Imaging Evaluation of Enhancement Patterns of Flat Gall Bladder Wall Thickening and Its Correlation with Clinical and Histopathological Findings

Abstract

Introduction: Gall bladder Wall Thickening (GWT) is caused by wide spectrum of diseases. Initially Ultrasound (USG) was used as imaging modality for screening of acute abdomen because of its high sensitivity and real time character. Now, Computed Tomography (CT) is used because of its high temporal and spatial resolution.Aim: Evaluation of GWT and its enhancement patterns on contrast enhanced CT scan in a bid to differentiate benign from malignant causes and to correlate the imaging features with clinical and histopathological findings. Materials and Methods:It was a hospital based prospective study in which USG was done as an initial modality for screening and Multi Detector Computed Tomography (MDCT) scan was done later on for detailed evaluation of enhancement patterns of GWT. The study cases were then divided into five CT patterns according to enhancement patterns. The diagnostic performance of MDCT was compared with histopathological and serological findings. Relevant history, clinical examination and routine investigations were done. Results:The one layered pattern with a heterogeneously enhancing thick layered pattern (Type 1) was significantly associated with gall bladder cancer (p<0.001). The sensitivity and specificity of Type 1 enhancement pattern on CT for predicting the Gall Bladder (GB) malignancy were 90.476% and 97.43% respectively. The positive and negative predictive values were 95% and 95%, respectively. Focal wall thickening, irregular margin character and hepatic infiltration by GWT and lymphadenopathy were other findings that predict malignancy (p-value<0.05).

Gall bladder carcinoma: the facts and the mimics

“…Type 3 showed borderline enhancement and thickness of the inner layer with small cystic spaces and non-enhancing outer layer; as seen in adenomyomatosis. Type 4, weakly enhancing thin inner layer and non-enhancing thin outer layer; seen in chronic cholecystitis, and type 5, weakly enhancing thin inner layer and non-enhancing thick outer layer as seen in acute cholecystitis and dengue [16,17]. The sensitivity and specificity of type 1 enhancement pattern on computed tomography for predicting the GB malignancy according to this study were 90.476% and 97.43%, respectively.…”

“…The sensitivity and specificity of type 1 enhancement pattern on computed tomography for predicting the GB malignancy according to this study were 90.476% and 97.43%, respectively. The positive and negative predictive values were found to be 95% and 95%, respectively [16]. In our previously published study in a region of India endemic for CA GB, we have reported the sensitivity and specificity of MDCT in detection of carcinoma of gall bladder to be 92.8% and 96.7%, respectively [18] ( Table 5).…”

“…Xanthogranulomatous cholecystitis, an unusual variant of chronic cholecystitis, is characterized by focal or diffuse destructive inflammatory process, followed by fibrosis along with infiltration of macrophages and foamy cells. In a recent retrospective cohort study [16], it was shown on multivariate analysis that the following can be useful in making or excluding diagnosis of gall bladder cancer: focal gall bladder wall thickening (p = 0.003), pericholecystic "fat stranding" (p = 0.018), and maximum short axis lymph node diameter (p = 0.043). The authors concluded that MDCT had moderate sensitivity and poor specificity for the differentiation of gall bladder cancer from acute cholecystitis and Xanthogranulomatous cholecystitis (XGC).…”

Chronic gallbladder wall thickening: Is it always malignancy?

“…However, this pattern may also be seen in cirrhosis and viral hepatitis. 14 The type 5 pattern is depicted by a weakly enhancing, fuzzy, inner layer with a nonenhancing thick outer layer of submucosal oedema, as seen in acute calculous cholecystitis and Dengue fever. 13,14 5.…”

MDCT in Characterizing Gall Bladder Carcinoma: Experience From an Endemic Region

“…The sensitivity and specificity of Type 1 enhancement pattern on CT for predicting the Gall Bladder (GB) malignancy were 90.476% and 97.43% respectively, by a study in 2017. 5 The radiologic differential diagnosis includes the more common inflammatory conditions of the gallbladder, benign polyps, xanthogranulomatous cholecystitis, adenomyomatosis, other hepatobiliary malignancies, and metastasis. 6 The study aimed to determine the utility of multi-phase MDCT in the staging and resectability of gallbladder carcinoma.…”