). Conclusions GB-RADS combined with CDFI demonstrated excellent diagnostic accuracy when it comes to distinguishing various diseases that caused gallbladder wall thickening in the Asian population, which has good clinical value and can improve the detection rate of malignant tumors in patients with gallbladder wall thickening.
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Affiliation(s)
| | | | - Li Li
- Department of Ultrasound, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong, China
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Zhu L, Li N, Zhu Y, Han P, Jiang B, Li M, Luo Y, Clevert DA, Fei X. Value of high frame rate contrast enhanced ultrasound in gallbladder wall thickening in non-acute setting. Cancer Imaging 2024; 24:7. [PMID: 38191513 PMCID: PMC10775603 DOI: 10.1186/s40644-023-00651-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/25/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Ultrasound (US) has been widely used in screening and differential diagnosis of gallbladder wall thickening (GWT). However, the sensitivity and specificity for diagnosing wall-thickening type gallbladder cancer are limited, leading to delayed treatment or overtreatment. We aim to explore the value of high frame rate contrast enhanced ultrasound (H-CEUS) in distinguishing wall-thickening type gallbladder cancer (malignant) from GWT mimicking malignancy (benign). METHODS This retrospective study enrolled consecutive patients with non-acute GWT who underwent US and H-CEUS examination before cholecystectomy. Clinical information, US image and H-CEUS image characteristics between malignant and benign GWT were compared. The independent risk factors for malignant GWT on H-CEUS images were selected by multivariate logistic regression analysis. The diagnostic performance of H-CEUS in determining malignant GWT was compared with that of the gallbladder reporting and data system (GB-RADS) score. RESULTS Forty-six patients included 30 benign GWTs and 16 malignant GWTs. Only mural layering and interface with liver on US images were significantly different between malignant and benign GWT (P < 0.05). Differences in enhancement direction, vascular morphology, serous layer continuity, wash-out time and mural layering in the venous phase of GWT on H-CEUS images were significant between malignant and benign GWT (P < 0.05). The sensitivity, specificity and accuracy of H-CEUS based on enhancement direction, vascular morphology and wash-out time in the diagnosis of malignant GWT were 93.75%, 90.00%, and 91.30%, respectively. However, the sensitivity, specificity and accuracy of the GB-RADS score were only 68.75%, 73.33% and 71.74%, respectively. The area under ROC curve (AUC) of H-CEUS was significantly higher than that of the GB-RADS score (AUC = 0.965 vs. 0.756). CONCLUSIONS H-CEUS can accurately detect enhancement direction, vascular morphology and wash-out time of GWT, with a higher diagnostic performance than the GB-RADS score in determining wall-thickening type gallbladder cancer. This study provides a novel imaging means with high accuracy for the diagnosis of wall-thickening type gallbladder cancer, thus may be better avoiding delayed treatment or overtreatment.
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Affiliation(s)
- Lianhua Zhu
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Nan Li
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yaqiong Zhu
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Peng Han
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Bo Jiang
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Miao Li
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Dirk-André Clevert
- Department of Clinical Radiology, Interdisciplinary Ultrasound-Center, University of Munich, Grosshadern Campus, Munich, Germany.
| | - Xiang Fei
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Beijing, China.
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Matsubara H, Suzuki H, Naitoh T, Urano F, Kiura N. Usefulness of contrast-enhanced ultrasonography for biliary tract disease. J Med Ultrason (2001) 2023:10.1007/s10396-023-01338-3. [PMID: 37523000 DOI: 10.1007/s10396-023-01338-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/26/2023] [Indexed: 08/01/2023]
Abstract
Conventional ultrasonography (US) for biliary tract disease shows high time and spatial resolution. In addition, it is simple and minimally invasive, and is selected as a first-choice examination procedure for biliary tract disease. Currently, contrast-enhanced US (CEUS), which facilitates the more accurate assessment of lesion blood flow in comparison with color and power Doppler US, is performed using a second-generation ultrasonic contrast agent. Such agents are stable and provide a timeline for CEUS diagnosis. Gallbladder lesions are classified into three types: gallbladder biliary lesion (GBL), gallbladder polypoid lesion (GPL), and gallbladder wall thickening (GWT). Bile duct lesions can also be classified into three types: bile duct biliary lesion (BBL), bile duct polypoid lesion (BDPL), and bile duct wall thickening (BDWT). CEUS facilitates the differentiation of GBL/BBL from tumorous lesions based on the presence or absence of blood vessels. In the case of GPL, it is important to identify a vascular stalk attached to the lesion. In the case of GWT, the presence or absence of a non-contrast-enhanced area, the Rokitansky-Aschoff sinus, and continuity of a contrast-enhanced gallbladder wall layer are important for differentiation from gallbladder cancer. In the case of BDWT, it is useful to evaluate the contour of the contrast-enhanced medial layer of the bile duct wall for differentiating IgG4-related sclerosing cholangitis from primary sclerosing cholangitis. CEUS for ampullary carcinoma accurately reflects histopathological findings of the lesion. Evaluating blood flow in the lesion, continuity of the gallbladder wall, and contour of the bile duct wall via CEUS provides useful information for the diagnosis of biliary tract disease.
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Affiliation(s)
- Hiroshi Matsubara
- Department of Gastroenterology, Toyohashi Municipal Hospital, 50 Hakkennishi, Aotake, Toyohashi, Aichi, 441-8570, Japan.
| | - Hirotaka Suzuki
- Department of Gastroenterology, Toyohashi Municipal Hospital, 50 Hakkennishi, Aotake, Toyohashi, Aichi, 441-8570, Japan
| | - Takehito Naitoh
- Department of Gastroenterology, Toyohashi Municipal Hospital, 50 Hakkennishi, Aotake, Toyohashi, Aichi, 441-8570, Japan
| | - Fumihiro Urano
- Department of Gastroenterology, Toyohashi Municipal Hospital, 50 Hakkennishi, Aotake, Toyohashi, Aichi, 441-8570, Japan
| | - Nobuyuki Kiura
- Department of Gastroenterology, Toyohashi Municipal Hospital, 50 Hakkennishi, Aotake, Toyohashi, Aichi, 441-8570, Japan
- Department of Radiology, Toyohashi Municipal Hospital, 50 Hakkennishi, Aotake, Toyohashi, Aichi, 441-8570, Japan
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Nugent JP, Li J, Pang E, Harris A. What's new in the hot gallbladder: the evolving radiologic diagnosis and management of acute cholecystitis. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:31-46. [PMID: 35230497 DOI: 10.1007/s00261-022-03451-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 02/06/2023]
Abstract
Acute cholecystitis (AC) is a common condition and its incidence is rising. New technologies have advanced the imaging diagnosis of AC, providing more structural and functional information as well as allowing the radiologist to distinguish AC from mimics and identify complications from both the disease and its management. Dual energy CT aids in detecting gallstones and gallbladder wall enhancement, which helps to diagnose AC and identify its complications. Similarly, contrast-enhanced and non-contrast perfusion ultrasound techniques improve detection of abnormal gallbladder wall enhancement. Advances in MR imaging including hepatobiliary contrast agents aid in characterizing post-cholecystectomy complications such as bile leaks. Newer interventional techniques have also expanded the suite of options for minimally invasive management. Lumen apposing metal stents provide more options for conservative treatment in non-surgical candidates and are compared to a standard percutaneous cholecystostomy. Radiologists should be familiar with these advanced imaging methods and intervention techniques and the value they can bring to the diagnosis and management of AC.
