Contrast-Enhanced Ultrasound in the Diagnosis of Gallbladder Diseases: A Multi-Center Experience

Abstract

ObjectiveTo assess the usefulness of contrast–enhanced ultrasound (CEUS) in differentiating malignant from benign gallbladder (GB) diseases.MethodsThis study had institutional review board approval. 192 patients with GB diseases from 9 university hospitals were studied. After intravenous bonus injection of a phospholipid-stabilized shell microbubble contrast agent, lesions were scanned with low acoustic power CEUS. A multiple logistic regression analysis was performed to identify diagnostic clues from 17 independent variables that enabled differentiation between malignant and benign GB diseases. Receiver operating characteristic (ROC) curve analysis was performed.ResultsAmong the 17 independent variables, multiple logistic regression analysis showed that the following 4 independent variables were associated with the benign nature of the GB diseases, including the patient age, intralesional blood vessel depicted on CEUS, contrast washout time, and wall intactness depicted on CEUS (all P<0.05). ROC analysis showed that the patient age, intralesional vessels on CEUS, and the intactness of the GB wall depicted on CEUS yielded an area under the ROC curve (Az) greater than 0.8 in each and Az for the combination of the 4 significant independent variables was 0.915 [95% confidence interval (CI): 0.857–0.974]. The corresponding Az, sensitivity, and specificity for the age were 0.805 (95% CI: 0.746–0.863), 92.2%%, and 59.6%; for the intralesional vessels on CEUS were 0.813 (95% CI: 0.751–0.875), 59.8%, and 98.0%; and for the GB wall intactness were 0.857 (95% CI: 0.786–0.928), 78.4%, and 92.9%. The cut-off values for benign GB diseases were patient age <53.5 yrs, dotted intralesional vessels on CEUS and intact GB wall on CEUS.ConclusionCEUS is valuable in differentiating malignant from benign GB diseases. Branched or linear intralesional vessels and destruction of GB wall on CEUS are the CEUS features highly suggestive of GB malignancy and the patient age >53.5 yrs is also a clue for GB malignancy.

Meta-analysis of contrast-enhanced ultrasonography for the detection of gallbladder carcinoma

“…From eighty-nine clinical studies, sixteen studies fulfilled the inclusion criteria and were included in the metaanalysis [7,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. There were a total of 1673 gallbladder carcinoma cases.…”

Contrast-enhanced ultrasound may distinguish gallbladder adenoma from cholesterol polyps: a prospective case–control study

“…Therefore, wall integrity was not a discriminator for adenoma or cholesterol polyp. Several previous studies have reported that wall integrity serves as a risk factor for gallbladder cancer [32,33] but these studies do not report on the relationship between GB wall integrity and the presence of adenoma or cholesterol polyp.…”

Contrast-enhanced ultrasonography to diagnose complicated acute cholecystitis

“…Although the CEUS study has been used to evaluate acute and chronic gallbladder disease, data about its usefulness in the detection of inflammatory complications of acute cholecystitis are sparse [10,[24][25][26][27][28][29][30]. Few reports focus on the diagnostic aid of a CEUS study in the detection of complicated acute cholecystitis such as gangrenous changes or perforation.…”