Comet tail artifact on ultrasonography: is it a reliable finding of benign gallbladder diseases?

Abstract

Purpose The aim of this study was to evaluate whether the comet tail artifact on ultrasonography can be used to reliably diagnose benign gallbladder diseases. Methods This retrospective study reviewed the clinical findings, imaging findings, preoperative ultrasonographic diagnoses, and pathological diagnoses of 150 patients with comet tail artifacts who underwent laparoscopic cholecystectomy with pathologic confirmation. The extent of the involved lesion was classified as localized or diffuse, depending on the degree of involvement and the anatomical section of the gallbladder that was involved. This study evaluated the differences in clinical and imaging findings among pathologic diagnoses. Results All gallbladder lesions exhibiting the comet tail artifact on ultrasound examination were confirmed as benign gallbladder diseases after cholecystectomy, including 71 cases of adenomyomatosis (47.3%), 74 cases of chronic cholecystitis (49.3%), two cases of xanthogranulomatous cholecystitis (1.3%), and three cases of cholesterolosis (2.0%); there were two cases of coexistent chronic cholecystitis and low-grade dysplasia. There were no statistically significant differences in any of the clinical and ultrasonographic findings, with the exception of gallstones (P=0.007), among the four diseases. There were no significant differences in the average length, thickness, or number of comet tail artifacts among the four diagnoses. No malignancies were detected in any of the 150 thickened gallbladder lesions. Conclusion The ultrasonographic finding of the comet tail artifact in patients with thickened gallbladder lesions is associated with the presence of benign gallbladder diseases, and can be considered a reliable sign of benign gallbladder disease.

Gallbladder polyps ultrasound: what the sonographer needs to know

“…There is evidence suggesting that pseudopolyps, such as cholesterolosis-related polyps and inflammatory polyps, tend to be smaller than true polyps [2,3]. If the gallbladder polyp is greater than or equal to 1 cm, cholecystectomy is recommended [1,3,25,26]. If the polyps are less than 1 cm in size, the following risk factors must be considered: age > 50, history of primary sclerosing cholangitis (PSC), Indian ethnicity, and sessile polyps.…”

“…Adenomyomatosis may involve the gallbladder according to four main patterns: localised, segmental, annular, and diffuse (Fig. 8 ) [ 19 , 24 , 25 ]. Sonographic detection and characterisation of GA demonstrate accuracy values that range from 91.5 to 94.8% in differentiating GA from early-stage gallbladder cancer [ 26 ].…”

Point-of-care ultrasound for the early diagnosis of emphysematous pyelonephritis: A case report and literature review

“…B-lines are well defined, vertical, laser-like artifacts, and are generated by a ring down effect when the sound waves pass through gas bubbles associated with fluid collection, and provokes resonance within the air-fluid interface, emitting continuous waves back to the transducer (Figure 4D )[ 49 ]. A comet-tail artifact is produced when ultrasound beams are repeatedly reflecting on the shallow and deep sides of gas bubbles (Figure 4E )[ 50 ], which usually looks like an inverted triangular hyperechoic lesion with reduced thickness and strength (Figure 1A ).…”

Imaging-based algorithmic approach to gallbladder wall thickening

“…This artefact is caused by the accumulation of cholesterol crystals in the Rokitansky-Aschoff sinuses and can also be seen in the other benign conditions of GB. Studies have shown comet tail artefact to be a reliable sign of benignity of the lesion[ 47 ]. Certain MRI features help to differentiate ADM from GBC.…”