Gallbladder adenoma: report of a case with emphasis on contrast-enhanced US findings

Kumagai, Youichi; Kotanagi, Hitoshi; Ishida, Hideaki; Komatsuda, Tomoya; Furukawa, Kayoko; Yamada, Mamiko; Ohuchi, Shinichiro; Sakusabe, Masaru

doi:10.1007/s00261-005-0393-6

Cited by 14 publications

(7 citation statements)

References 13 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced ultrasonography to diagnose complicated acute cholecystitis

et al. 2015

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Gangrenous cholecystitis and perforation are severe complications of acute cholecystitis, which have a challenging preoperative diagnosis. Early identification allows better surgical management. Contrast-enhanced computed tomography (ceCT) is the current diagnostic gold standard. Contrast-enhanced ultrasonography (CEUS) is a promising tool for the diagnosis of gallbladder perforation, but data from the literature concerning efficacy are sparse. The aim of the study was to evaluate CEUS findings in pathologically proven complicated cholecystitis (gangrenous, perforated gallbladder, pericholecystic abscess). A total of 8 patients submitted to preoperative CEUS, and with subsequent proven acute complicated cholecystitis at surgical inspection and pathological analysis, were retrospectively identified. The final diagnosis was gangrenous/phlegmonous cholecystitis (n. 2), phlegmonous/ulcerative changes plus pericholecystic abscess (n. 2), perforated plus pericholecystic abscess (n. 3), or perforated plus pericholecystic biliary collection (n. 1). Conventional US findings revealed irregularly thickened gallbladder walls in all 8 patients, with vaguely defined walls in 7 patients, four of whom also had striated wall thickening. CEUS revealed irregular enhancing gallbladder walls in all patients. A distinct wall defect was seen in six patients, confirmed as gangrenous/phlegmonous cholecystitis at pathology in all six, and in four as perforation at macroscopic surgical inspection. CEUS is a non-invasive easily repeatable technique that can be performed at the bedside, and is able to accurately diagnose complicated/perforated cholecystitis. Despite the limited sample size in the present case series, CEUS appears as a promising tool for the management of patients with the clinical possibility of having an acute complicated cholecystitis.

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Section: Discussionmentioning

confidence: 99%

Contrast-enhanced ultrasonography to diagnose complicated acute cholecystitis

et al. 2015

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“…The successful use of CEUS in other organs such as liver, kidney, and pancreas has prompted the use of CEUS in GB [13], [15], [19]. Unfortunately, its usefulness in GB is controversial.…”

Section: Discussionmentioning

confidence: 99%

“…Although CEUS has been tentatively used in GB diseases, the role of CEUS in GB is less well recognized and multicenter experience is not available [10], [11], [12], [13], [14], [15], [16]. In this prospective study, the application of GB CEUS in 9 centers was reported with an aim to evaluate the role of CEUS in the differential diagnosis between benign and malignant GB diseases.…”

Section: Introductionmentioning

confidence: 99%

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

Liu

Lü³

et al. 2012

PLoS ONE

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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.

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“…mechanical index less than 0.2) has been introduced in the diagnosis of GB diseases in recent years since CEUS allows depiction of microvasculization and the microvasculization between the lesion and the surrounding might be different [1, 6, 7, 10, 12, 13, 16, 18, 21-24, 27-30, 33, 34]. Some authors concluded that CEUS is useful for the differential diagnosis of benign and malignant polypoid lesions, whereas a recently released non-liver CEUS guideline was controversial [1,12,13,18,21,22,24,27,28,30,33,34]. In the guideline, the panel experts concluded that the differentiation between benign and malignant lesions is mainly determined by clinical features and size and enlargement of polyps to >10 mm is an indication for cholecystectomy.…”

Section: Introductionmentioning

confidence: 99%

Contrast-enhanced ultrasound versus conventional ultrasound in the diagnosis of polypoid lesion of gallbladder: A multi-center study of dynamic microvascularization

Zheng

Liu

et al. 2013

Clinical Hemorheology and Microcirculation

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OBJECTIVE: To assess the value of contrast-enhanced ultrasound (CEUS) in the diagnosis of polypoid lesions of gallbladder (PLGs). METHODS: CEUS was performed to 116 patients (mean age, 49.6 years; range, 21-80 years) with PLGs from 8 university hospitals. 9 cases of biliary sludge were proven by surgery and the remaining 107 cases were confirmed by histopathological examination. The confidence level, diagnostic performance, inter-observer agreement of two independent readers with different experience was assessed. The readers were blind to the imaging and clinical results of the patients. RESULTS:There were significant differences between benign and malignant PLGs in patient age, gender, lesion size, echogenicity, stalk, time-to-peak, vascularity on CEUS, enhancement pattern, and wall destruction. The confidence levels increased significantly and the interobserver agreement increased from 0.425 to 0.601 after CEUS. The sensitivity increased from 22.2 to 77.8% after CEUS in the staff radiologist, and from 22.2 to 66.7% in the resident radiologist. The correctly characterized lesions were 64.7% before versus 87.1% after CEUS (P = 0.125) for the staff radiologist, and 57.8% versus 70.7% for the resident radiologist (P = 0.007). No significance was found in the subgroup of lesions ≤1.0 cm before and after CEUS for the two radiologists. CONCLUSIONS: CEUS using convex multifrequency probes could detect the dynamic microvascularization of PLGs greater than 1.0 cm and facilitate the differentiation between benign and malignant tumors.

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Gallbladder adenoma: report of a case with emphasis on contrast-enhanced US findings

Cited by 14 publications

References 13 publications

Contrast-enhanced ultrasonography to diagnose complicated acute cholecystitis

Contrast-enhanced ultrasonography to diagnose complicated acute cholecystitis

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

Contrast-enhanced ultrasound versus conventional ultrasound in the diagnosis of polypoid lesion of gallbladder: A multi-center study of dynamic microvascularization

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