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Affiliation(s)
- James P Nugent
- Department of Radiology, Faculty of Medicine, University of British Columbia, 2775 Laurel Street 11th Floor, Vancouver, V5Z 1M9, Canada.
| | - Jessica Li
- Department of Radiology, Faculty of Medicine, University of British Columbia, 2775 Laurel Street 11th Floor, Vancouver, V5Z 1M9, Canada
| | - Emily Pang
- Department of Radiology, Faculty of Medicine, University of British Columbia, 2775 Laurel Street 11th Floor, Vancouver, V5Z 1M9, Canada
| | - Alison Harris
- Department of Radiology, Faculty of Medicine, University of British Columbia, 2775 Laurel Street 11th Floor, Vancouver, V5Z 1M9, Canada
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Zhang X, Tang S, Huang L, Jin H, Wang Y, Wang Y, Liu Z, Lu C. Value of contrast-enhanced ultrasound in diagnosis and differential diagnosis of polypoid lesions of gallbladder ≥ 1 cm. BMC Gastroenterol 2022; 22:354. [PMID: 35879663 PMCID: PMC9316436 DOI: 10.1186/s12876-022-02373-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To evaluate the usefulness of Contrast-enhanced ultrasound (CEUS) in the diagnosis and differential diagnosis of Polypoid lesions of gallbladder (PLGs) ≥ 1 cm. METHODS A prospective analysis was performed on 180 patients with PLGs ≥ 1 cm. 175 cases were confirmed by pathological diagnosis and the remaining were confirmed by other imaging findings. The characteristics of lesions on conventional Ultrasonography (US) and CEUS were recorded. RESULTS Significant differences were observed in enhancement patterns between benign and malignant PLGs during both arterial (P < 0.001) and venous phases (P < 0.001). The malignant lesions typically yielded a "fast-in and fast-out" enhancement pattern. There was no significant difference in Arrival time (AT) between malignant and benign PLGs. If we consider wash-out time ≤ 40 s as a diagnostic standard for malignant lesions, the sensitivity, specificity, and accuracy were 88.24%, 85.62%, and 86.11%, respectively. Destruction of the Gallbladder (GB) wall was a particularly important indication of malignant PLGs, and the sensitivity, specificity, and accuracy were 93.33%, 92.12%, and 92.22%, respectively. The accuracy of CEUS in the diagnosis of PLGs, as well as malignant and benign lesions, was 92.22%, 92.47%, and 91.17%, respectively. CONCLUSIONS The "fast-in and fast-out" enhancement pattern, hyper-enhancement in comparison to the GB wall in the arterial phase, wash-out time ≤ 40 s, GB wall destruction, and hepatic parenchymal infiltration are the characteristic findings of malignant PLGs. Besides, CEUS provides a valuable reference to classify some of the benign lesions.
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Affiliation(s)
- Xiaoyue Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Sanhao Street No. 36, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Shaoshan Tang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Sanhao Street No. 36, Heping District, Shenyang, 110004, Liaoning Province, China.
| | - Liping Huang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Sanhao Street No. 36, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Hong Jin
- Department of Ultrasound, Shengjing Hospital of China Medical University, Sanhao Street No. 36, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Yijiao Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Sanhao Street No. 36, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Yao Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Sanhao Street No. 36, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Zhan Liu
- Department of Ultrasound, Shengjing Hospital of China Medical University, Sanhao Street No. 36, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Chunyu Lu
- Department of Ultrasound, Shengjing Hospital of China Medical University, Sanhao Street No. 36, Heping District, Shenyang, 110004, Liaoning Province, China
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Wang X, Zhu JA, Liu YJ, Liu YQ, Che DD, Niu SH, Gao S, Chen DB. Conventional Ultrasound Combined With Contrast-Enhanced Ultrasound in Differential Diagnosis of Gallbladder Cholesterol and Adenomatous Polyps (1-2 cm). JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:617-626. [PMID: 33938029 DOI: 10.1002/jum.15740] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/15/2021] [Accepted: 04/17/2021] [Indexed: 05/23/2023]
Abstract
OBJECTIVES This study aimed to determine ultrasonic image characteristics that enable differentiation between cholesterol and adenomatous polyps and to assess the diagnostic efficacy of combining conventional ultrasound (CUS) with contrast-enhanced ultrasound (CEUS). METHODS Eighty-nine patients with gallbladder polyps of 1-2 cm in diameter were enrolled and examined by CUS and CEUS before cholecystectomy. The appearances on CUS and CEUS were recorded and analyzed. The receiver operating characteristic (ROC) curve was used to calculate the optimal size threshold for distinguishing cholesterol from adenomatous polyps. A logistic regression analysis was performed to identify diagnostic variables. ROC analysis was performed to evaluate the diagnostic efficacy of the size, the independent variables, and the combined factors. RESULTS There were differences in size, number, vascularity on CUS and intralesional vascular shape, wash-out, and area under the curve on CEUS between the two groups (P < .05). ROC analysis indicated that a maximum diameter of 1.45 cm was the optimal threshold for the prediction of adenomatous polyps. The logistic regression analysis proved that the single polyp, presence of vascularity, and intralesional linear vessels were associated with adenomatous polyps (P < .05). ROC analysis showed that the area under the ROC curve, sensitivity, and specificity for the combination of the three independent variables were 0.858, 87.3%, and 67.6%. The number combined with intralesional vascular shape had the highest diagnostic sensitivity of 91.2%. CONCLUSIONS The combination of CUS and CEUS demonstrated great significance in the differential diagnosis of cholesterol and adenomatous polyps.
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Affiliation(s)
- Xue Wang
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Jia-An Zhu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Yue-Jie Liu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Yi-Qun Liu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Dong-Dong Che
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Si-Hua Niu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Shuang Gao
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Ding-Bao Chen
- Department of Pathology, Peking University People's Hospital, Beijing, China
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Franke D, Anupindi SA, Barnewolt CE, Green TG, Greer MLC, Harkanyi Z, Lorenz N, McCarville MB, Mentzel HJ, Ntoulia A, Squires JH. Contrast-enhanced ultrasound of the spleen, pancreas and gallbladder in children. Pediatr Radiol 2021; 51:2229-2252. [PMID: 34431006 DOI: 10.1007/s00247-021-05131-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 04/30/2021] [Accepted: 06/10/2021] [Indexed: 12/14/2022]
Abstract
Gray-scale and color/power Doppler ultrasound (US) are the first-line imaging modalities to evaluate the spleen, gallbladder and pancreas in children. The increasing use of contrast-enhanced ultrasound (CEUS) as a reliable and safe method to evaluate liver lesions in the pediatric population promises potential for imaging other internal organs. Although CEUS applications of the spleen, gallbladder and pancreas have been well described in adults, they have not been fully explored in children. In this manuscript, we present an overview of the applications of CEUS for normal variants and diseases affecting the spleen, gallbladder and pancreas. We highlight a variety of cases as examples of how CEUS can serve in the diagnosis and follow-up for such diseases in children. Our discussion includes specific examination techniques; presentation of the main imaging findings in various benign and malignant lesions of the spleen, gallbladder and pancreas in children; and acknowledgment of the limitations of CEUS for these organs.
