Diagnosis Of Gallbladder Wall Thickening Research Articles

Value of high frame rate contrast enhanced ultrasound in gallbladder wall thickening in non-acute setting

BackgroundUltrasound (US) has been widely used in screening and differential diagnosis of gallbladder wall thickening (GWT). However, the sensitivity and specificity for diagnosing wall-thickening type gallbladder cancer are limited, leading to delayed treatment or overtreatment. We aim to explore the value of high frame rate contrast enhanced ultrasound (H-CEUS) in distinguishing wall-thickening type gallbladder cancer (malignant) from GWT mimicking malignancy (benign).MethodsThis retrospective study enrolled consecutive patients with non-acute GWT who underwent US and H-CEUS examination before cholecystectomy. Clinical information, US image and H-CEUS image characteristics between malignant and benign GWT were compared. The independent risk factors for malignant GWT on H-CEUS images were selected by multivariate logistic regression analysis. The diagnostic performance of H-CEUS in determining malignant GWT was compared with that of the gallbladder reporting and data system (GB-RADS) score.ResultsForty-six patients included 30 benign GWTs and 16 malignant GWTs. Only mural layering and interface with liver on US images were significantly different between malignant and benign GWT (P < 0.05). Differences in enhancement direction, vascular morphology, serous layer continuity, wash-out time and mural layering in the venous phase of GWT on H-CEUS images were significant between malignant and benign GWT (P < 0.05). The sensitivity, specificity and accuracy of H-CEUS based on enhancement direction, vascular morphology and wash-out time in the diagnosis of malignant GWT were 93.75%, 90.00%, and 91.30%, respectively. However, the sensitivity, specificity and accuracy of the GB-RADS score were only 68.75%, 73.33% and 71.74%, respectively. The area under ROC curve (AUC) of H-CEUS was significantly higher than that of the GB-RADS score (AUC = 0.965 vs. 0.756).ConclusionsH-CEUS can accurately detect enhancement direction, vascular morphology and wash-out time of GWT, with a higher diagnostic performance than the GB-RADS score in determining wall-thickening type gallbladder cancer. This study provides a novel imaging means with high accuracy for the diagnosis of wall-thickening type gallbladder cancer, thus may be better avoiding delayed treatment or overtreatment.

Точність методів візуалізації в діагностиці гострого холециститу

Дослідження проведено для оцінки діагностичної точності при гострому холециститі, гострому холангіті та отримання зведених даних. Інформаційний пошук результатів клінічних досліджень, систематичних оглядів, метааналізів, клінічних настанов стосовно чутливості та специфічності гепатобіліарної сцинтиграфії, ультразвукового дослідження, магнітно-резонансної томографії, комп’ютерної томографії при гострому холециститі проводився в базі Cochrane library, Medline/PubMed та в інших пошукових системах за ключовими словами: gallstone disease, acute cholecystitis, US, cholescintigraphy, CT, MR, sensitivity, specificity з січня 2000 р. до лютого 2014 р. Критерії включення: а) чіткі критерії для визначення позитивного результату візуалізації; б) операції і/або клінічні спостереження були використані як еталон; в) достатньо наведено даних, щоб оцінити число істинно позитивних, негативних результатів, хибнопозитивних і хибнонегативних результатів.У дослідженнях з оцінкою гепатобіліарної сцинтиграфії чутливість (88,5 % (95% ДІ: 81–97 %)) і специфічність (91,8 % (95% ДІ: 86–93 %)) були порівнянні з даними 2012 року, але чутливість трохи нижча в нашому дослідженні. Для досліджень з оцінкою УЗД чутливість становила 84,4 % (95% ДІ: 76–93 %) при специфічності 85,1 % (95% ДІ: 78–91 %), що трохи вище порівняно з даними, отриманими в систематичному огляді 2012 року. Ми показали, що магнітно-резонансна томографія і ультразвукове дослідження не виявили статистично значимих відмінностей у діагностиці потовщення стінки жовчного міхура, наявності каменів у ньому, наявності перихолецистичної рідини або гострого холециститу (р &gt; 0,05). Чутливість для гострого холециститу становила 89,4 % (95% ДІ: 85–91 %) і специфічність — 87,2 % (95% ДІ: 83–99 %) для магнітно-резонансної томографії. Цей метод еквівалентний ультразвуковому дослідженню в діагностиці жовчнокам’яної хвороби, потовщення стінки жовчного міхура, визначенні наявності перихолецистичного набряку й гострого холециститу в пацієнтів із симптомами гострого болю в правому верхньому квадранті живота. Особливо в сонографічно складних пацієнтів магнітно-резонансна томографія може застосовуватися як більш швидкий і простий метод діагностики.

