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.
Highlights
Ultrasound (US) examination is accepted as the primary imaging modality in the assessment of gallbladder (GB) disease, which is ascribed to its inherent superiority in comparison to other imaging modalities such as real-time scanning, easy manipulation, cost-effectiveness, no radiation, high resolution, and repeatability
The results showed that the following independent variables were associated with the benign nature of the GB diseases, including the patient age, intralesional vessels on contrast–enhanced ultrasound (CEUS), contrast washout time, and wall intactness depicted on CEUS (Table 3)
The results showed that the patient age, intralesional vessels on CEUS, and the intactness of the GB wall depicted on CEUS yielded an Az value greater than 0.8 in each whereas the Az value for the washout time was only 0.669 (Table 4)
Summary
Ultrasound (US) examination is accepted as the primary imaging modality in the assessment of gallbladder (GB) disease, which is ascribed to its inherent superiority in comparison to other imaging modalities such as real-time scanning, easy manipulation, cost-effectiveness, no radiation, high resolution, and repeatability. Despite the widespread use of modern imaging techniques, early diagnosis is rare because there are no specific signs and symptoms, and many GB carcinomas are not diagnosed preoperatively. Despite of its obvious superiority, US has difficulty to make definite diagnosis for GB carcinoma under some circumstances [4,5,6]. It is necessary to develop new US techniques to improve the diagnosis of GB diseases and facilitate the early diagnosis of GB carcinoma
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