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Affiliation(s)
- Doris Franke
- Department of Pediatric Kidney, Liver and Metabolic Diseases, MHH, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Sudha A Anupindi
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Carol E Barnewolt
- Department of Radiology, Boston Children's Hospital, Harvard University, Boston, MA, USA
| | - Thomas G Green
- Department of Radiology, Crouse Hospital, Syracuse, NY, USA
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Zoltan Harkanyi
- Department of Radiology, Heim Pal National Pediatric Institute, Budapest, Hungary
| | - Norbert Lorenz
- Children's Hospital, Dresden Municipal Hospital, Teaching-Hospital of Technical University Dresden, Dresden, Germany
| | - M Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Hans-Joachim Mentzel
- Section of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, University Hospital, Jena, Germany
| | - Aikaterini Ntoulia
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Judy H Squires
- Department of Radiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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12
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Fei X, Li N, Zhu L, Han P, Jiang B, Tang W, Sang M, Zhang X, Luo Y. Value of high frame rate contrast-enhanced ultrasound in distinguishing gallbladder adenoma from cholesterol polyp lesion. Eur Radiol 2021; 31:6717-6725. [PMID: 33569621 DOI: 10.1007/s00330-021-07730-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/10/2020] [Accepted: 01/28/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To compare the diagnostic value of high frame rate contrast-enhanced ultrasound (H-CEUS) in distinguishing gallbladder adenomas from cholesterol polyp lesions with that of CEUS. METHODS This study enrolled 94 patients with gallbladder polyp lesions (GPLs) who underwent laparoscopic cholecystectomy. CEUS and H-CEUS were performed before surgery. The perfusion features of GPLs and the final diagnosis as determined by both technologies were compared. RESULTS There were differences in vascular types between gallbladder adenomas and cholesterol polyp lesions observed on H-CEUS (p < 0.05), while there were no differences in vascular types between gallbladder adenomas and cholesterol polyp lesions observed on CEUS (p > 0.05). In the cholesterol polyp lesion group, there were no differences in vascular types between CEUS and H-CEUS (p > 0.05), while the vascular types were different between CEUS and H-CEUS in the gallbladder adenoma group (p < 0.05). The diagnostic value of H-CEUS in distinguishing gallbladder adenomas from cholesterol polyp lesions was better than that of CEUS. CONCLUSIONS H-CEUS improved the time resolution by increasing the frame rate, which helped to accurately reflect the difference in the microcirculation of GPLs and improved the ability of a differential diagnosis between cholesterol polyp lesions and adenomas. H-CUES may provide an effective means of imaging for patients with GPLs regarding the choice of treatment options. KEY POINTS • High frame rate CEUS improves the time resolution of CEUS by increasing the frame rate. • High frame rate CEUS is helpful to accurately evaluate the microvascular morphology of a gallbladder polyp lesion in the arterial phase. • High frame rate CEUS helps patients with gallbladder polyp lesions to choose the appropriate treatment means.
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Affiliation(s)
- Xiang Fei
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Nan Li
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Lianhua Zhu
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Peng Han
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Bo Jiang
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Wenbo Tang
- Department of Hepatobiliary Surgery, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Maodong Sang
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Nanshan District, Shenzhen, 518055, China
| | - Xirui Zhang
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Nanshan District, Shenzhen, 518055, China
| | - Yukun Luo
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China.
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13
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Hunt TM, Waletzko MR, Knudsen JM, Atwell TD, Chupka NM. The Effectiveness of Identifying Primary Gallbladder Adenocarcinoma Utilizing Contrast-Enhanced Ultrasound: A Case Report. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/87564793211018959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gallbladder carcinoma is rare and difficult to detect in the early stages of the disease process, due to lack of symptoms. Sonography is typically the first modality of choice for assessing gallbladder pathology due to its high sensitivity, portability, real-time imaging capability, and non-ionizing technique. Conventional gray-scale and color Doppler sonographic imaging may be ambiguous for diagnosing solid tumors, such as gallbladder carcinoma. In this case, gallbladder carcinoma was definitively diagnosed utilizing contrast-enhanced ultrasound, allowing for quick patient treatment options and an optimal surgical outcome.
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Yuan Z, Liu X, Li Q, Zhang Y, Zhao L, Li F, Chen T. Is Contrast-Enhanced Ultrasound Superior to Computed Tomography for Differential Diagnosis of Gallbladder Polyps? A Cross-Sectional Study. Front Oncol 2021; 11:657223. [PMID: 34109116 PMCID: PMC8181139 DOI: 10.3389/fonc.2021.657223] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/27/2021] [Indexed: 01/12/2023] Open
Abstract
Objective To compare the clinical value of contrast-enhanced ultrasonography (CEUS) versus computed tomography (CT) for distinguishing neoplastic and non-neoplastic gallbladder polyps. Given whether laparoscopic cholecystectomy is needed, differential diagnosis of neoplastic and non-neoplastic gallbladder polyps is more important than benign and malignant polyps. Methods A total of 89 consecutive patients with polypoid lesions of the gallbladder > 10 mm in size without local invasion or distant metastasis during primary screening were enrolled in this prospective and comparative study. All patients who met the inclusion criteria underwent CEUS and CT examinations prior to surgical resection. The enhancement patterns and microvascular imaging types were analyzed on CEUS. The maximum diameter and CT value of the lesions were also recorded and subjected to a comparative analysis. The clinical value of the two diagnostic methods is compared. Results Of the 89 patients, there were 58 (65.2%) cases of non-neoplastic polyps and 31 (34.8%) cases of neoplastic polyps. The average diameter of neoplastic polyps was significantly higher than that of non-neoplastic polyps (P<0.001). The detection rate using CEUS was 100%. The proportion of perceived non-neoplastic polyps in the nonenhanced and arterial phases were 48.3% and 77.6%, respectively, which were significantly lower than those of neoplastic polyps (93.5%, P<0.001 and 100.0%, P<0.001, respectively). However, in the venous and delayed phases, all cholesterol polyps and neoplastic polyps were perceived. CT showed that non-neoplastic polyps exhibited delayed enhancement. On CEUS 29.0% neoplastic polyps showed a perfusion defect, whereas 6.9% non-neoplastic polyps showed a perfusion defect (P=0.005). The microvascular architecture of the lesions on CEUS was categorized into 4 types: spotty, linear, branched, and spinous, and there were significant differences between the two groups (P<0.001). The sensitivities and specificities were 87.10% and 68.97% for CEUS and 83.87% and 77.59% for CT, respectively (P=0.406). Conclusions CEUS and CT are useful for differential diagnosis of neoplastic and nonneoplastic polypoid lesions of the gallbladder. Diagnostic efficacy was comparable between CEUS and CT. Thus, CEUS is preferred over CT in the differential diagnosis of neoplastic and non-neoplastic gallbladder polyps due to its comparable diagnostic efficacy and lack of radiation dose.