Imaging-based algorithmic approach to gallbladder wall thickening.

Gallbladder (GB) wall thickening is a frequent finding caused by a spectrum of conditions. It is observed in many extracholecystic as well as intrinsic GB conditions. GB wall thickening can either be diffuse or focal. Diffuse wall thickening is a secondary occurrence in both extrinsic and intrinsic pathologies of GB, whereas, focal wall thickening is mostly associated with intrinsic GB pathologies. In the absence of specific clinical features, accurate etiological diagnosis can be challenging. The survival rate in GB carcinoma (GBC) can be improved if it is diagnosed at an early stage, especially when the tumor is confined to the wall. The pattern of wall thickening in GBC is often confused with benign diseases, especially chronic cholecystitis, xanthogranulomatous cholecystitis, and adenomyomatosis. Early recognition and differentiation of these conditions can improve the prognosis. In this minireview, the authors describe the patterns of abnormalities on various imaging modalities (conventional as well as advanced) for the diagnosis of GB wall thickening. This paper also illustrates an algorithmic approach for the etiological diagnosis of GB wall thickening and suggests a formatted reporting for GB wall abnormalities.

Contrast-Enhanced Harmonic Endoscopic Ultrasonography in the Differential Diagnosis of Gallbladder Wall Thickening

Differentiation of gallbladder (GB) carcinoma from benign GB wall thickening is challenging. The recent introduction of second-generation ultrasonic contrast agents has made contrast harmonic imaging with EUS possible. The aim of our study was to evaluate the utility of contrast-enhanced harmonic EUS (CH-EUS) for the differential diagnosis of GB wall thickening. Thirty-six consecutive patients with GB wall thickening imaged by CH-EUS and then underwent surgery were enrolled in this study. After the lesions were observed with conventional harmonic EUS (H-EUS), CH-EUS was performed with intravenous injection of 0.015 ml/kg of Sonazoid. Three reviewers with various levels of experience of EUS (Reviewer A: experienced endosonographer, B: EUS trainee, C: experienced gastroenterologist with expertise in transabdominal ultrasound but no EUS experience) were blinded to findings of recorded video of H-EUS and CH-EUS. The diagnostic accuracy of H-EUS and CH-EUS for malignant GB wall thickening was compared. Final diagnoses based on surgical histology were GB carcinoma in 16, cholecystitis in 11, adenomyomatosis in 6 and cholesterolosis in 3. Overall sensitivity, specificity and accuracy for diagnosing malignant GB wall thickening of H-EUS and CH-EUS were 83.3 versus 89.6, 65 versus 98% (p < 0.001) and 73.1 versus 94.4% (p < 0.001). The inter-observer agreement for H-EUS was moderate (κ = 0.51), whereas that for CH-EUS was substantial (κ = 0.77). The inhomogeneous enhanced pattern on CH-EUS was a strong predictive factor of malignant GB wall thickening. CH-EUS has the potential to improve the preoperative diagnostic accuracy and inter-observer agreement in the differential diagnosis of GB wall thickening.

