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

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Abstract

Background and Aims

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.

Methods

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.

Results

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.

Conclusion

CH-EUS has the potential to improve the preoperative diagnostic accuracy and inter-observer agreement in the differential diagnosis of GB wall thickening.

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Abbreviations

GB:

Gallbladder

CH-EUS:

Contrast-enhanced harmonic EUS

H-EUS:

Harmonic EUS

US:

Ultrasonography

THE:

Tissue harmonic echo

CT:

Computed tomography

ExPHD:

Extended pure harmonic detection

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Authors and Affiliations

  1. Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan

    Hiroo Imazu, Naoki Mori, Keisuke Kanazawa, Masafumi Chiba, Hirobumi Toyoizumi & Seita Koyama

  2. Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan

    Yuichi Torisu & Hisao Tajiri

  3. Department of Neuropsychiatry, Takamatsu Hospital, Ya36 Uchitakamatsu, Kahoku, Kanazawa, 929-1293, Japan

    Shoryoku Hino

  4. Department of Gastroenterology and Hepatology, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore

    Tiing Leong Ang

Authors
  1. Hiroo Imazu
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  2. Naoki Mori
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  3. Keisuke Kanazawa
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  4. Masafumi Chiba
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  5. Hirobumi Toyoizumi
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  6. Yuichi Torisu
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  7. Seita Koyama
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  8. Shoryoku Hino
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  9. Tiing Leong Ang
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  10. Hisao Tajiri
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Correspondence to Hiroo Imazu.

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Imazu, H., Mori, N., Kanazawa, K. et al. Contrast-Enhanced Harmonic Endoscopic Ultrasonography in the Differential Diagnosis of Gallbladder Wall Thickening. Dig Dis Sci 59, 1909–1916 (2014). https://doi.org/10.1007/s10620-014-3115-5

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  • DOI: https://doi.org/10.1007/s10620-014-3115-5

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