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Affiliation(s)
- Zhiqing Yuan
- Department of General Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xuesong Liu
- Department of Ultrasound, RenJi Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiwei Li
- Department of General Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yunhe Zhang
- Department of Critical Care Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ling Zhao
- Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fenghua Li
- Department of Ultrasound, RenJi Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tao Chen
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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15
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Zhu L, Han P, Lee R, Jiang B, Jiao Z, Li N, Tang W, Fei X. Contrast-enhanced ultrasound to assess gallbladder polyps. Clin Imaging 2021; 78:8-13. [PMID: 33706069 DOI: 10.1016/j.clinimag.2021.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the value of contrast-enhanced ultrasound (CEUS) in distinguishing adenomatous gallbladder polyps from cholesterol gallbladder polyps. METHODS A total of 164 patients with gallbladder polyps were retrospectively analyzed. All patients underwent B-mode ultrasound (US) and CEUS before cholecystectomy. Gallbladder polyps were divided into cholesterol polyp group and adenomatous polyp group according to pathology. Differences in patient's age, gender, maximum polyp size, number, presence of gallstones, vascularity and stalk width measured by US and vascular stalk width measured by CEUS were tested between the two groups. The diagnostic performance of specific US features was evaluated. The independent factors related with adenomatous polyps were analyzed by multiple logistic regression analyses. RESULTS There were 114 cholesterol polyps and 50 adenomatous polyps in 164 patients analyzed in the study. Differences in maximum size, vascularity, and stalk width of the gallbladder polyp were significant between the two groups (p < 0.05), whereas differences in patient's age, gender, number of gallbladder polyp, and presence of gallstones between the two groups were not (p > 0.05). Stalk width was wider than vascular stalk width between the two groups (p < 0.05). Vascular stalk width was also statistically different between the two groups (p < 0.05). The diagnostic performance of vascular stalk width was more significant than stalk width. Only vascular stalk width and vascularity were independent factors related with adenomatous polyps. CONCLUSION Vascular stalk width measured by CEUS is more accurate than stalk width measured by grayscale US in distinguishing adenomatous polyps from cholesterol polyps.
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Affiliation(s)
- Lianhua Zhu
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Peng Han
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Regis Lee
- Department of Ultrasound in Research and Education, Rocky Vista University, 255 East Center Street, Room C286, Ivins, UT 84738, USA
| | - Bo Jiang
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Ziyu Jiao
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Nan Li
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Wenbo Tang
- Department of Hepatobiliary Surgery, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Xiang Fei
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China.
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Randhawa DS, Shoucair S, McCarron E. Silent and formidable foe: neuroendocrine tumours of the gallbladder. BMJ Case Rep 2020; 13:13/12/e237063. [PMID: 33370977 PMCID: PMC7757469 DOI: 10.1136/bcr-2020-237063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Neuroendocrine neoplasms of the gallbladder occur infrequently, with the diagnosis being incidental in most cases. We present a case of an 81-year-old African American woman who initially presented with acute suppurative cholecystitis, found on pathology to have a moderately differentiated infiltrating adenocarcinoma. A partial hepatic resection with periportal lymph node dissection was planned which was subsequently aborted intraoperatively due to the presence of diffuse carcinomatosis. Pathology of the cancerous lesions revealed neuroendocrine carcinoma. Gallbladder neuroendocrine tumours demonstrate no specific clinical features. Given its often late presentation, neuroendocrine tumours of the gallbladder pose a therapeutic and prognostic challenge.
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Affiliation(s)
| | - Sami Shoucair
- Department of Surgery, MedStar Health, Columbia, Maryland, USA
| | - Edward McCarron
- Department of Surgery, MedStar Health, Columbia, Maryland, USA
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17
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Behzadmehr R, Salarzaei M. Is contrast enhanced ultrasonography an accurate way to diagnose gallbladder adenoma? A systematic review and meta-analysis. J Med Imaging Radiat Sci 2020; 52:127-136. [PMID: 33129756 DOI: 10.1016/j.jmir.2020.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/26/2020] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Gallbladder adenoma (GA) is a precancerous neoplasm and needs surgical resection. It is difficult to differentiate adenoma from other gallbladder polyps using imaging examinations. The aim of present systematic review and meta-analysis was to evaluate the diagnostic accuracy of contrast-enhanced ultrasound in the diagnosis of gallbladder adenoma. METHODS The searches were conducted by two independent researchers to find the relevant studies published from 1/1/2009 until end of 30/06/2019. The search included published literature in the English language in MEDLINE via PubMed, EMBASE via Ovid, The Cochrane Library, and Trip databases. For literature published in other languages, national databases (Magiran and SID), KoreaMed, and LILACS were searched. The risk of bias of every article was evaluated by using QUADAS-2. On the basis of the results from the 2 × 2 tables, pooled measures for sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curves (AUC) along with their 95% confidence intervals (CIs) were calculated using the DerSimonian Lair methodology. RESULTS Overall, 868 patients were studied in the 10 studies chosen for inclusion. Of these 10 studies, 5 (50%) were retrospective and 5 (50%) were prospective. The total prevalence of gallbladder adenoma in 10 studies was 16% (95% CI 13%, 18%). The sensitivity and specificity of contrast-enhanced ultrasound were 0.846 (95% CI 0.818-0.871) and 0.870 (95% CI: 0.844-0.894), respectively. The diagnostic odds ratio was 40.807 (95% CI 18.838-88.393). CONCLUSION CEUS is a reliable, non-invasive, and no-radiation-exposure imaging modality with a high sensitivity and specificity for detection of gallbladder adenoma. Nonetheless, it should be applied cautiously, and large scale, well-designed trials are necessary to assess its clinical value.
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Affiliation(s)
- Razieh Behzadmehr
- Associate Professor of Radiology, Zabol University of Medical Sciences, Zabol, Iran
| | - Morteza Salarzaei
- Student Research Committee, Zabol University of Medical Sciences, Zabol, Iran.
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Gupta P, Marodia Y, Bansal A, Kalra N, Kumar-M P, Sharma V, Dutta U, Sandhu MS. Imaging-based algorithmic approach to gallbladder wall thickening. World J Gastroenterol 2020; 26:6163-6181. [PMID: 33177791 PMCID: PMC7596646 DOI: 10.3748/wjg.v26.i40.6163] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/12/2020] [Accepted: 09/16/2020] [Indexed: 02/06/2023] Open
Abstract
Gallbladder (GB) wall thickening is a frequent finding caused by a spectrum of conditions. It is observed in many extracholecystic as well as intrinsic GB conditions. GB wall thickening can either be diffuse or focal. Diffuse wall thickening is a secondary occurrence in both extrinsic and intrinsic pathologies of GB, whereas, focal wall thickening is mostly associated with intrinsic GB pathologies. In the absence of specific clinical features, accurate etiological diagnosis can be challenging. The survival rate in GB carcinoma (GBC) can be improved if it is diagnosed at an early stage, especially when the tumor is confined to the wall. The pattern of wall thickening in GBC is often confused with benign diseases, especially chronic cholecystitis, xanthogranulomatous cholecystitis, and adenomyomatosis. Early recognition and differentiation of these conditions can improve the prognosis. In this minireview, the authors describe the patterns of abnormalities on various imaging modalities (conventional as well as advanced) for the diagnosis of GB wall thickening. This paper also illustrates an algorithmic approach for the etiological diagnosis of GB wall thickening and suggests a formatted reporting for GB wall abnormalities.