Clinical Usefulness of Endoscopic Ultrasonography in the Differential Diagnosis of Gallbladder Wall Thickening

The differential diagnosis of gallbladder (GB) cancer from inflammatory diseases in patients with a thickened GB wall is difficult, whereas the pre-operative diagnosis of GB cancer is critical for selecting the appropriate surgical modality. We evaluated the clinical usefulness of endoscopic ultrasonography (EUS) for the differential diagnosis of GB wall thickening. The medical records, post-operative pathology reports, and images of EUS for 134 patients with GB wall thickening (>3 mm) who underwent laparoscopic or open cholecystectomies at our institution between December 2006 and February 2010 were retrospectively reviewed. Thirteen patients (9.7%) had neoplastic GB wall thickening (11 with adenocarcinomas and two with adenosquamous carcinomas) and the remaining 121 patients (90.3%) had non-neoplastic GB wall thickening (117 with inflammatory GB wall thickening and four with adenomyomatosis). The mean (± standard deviation [SD], mm) GB wall thickness was 6.5 ± 3.3 and 19.4 ± 7.7 for non-neoplastic and neoplastic GB wall thickening, respectively (P < 0.01). The EUS variables which had a statistically significant association with neoplastic GB wall thickening were GB wall thickening >10 mm, disruption of the normal two layers of the GB wall, hypoechoic internal echogenecity, and the absence of gallstones. Based on the multivariate analyses, GB wall thickening >10 mm and hypoechoic internal echogenecity were independent predictive factors for neoplastic GB wall thickening. The diagnostic power of EUS for differentiating neoplastic and non-neoplastic GB wall thickening could be improved by the appropriate application of some EUS variables.

Differential Diagnosis of Gallbladder Wall Thickening by Two Phase Spiral CT: Gallbladder Carcinoma versus Cholecystitis

Purpose: To determine whether an analysis of two-phase spiral CT features provides a sound basis for differential diagnosis between gallbladder carcinoma and cholecystitis. Materials and Methods: We reviewed a total of 89 cases of gallbladder carcinoma (n=35) or cholecystitis (n=54) in patients who had undergone two-phase spiral CT. For this, a GE Highspeed Advantage scanner (GE Medical Systems, Milwaukee, U.S.A.) was used. A total of 120ml of contrast material was injected at a rate of 2- 3 ml/sec. Arterial and venous phase scans were obtained 35 and 65 seconds, respectively, after the initiation of contrast infusion. All cases of gallbladder carcinoma and 468 of cholecystitis (of a total of 482) were confirmed by histopathology. We reviewed the two phase spiral CT features, analyzing and assessing thickness of the lesion, the enhancement pattern seen during the arterial and the venous phase, invasion of the liver, pericholecystic fat infiltration, dilatation of intrahepatic ducts, and other associated findings. Results: Mean wall thickness was 12.6 mm in the gallbladder carcinoma group, and 7.2 mm in the cholecystitis group. The common enhancement patterns seen in gallbladder carcinoma were 1) a highly enhanced thick inner wall layer during the arterial phase which became iso attenuated with adjacent liver parenchyma during the venous phase (16/35; 45.7%), and 2) a highly enhanced thick inner wall layer during both the arterial and the venous phase (8/35; 22.9%). The most common enhancement pattern in cholecystitis cases was an iso attenuated thin inner wall layer during both the arterial and the venous phase (44/54; 81.5%). Findings of intrahepatic mass formation by direct invasion (9/35), lymph node enlargement (12/35), and metastasis to other organs (7/35) occurred only in cases of gallbladder carcinoma. Dilatation of intrahepatic ducts was more frequent in cases of gallbladder carcinoma (18/35, 51.4%) than of cholecystitis (10/54, 18.5%). The incidence of pericholecystic fat infiltration and fluid collection was not significantly different between the gallbladder cancer and cholecystitis groups. Conclusion: Gallbladder carcinoma and cholecystitis varied in terms of wall thickness, enhancement pattern, and intrahepatic ductal dilatation, as seen on two phase spiral CT. Findings of liver invasion, lymph node enlargement and distant metastasis strongly suggested gallbladder carcinoma. These results suggested that gallbladder carcinoma and cholecystitis can be distinguished by analysis of their two phase spiral CT features.