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Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Yashi Marodia
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Akash Bansal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Naveen Kalra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Manavjit Singh Sandhu
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Hu J, Zhou ZY, Ran HL, Yuan XC, Zeng X, Zhang ZY. Diagnosis of liver tumors by multimodal ultrasound imaging. Medicine (Baltimore) 2020; 99:e21652. [PMID: 32769936 PMCID: PMC7593067 DOI: 10.1097/md.0000000000021652] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/30/2020] [Accepted: 07/08/2020] [Indexed: 12/12/2022] Open
Abstract
To investigate the diagnostic value of multimodal ultrasound imaging composed of conventional ultrasonography (US), contrast-enhanced ultrasonography (CEUS), and shear wave elastography (SWE) for liver tumors.Between October 2017 and October 2019, US, CEUS, and SWE examinations of a total of 158 liver tumors in 136 patients at The First Affiliated Hospital of Nanchang University were performed. The histopathological or imaging diagnostic results were used as controls to evaluate the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of US, CEUS, SWE, and multimodal ultrasound imaging, which combines these 3 modes, in the differential diagnosis of benign and malignant liver tumors.Among the 158 tumors, there were 64 benign tumors, including 55 cases of hepatic hemangioma, 3 cases of focal nodular hyperplasia of the liver, 4 cases of hepatic cyst, and 2 cases of focal nonuniform distribution of fat in the liver. There were 94 malignant tumors, including 32 cases of hepatocellular carcinoma, 22 cases of intrahepatic cholangiocellular carcinoma, 29 cases of metastatic liver cancer, and 11 cases of dysplastic nodules in cirrhotic liver. In the diagnosis of benign and malignant liver tumors, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 82.56%, 68.06%, 75.96%, 75.53%, and 76.56% for US; 92.39%, 86.36%, 89.87%, 90.43%, and 89.06% for CEUS; 87.14%, 76.81%, 82.91%, 82.98%, and 82.81% for SWE; and 97.85%, 95.38%, 96.83%, 96.81%, and 96.88% for multimodal ultrasound imaging, respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were all significantly higher for multimodal ultrasound imaging than those values for US, CEUS, and SWE (all P < .05). The areas under the receiver operating characteristic curve for US, CEUS, SWE, and multimodal ultrasound imaging in the diagnosis of benign and malignant liver tumors were 0.760, 0.897, 0.829, and 0.968, respectively.US, CEUS, and SWE all have diagnostic value in the diagnosis of benign and malignant liver tumors. Multimodal ultrasound imaging could significantly increase the accuracy of the diagnosis of benign and malignant liver tumors and has higher value for clinical application.
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Affiliation(s)
- Jia Hu
- Department of Medical Ultrasound, The First Affiliated Hospital of Nanchang University
| | - Zhi-Yu Zhou
- College of Traditional Chinese Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Hong-Ling Ran
- Department of Medical Ultrasound, The First Affiliated Hospital of Nanchang University
| | - Xin-Chun Yuan
- Department of Medical Ultrasound, The First Affiliated Hospital of Nanchang University
| | - Xi Zeng
- Department of Medical Ultrasound, The First Affiliated Hospital of Nanchang University
| | - Zhe-Yuan Zhang
- Department of Medical Ultrasound, The First Affiliated Hospital of Nanchang University
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Dong Y, Liu L, Cao Q, Zhang Q, Qiu Y, Yang D, Yu L, Wang WP. Differential diagnosis of focal gallbladder lesions: The added value of contrast enhanced ultrasound with liner transducers. Clin Hemorheol Microcirc 2020; 74:167-178. [PMID: 31306115 DOI: 10.3233/ch-190639] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM To evaluate the benefits of contrast-enhanced ultrasound (CEUS) with high frequency transducers in characterization of focal gallbladder lesions (FGL). MATERIAL AND METHODS From January 2017 to April 2019, 59 FGL detected by B mode ultrasound (BMUS) were examined, first with the low frequency convex transducer (1-5 MHz) and afterwards with high frequency transducer (7.5-12 MHz). High frequency dynamic CEUS were applied after bolus injection of 4.8 ml Sulphur hexafluoride microbubbles (SonoVue®, Milan). The BMUS and CEUS imaging features were recorded and compared. All lesions were confirmed by surgical resection and histopathologic results. RESULTS The final diagnoses of 59 FGL included gallbladder adenocarcinoma (n = 15), gallbladder polyps (n = 11), gallbladder adenomas (n = 18), focal adenomyomatosis (n = 9), and gallbladder Ascariasis debris (n = 6). The mean diameter of FGL was 24.5±11.4 mm, and mean depth to the abdominal wall was 21.2±7.3 mm. While applying CEUS with high frequency transducer, specific diagnostic features, including arterial phase irregular intralesional vascularity (10/15, 66.7%), late phase hypoenhancement (12/15, 80%), destruction of gallbladder wall (8/15, 53.3%), infiltration to the adjacent liver (6/15, 40.0%) were significantly higher in malignant FGL. The overall sensitivity, specificity and diagnostic accuracy for the correct characterization of malignant FGL were significantly improved by CEUS with high frequency transducer (sensitivity 93.3%, specificity 88.5%, accuracy 100%). CONCLUSION With its superior contrast resolution, CEUS performed with high frequency transducers is helpful to achieve better visualization of gallbladder fundus and make differential diagnosis of gallbladder lesions, which might greatly improve diagnostic confidence between malignant and benign FGL.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lingxiao Liu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiong Cao
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi Zhang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yijie Qiu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daohui Yang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lingyun Yu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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Yu MH, Kim YJ, Park HS, Jung SI. Benign gallbladder diseases: Imaging techniques and tips for differentiating with malignant gallbladder diseases. World J Gastroenterol 2020; 26:2967-2986. [PMID: 32587442 PMCID: PMC7304100 DOI: 10.3748/wjg.v26.i22.2967] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/27/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023] Open
Abstract
Benign gallbladder diseases usually present with intraluminal lesions and localized or diffuse wall thickening. Intraluminal lesions of the gallbladder include gallstones, cholesterol polyps, adenomas, or sludge and polypoid type of gallbladder cancer must subsequently be excluded. Polyp size, stalk width, and enhancement intensity on contrast-enhanced ultrasound and degree of diffusion restriction may help differentiate cholesterol polyps and adenomas from gallbladder cancer. Localized gallbladder wall thickening is largely due to segmental or focal gallbladder adenomyomatosis, although infiltrative cancer may present similarly. Identification of Rokitansky-Aschoff sinuses is pivotal in diagnosing adenomyomatosis. The layered pattern, degree of enhancement, and integrity of the wall are imaging clues that help discriminate innocuous thickening from gallbladder cancer. High-resolution ultrasound is especially useful for analyzing the layering of gallbladder wall. A diffusely thickened wall is frequently seen in inflammatory processes of the gallbladder. Nevertheless, it is important to check for coexistent cancer in instances of acute cholecystitis. Ultrasound used alone is limited in evaluating complicated cholecystitis and often requires complementary computed tomography. In chronic cholecystitis, preservation of a two-layered wall and weak wall enhancement are diagnostic clues for excluding malignancy. Magnetic resonance imaging in conjunction with diffusion-weighted imaging helps to differentiate xathogranulomatous cholecystitis from gallbladder cancer by identifying the presence of fat and degree of diffusion restriction. Such distinctions require a familiarity with typical imaging features of various gallbladder diseases and an understanding of the roles that assorted imaging modalities play in gallbladder evaluations.
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Affiliation(s)
- Mi Hye Yu
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, South Korea
| | - Young Jun Kim
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, South Korea
| | - Hee Sun Park
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, South Korea
| | - Sung Il Jung
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, South Korea
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Valibouze C, El Amrani M, Truant S, Leroy C, Millet G, Pruvot FR, Zerbib P. The management of gallbladder polyps. J Visc Surg 2020; 157:410-417. [PMID: 32473822 DOI: 10.1016/j.jviscsurg.2020.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Neoplastic gallbladder polyps (NGP) are rare; the prevalence in the overall population is less than 10%. NGP are associated with a risk of malignant degeneration and must be distinguished from other benign gallbladder polypoid lesions that occur more frequently. NGP are adenomas and the main risk associated with their management is to fail to detect their progression to gallbladder cancer, which is associated with a particular poor prognosis. The conclusions of the recent European recommendations have a low level of evidence, based essentially on retrospective small-volume studies. Abdominal sonography is the first line study for diagnosis and follow-up for NGP. To prevent the onset of gallbladder cancer, or treat malignant degeneration in its early phases, all NGP larger than 10mm, or symptomatic, or larger than 6mm with associated risk factors for cancer (age over 50, sessile polyp, Indian ethnicity, or patient with primary sclerosing cholangitis) are indications for cholecystectomy. Apart from these situations, simple sonographic surveillance is recommended for at least five years; if the NGP increases in size by more than 2mm in size, cholecystectomy is indicated. Laparoscopic cholecystectomy is possible but if the surgeon feels that the risk of intra-operative gallbladder perforation is high, conversion to laparotomy should be preferred to avoid potential intra-abdominal tumoral dissemination. When malignant NGP is suspected (size greater than 15mm, signs of locoregional extension on imaging), a comprehensive imaging workup should be performed to search for liver extension: in this setting, radical surgery should be considered.
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Affiliation(s)
- C Valibouze
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France.
| | - M El Amrani
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France
| | - S Truant
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France
| | - C Leroy
- Department of Radiology and Digestive and Endocrine Imaging, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, 59037 Lille, France
| | - G Millet
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France
| | - F R Pruvot
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France
| | - P Zerbib
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France
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Hunt TM, Boyum JH. Diagnosing Gallbladder Perforation With Contrast-Enhanced Ultrasound: A Case Report. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479319895471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gallbladder perforation is a rare and severe complication of acute cholecystitis. Sonography is typically the first modality of choice for assessing gallbladder pathology due to its high sensitivity, portability, real-time imaging capability, and nonionizing technique. Gray-scale and color Doppler sonographic imaging may be equivocal for diagnosing perforation. In the presented case, gallbladder wall perforation was definitively diagnosed utilizing contrast-enhanced ultrasound, allowing for prompt treatment and a successful patient outcome.
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Affiliation(s)
| | - James H. Boyum
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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24
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A pictorial review of gall stones and its associated complications. Clin Imaging 2020; 60:228-236. [DOI: 10.1016/j.clinimag.2019.11.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/13/2019] [Accepted: 11/04/2019] [Indexed: 01/11/2023]
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Smereczyński A, Kołaczyk K, Bernatowicz E. Optimization of diagnostic ultrasonography of the gallbladder based on own experience and literature. J Ultrason 2020; 20:e29-e35. [PMID: 32320550 PMCID: PMC7266065 DOI: 10.15557/jou.2020.0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/13/2019] [Indexed: 12/07/2022] Open
Abstract
Although transabdominal imaging of the gallbladder has become a gold standard, new light should be shed on some aspects, which will prove useful in everyday practice. Therefore, based on our own experience and the available literature, we would like to draw attention to those elements of gallbladder ultrasound imaging which may increase its diagnostic efficacy. The paper draws attention to the difficulty in assessing certain anatomical structures, such as the inferior wall, the bottom and the region of the neck of the gallbladder, and offers ways to improve their imaging. We also emphasized the negative effects of duodenal and transverse colon (along with their contents) adhesion to the bottom of the gallbladder on the correct diagnosis. Due to the importance of size in the management strategy for detected gallbladder polyps, we suggest their measurement on an image enlarged with the zoom function. This technique also allows for an accurate assessment of the shape and echostructure of these lesions. An enlarged image of a polyp makes it possible to trace its behavior in time. We also remind that the hepatic wall of the gallbladder is the only site allowing for a reliable wall thickness measurement. We also pointed to the importance of changing patient's position when assessing the mobility and the nature of lesions. Altering patient's position during examination may help detect anomalies in the form of a floating gallbladder, which may promote its torsion. Finally, pathologies whose diagnosis may be facilitated by color-coded blood flow imaging are also presented. The issues discussed in this paper are only a fraction of problems faced by an ultrasound operator in the field of gallbladder diagnostic imaging. However, the proposed ultrasound approaches should help solve some of these problems in everyday practice. Although transabdominal imaging of the gallbladder has become a gold standard, new light should be shed on some aspects, which will prove useful in everyday practice. Therefore, based on our own experience and the available literature, we would like to draw attention to those elements of gallbladder ultrasound imaging which may increase its diagnostic efficacy. The paper draws attention to the difficulty in assessing certain anatomical structures, such as the inferior wall, the bottom and the region of the neck of the gallbladder, and offers ways to improve their imaging. We also emphasized the negative effects of duodenal and transverse colon (along with their contents) adhesion to the bottom of the gallbladder on the correct diagnosis. Due to the importance of size in the management strategy for detected gallbladder polyps, we suggest their measurement on an image enlarged with the zoom function. This technique also allows for an accurate assessment of the shape and echostructure of these lesions. An enlarged image of a polyp makes it possible to trace its behavior in time. We also remind that the hepatic wall of the gallbladder is the only site allowing for a reliable wall thickness measurement. We also pointed to the importance of changing patient’s position when assessing the mobility and the nature of lesions. Altering patient’s position during examination may help detect anomalies in the form of a floating gallbladder, which may promote its torsion. Finally, pathologies whose diagnosis may be facilitated by color-coded blood flow imaging are also presented. The issues discussed in this paper are only a fraction of problems faced by an ultrasound operator in the field of gallbladder diagnostic imaging. However, the proposed ultrasound approaches should help solve some of these problems in everyday practice.
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Affiliation(s)
- Andrzej Smereczyński
- Self-education Ultrasonographic Association, Department of Genetics and Pathomorphology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Kołaczyk
- Self-education Ultrasonographic Association, Department of Genetics and Pathomorphology, Pomeranian Medical University, Szczecin, Poland
| | - Elżbieta Bernatowicz
- Self-education Ultrasonographic Association, Department of Genetics and Pathomorphology, Pomeranian Medical University, Szczecin, Poland
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26
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Vascular evaluation using transabdominal ultrasound for gallbladder polyps. J Med Ultrason (2001) 2020; 48:159-173. [DOI: 10.1007/s10396-020-01008-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/21/2020] [Indexed: 12/17/2022]
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Chen T, Tu S, Wang H, Liu X, Li F, Jin W, Liang X, Zhang X, Wang J. Computer-aided diagnosis of gallbladder polyps based on high resolution ultrasonography. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 185:105118. [PMID: 31671340 DOI: 10.1016/j.cmpb.2019.105118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/06/2019] [Accepted: 10/03/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Gallbladder polyp is a common disease with an overall population prevalence between 4 and 7%. It can be classified as neoplastic and non-neoplastic lesions. Surgical treatment is necessary for neoplastic polyps. Due to its easy accessibility and nonradioactive, ultrasonography is the mostly used preoperative diagnosis tool for gallbladder polyps. However, human image analysis depends greatly on levels of experience, which results in many overtreatment cases and undertreatment cases in clinics. METHODS In this study, we proposed an ultrasound image segmentation algorithm, combined with principal components analysis (PCA) and AdaBoost algorithms to construct a computer-aided diagnosis system for the differentiate diagnosis of neoplastic and non-neoplastic gallbladder polyps. RESULTS The proposed segmentation method achieved a high accuracy of 95% for outlining the gallbladder region. The accuracy, sensitivity, specificity for the proposed computer-aided diagnosis system based on the segmented images are 87.54%, 86.52% and 89.40%, compared to 69.05%, 67.86% and 70.17% with convolutional neural network. The diagnosis result is also slightly higher than the human eyes of sonologists (86.22%, 85.19% and 89.18% as an average of four sonologists), while with a much faster diagnosis speed (0.02s vs 3s). CONCLUSIONS We proposed an efficient ultrasound image segmentation approach and a reliable system of automatic diagonals of neoplastic and non-neoplastic gallbladder polyps. The results show that the diagnosis accuracy is competitive to the expert sonologists while requires much less diagnosis time.
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Affiliation(s)
- Tao Chen
- Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 800, Dongchuan Road, Shanghai 200240, China
| | - Shaoxiong Tu
- School of Mathematical Sciences, Shanghai Jiao Tong University, 800, Dongchuran Road, Shanghai 200240 China
| | - Haolu Wang
- Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 800, Dongchuan Road, Shanghai 200240, China; Diamantina Institute, Translational Research Institute, The University of Queensland, 37 Kent Street, Woolloongabba, Brisbane, QLD 4102, Australia
| | - Xuesong Liu
- Department of Ultrasound, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Fenghua Li
- Department of Ultrasound, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Wang Jin
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Xiaowen Liang
- Diamantina Institute, Translational Research Institute, The University of Queensland, 37 Kent Street, Woolloongabba, Brisbane, QLD 4102, Australia
| | - Xiaoqun Zhang
- School of Mathematical Sciences, Shanghai Jiao Tong University, 800, Dongchuran Road, Shanghai 200240 China; Institute of Natural Sciences, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Jian Wang
- Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 800, Dongchuan Road, Shanghai 200240, China.
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Rapidly growing neuroendocrine carcinoma of the gallbladder: A case report. Radiol Case Rep 2020; 15:259-265. [PMID: 31956384 PMCID: PMC6957802 DOI: 10.1016/j.radcr.2019.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/08/2019] [Accepted: 12/16/2019] [Indexed: 12/16/2022] Open
Abstract
Gallbladder neuroendocrine carcinomas are rare tumors with a prognosis poorer than that of other gallbladder carcinomas. These tumors are often detected late and are difficult to treat. We present the case of a 68-year-old woman with small-cell gallbladder neuroendocrine carcinoma. Abdominal sonography and dynamic contrast-enhanced MRI performed at different points in time showed rapid growth. Treatment with surgical resection and adjuvant chemotherapy was instituted. In view of the rapid growth of these tumors, suspicious cases should at least be considered for close follow-up with appropriate imaging studies.
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Negrão de Figueiredo G, Mueller-Peltzer K, Armbruster M, Rübenthaler J, Clevert D. Contrast-enhanced ultrasound (CEUS) for the evaluation of gallbladder diseases in comparison to cross-sectional imaging modalities and histopathological results. Clin Hemorheol Microcirc 2019; 71:141-149. [DOI: 10.3233/ch-189404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- G. Negrão de Figueiredo
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany
| | - K. Mueller-Peltzer
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany
| | - M. Armbruster
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany
| | - J. Rübenthaler
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany
| | - D.A. Clevert
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany
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30
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Yuan HX, Wang WP, Guan PS, Lin LW, Wen JX, Yu Q, Chen XJ. Contrast-enhanced ultrasonography in differential diagnosis of focal gallbladder adenomyomatosis and gallbladder cancer. Clin Hemorheol Microcirc 2018; 70:201-211. [PMID: 29630529 DOI: 10.3233/ch-180376] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Focal gallbladder adenomyomatosis (ADM) is a common disease that mimics gallbladder cancer (GBC) on ultrasonography. OBJECTIVE Here we aim to assess the value of contrast-enhanced ultrasound (CEUS) in differentiating ADM from GBC. METHODS Forty-one histopathologically proven focal ADMs and 34 GBCs (≤T2 stage) were enrolled in the study. Lesion location, blood flow signals, contrast pattern and appearance on contrast-enhanced ultrasound (CEUS) were compared respectively. RESULTS Lesions were detected in fundus, body, neck at the rates of 61.0% (25/41), 26.8% (11/41) and 12.2% (5/41), respectively, in ADM patients, in comparison to 29.4% (10/34), 32.4% (11/34) and 38.2% (13/34), respectively, in GBC patients (p = 0.009). Blood flow signals were detected in 19.5% (8/41) of cases in ADMs, compared to 58.8% (20/34) in GBCs (p = 0.001). On CEUS, iso-enhancement, hypo-enhancement, intramural anechoic space and intactness of GB wall were detected in 41.5% (17/41), 39.0% (16/41), 56.1% (23/41) and 80.5% (33/41) cases of ADMs, in contrast to 17.6% (6/34), 20.6% (7/34), 20.6% (7/34) and 17.6% (6/34) of GBCs (p = 0.001, p = 0.001, p = 0.002, p < 0.001, respectively). The prior Youden's index were 0.81 based on intactness of GB wall on CEUS. CONCLUSION Combined with CEUS helps improve the differential diagnosis accuracy of focal gallbladder ADMs.
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Affiliation(s)
- Hai-Xia Yuan
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China.,Department of Ultrasound, Xiamen Branch, Zhongshan Hospital of Fudan University, Xiamen, Fujian Province, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Pei-Shan Guan
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China.,Department of Ultrasound, Xiamen Branch, Zhongshan Hospital of Fudan University, Xiamen, Fujian Province, China
| | - Le-Wu Lin
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China.,Department of Ultrasound, Xiamen Branch, Zhongshan Hospital of Fudan University, Xiamen, Fujian Province, China
| | - Jie-Xian Wen
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Qing Yu
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Xue-Jun Chen
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China.,Department of Ultrasound, Xiamen Branch, Zhongshan Hospital of Fudan University, Xiamen, Fujian Province, China
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31
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Helmberger H, Kammer B. [Radiologic diagnostics of the gall bladder and bile ducts-part 1 : Imaging techniques-normal variants and congenital disorders-cholelithiasis]. Radiologe 2018; 58:1021-1034. [PMID: 30353209 DOI: 10.1007/s00117-018-0460-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Upper abdominal pain, icterus and cholestasis are the main symptoms leading to evaluation of the biliary tract. Since the advent of contrast-enhanced ultrasound techniques the accuracy of bile duct imaging has significantly improved. This is also true for computed tomography using isotropic secondary reconstructions as well as magnetic resonance imaging (MRI) including MR cholangiography (MRC), classically and after iv injection of hepatobiliary contrast agent. Diffusion-weighted imaging sequences have a recently proven ability for improving biliary tract imaging. These technical improvements provide the depiction of the non-dilated biliary tract system in diagnostic quality. Therefore, normal variants and congenital disorders of biliary tract anatomy are delineated as well as insights into the postoperative situs and complications related to surgery. Cholelithiasis is the most frequent disease of the gall bladder and biliary tract. Together with related complications, in the majority of cases it is also the reason for bile duct inflammation. Due to the immediate need for treatment special care has to be taken for hydrops of the gall bladder.
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Affiliation(s)
- H Helmberger
- Zentrum für Radiologie und Nuklearmedizin Nymphenburg, Klinikum Dritter Orden, Menzingerstr. 44, 80638, München, Deutschland.
| | - B Kammer
- Kinderradiologie im Dr. von Haunerschen Kinderspital der Radiologischen Klinik und Poliklinik, Ludwig-Maximilians-Universität München, München, Deutschland
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Liu X, Jang HJ, Khalili K, Kim TK, Atri M. Successful Integration of Contrast-enhanced US into Routine Abdominal Imaging. Radiographics 2018; 38:1454-1477. [DOI: 10.1148/rg.2018170152] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Xiaoyang Liu
- From the Department of Medical Imaging, University of Toronto, University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Hyun-Jung Jang
- From the Department of Medical Imaging, University of Toronto, University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Korosh Khalili
- From the Department of Medical Imaging, University of Toronto, University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Tae Kyoung Kim
- From the Department of Medical Imaging, University of Toronto, University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Mostafa Atri
- From the Department of Medical Imaging, University of Toronto, University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
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34
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Lin LY, Chiou HJ, Chou YH, Wang HK, Lai YC, Lin YH. A Case of Tubular Adenoma of Gallbladder Diagnosed Using Contrast-Enhanced Ultrasonography. J Med Ultrasound 2018; 26:218-221. [PMID: 30662155 PMCID: PMC6314087 DOI: 10.4103/jmu.jmu_47_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 06/07/2018] [Indexed: 12/18/2022] Open
Abstract
Contrast-enhanced ultrasound (CEUS) has been used to diagnose gallbladder (GB) diseases for recent years because it is sensitive to visualize vascularity. Herein, we report a case who had a 1.7 cm × 1.2 cm polypoid lesion located in the gallbladder fundus with a feeding artery located in the stalk. On CEUS, the lesion showed early arterial phase enhancement (time to peak enhancement 18 s), persisting throughout the venous and delay phases. This enhancing pattern suggested that the lesion was a GB adenoma rather than a GB carcinoma. Cholecystectomy was performed, and pathology of the tissue revealed tubular adenoma of the GB.
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Affiliation(s)
- Lo-Yi Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hong-Jen Chiou
- Division of Ultrasound and Breast Imaging, Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming University, Taipei, Taiwan.,National Defense Medical Center, Taipei, Taiwan
| | - Yi-Hong Chou
- Division of Ultrasound and Breast Imaging, Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Hsin-Kai Wang
- Division of Ultrasound and Breast Imaging, Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Chen Lai
- Division of Ultrasound and Breast Imaging, Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yun-Hui Lin
- Division of Ultrasound and Breast Imaging, Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
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35
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Negrão de Figueiredo G, Mueller-Peltzer K, Zengel P, Armbruster M, Rübenthaler J, Clevert D. Diagnostic performance of contrast-enhanced ultrasound (CEUS) for the evaluation of gallbladder diseases1. Clin Hemorheol Microcirc 2018; 69:83-91. [DOI: 10.3233/ch-189116] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- G. Negrão de Figueiredo
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians- University of Munich – Grosshadern Campus, Marchioninistr, Munich, Germany
| | - K. Mueller-Peltzer
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians- University of Munich – Grosshadern Campus, Marchioninistr, Munich, Germany
| | - P. Zengel
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-Universität München, Munich, Germany
| | - M. Armbruster
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians- University of Munich – Grosshadern Campus, Marchioninistr, Munich, Germany
| | - J. Rübenthaler
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians- University of Munich – Grosshadern Campus, Marchioninistr, Munich, Germany
| | - D.A. Clevert
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians- University of Munich – Grosshadern Campus, Marchioninistr, Munich, Germany
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36
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Zhuang B, Li W, Wang W, Lin M, Xu M, Xie X, Lu M, Xie X. Contrast-enhanced ultrasonography improves the diagnostic specificity for gallbladder-confined focal tumors. Abdom Radiol (NY) 2018; 43:1134-1142. [PMID: 28765975 DOI: 10.1007/s00261-017-1268-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To investigate the value of contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of malignant and benign focal gallbladder diseases confined to the gallbladder wall. METHODS From July 2006 to May 2016, 88 patients (mean age 48.8 years; age range 18-77 years) were enrolled. All patients had focal gallbladder lesions confined to the gallbladder wall according to CEUS examination. The conventional ultrasound and CEUS characteristics of the lesions were evaluated, and diagnostic performance was evaluated via receiver-operating characteristic (ROC) analysis. RESULTS Multiple logistic regression analysis showed that three characteristics, an irregular shape, branched intralesional vessels and hypo-enhancement in the late phase, were features indicating a malignant gallbladder disease (all P < 0.05). When combining any two of these three features, diagnostic specificity improved from 51.5%-77.3% to 92.4% (P < 0.05 for all), and the area under the ROC (AUROC) curve improved from 0.735-0.874 to 0.917, without a significant loss of sensitivity. CONCLUSIONS CEUS features have greater specificity than those from conventional US for the differentiation of benign and malignant gallbladder diseases confined to the gallbladder wall, without a loss of sensitivity.
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Zhang HP, Bai M, Gu JY, He YQ, Qiao XH, Du LF. Value of contrast-enhanced ultrasound in the differential diagnosis of gallbladder lesion. World J Gastroenterol 2018; 24:744-751. [PMID: 29456413 PMCID: PMC5807677 DOI: 10.3748/wjg.v24.i6.744] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/03/2018] [Accepted: 01/15/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To describe contrast-enhanced ultrasound (CEUS) features and evaluate differential diagnosis value of CEUS and conventional ultrasound for patients with benign and malignant gallbladder lesions.
METHODS This study included 105 gallbladder lesions. Before surgical resection and pathological examination, conventional ultrasound and CEUS were performed to examine for lesions. Then, all the lesions were diagnosed as (1) benign, (2) probably benign, (3) probably malignant or (4) malignant using both conventional ultrasound and CEUS. The CEUS features of these gallbladder lesions were analyzed and diagnostic efficiency between conventional ultrasound and CEUS was compared.
RESULTS There were total 17 cases of gallbladder cancer and 88 cases of benign lesion. Some gallbladder lesions had typical characteristics on CEUS (e.g., gallbladder adenomyomatosis had typical characteristics of small nonenhanced areas on CEUS). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CEUS were 94.1%, 95.5%, 80.0%, 98.8% and 95.2%, respectively. These were significantly higher than conventional ultrasound (82.4%, 89.8%, 60.9%, 96.3% and 88.6%, respectively). CEUS had an accuracy of 100% for gallbladder sludge and CEUS helped in differential diagnosis among gallbladder polyps, gallbladder adenoma and gallbladder cancer.
CONCLUSION CEUS may provide more useful information and improve the diagnosis efficiency for the diagnosis of gallbladder lesions than conventional ultrasound.
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Affiliation(s)
- Hui-Ping Zhang
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Min Bai
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Ji-Ying Gu
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Ying-Qian He
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Xiao-Hui Qiao
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Lian-Fang Du
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
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Abstract
Despite the overwhelming prevalence of cholelithiasis, many health care professionals are not familiar with the basic pathophysiology of gallstone formation. This article provides an overview of the biochemical pathways related to bile, with a focus on the physical chemistry of bile. We describe the important factors in bile synthesis and secretion that affect the composition of bile and consequently its liquid state. Within this biochemical background lies the foundation for understanding the clinical and sonographic manifestation of cholelithiasis, including the pathophysiology of cholesterol crystallization, gallbladder sludge, and gallstones. There is a brief discussion of the clinical manifestations of inflammatory and obstructive cholestasis and the impact on bile metabolism and subsequently on liver function tests. Despite being the key modality in diagnosing cholelithiasis, ultrasound has a limited role in the characterization of stone composition.
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