Abstract
The value of contrast-enhanced ultrasound (CEUS) in differential diagnosis between benign and malignant gallbladder diseases was investigated. Thirty-three patients with gallbladder carcinomas and 47 with benign gallbladder diseases underwent CEUS. The lesion enhancement time, enhancement extent, pattern, dynamic change of enhancement and the intactness of gallbladder wall were evaluated. In the early phase at CEUS, hyper-, iso-, hypo-, and non-enhancement were found in 84.8% (28/33), 9.1% (3/33), 6.1% (2/33), and 0% (0/33) of gallbladder carcinomas, and 70.3% (33/47), 17.0% (8/47), 2.1% (1/47), and 10.6% (5/47) of benign diseases (p > 0.05). Hyper-enhancement or iso-enhancement in the early phase and then fading out to hypo-enhancement within 35 s after contrast agent administration was found in 90.9% (30/33) of carcinomas and 17.0% (8/47) of benign lesions (p < 0.001). Destruction of the gallbladder wall intactness was absent in benign diseases, whereas it was present in 28 (84.8%) of the 33 carcinomas (p < 0.001). Destruction of gallbladder wall intactness on CEUS yielded the highest capability in differential diagnosis, with sensitivity, specificity, and Youden’s index of 84.8% (28/33), 100% (47/47), and 0.85, respectively. Conventional US made correct original diagnoses in 55 (68.8%) patients, whereas CEUS in 77 (96.3%). Thus, CEUS is useful in differential diagnosis between malignant and benign gallbladder diseases.
Similar content being viewed by others
References
Soiva M, Aro K, Pamilo M et al (1987) Ultrasonography in carcinoma of the gallbladder. Acta Radiol 28:711–714
Demidov VN, Iantovskiĭ IuR, Arkhipov SN et al (1992) Ultrasonographic diagnosis of tumors of the gallbladder. Klin Med (Mosk) 70:44–49
Anastasi B, Sutherland GR (1981) Biliary sludge-ultrasonic appearance simulating neoplasm. Br J Radiol 54:679–681
Terzi C, Sokmen S, Albayray L (2000) Polypoid lesions of the gallbladder: report of 100 cases with special reference to operative indication. Surgery 127:622–627
Sun XJ, Shi JS, Han Y et al (2004) Diagnosis and treatment of polypoid lesions of the gallbladder: report of 194 cases. Hepatobiliary Pancreat Dis Int 3:591–594
Hirooka Y, Naitoh Y, Goto H et al (1996) Differential diagnosis of gall-bladder masses using colour doppler ultrasonography. J Gastroenterol Hepatol 11:840–846
Ueno N, Tomiyama T, Tano S et al (1996) Diagnosis of gallbladder carcinoma with color doppler ultrasonography. Am J Gastroenterol 91:1647–1649
Kim TK, Choi BI, Han JK et al (2000) Hepatic tumors: contrast agent-enhancement patterns with pulse inversion harmonic US. Radiology 216:411–417
Brannigan M, Burns PN, Wilson SR (2004) Blood flow patterns in focal liver lesions at microbubble enhanced US. Radiographics 24:921–935
Youk JH, Kim CS, Lee JM (2003) Contrast-enhanced agent detection imaging: value in the characterization of focal hepatic lesions. J Ultrasound Med 22:897–910
Leen E (2001) The role of contrast-enhanced ultrasound in the characterisation of focal liver lesions. Eur Radiol 11:E27–E34
Xu HX, Liu GJ, Lu MD et al (2006) Characterization of small focal liver lesions using real-time contrast-enhanced sonography: diagnostic performance analysis in 200 patients. J Ultrasound Med 25:349–361
Quaia E, Calliada F, Bertolotto M et al (2004) Characterization of focal liver lesions with contrast-specific US modes and a sulfur hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence. Radiology 232:420–430
Adamietz B, Wenkel E, Uder M et al (2007) Contrast enhanced sonography of the gallbladder: a tool in the diagnosis of cholecystitis? Eur J Radiol 61(2):262–266
Inoue T, Kitano M, Kudo M et al (2007) Diagnosis of gallbladder diseases by contrast-enhanced phase-inversion harmonic ultrasonography. Ultrasound Med Biol 33:353–361
Numata K, Oka H, Morimoto M et al (2007) Differential diagnosis of gallbladder diseases with contrast-enhanced harmonic gray scale ultrasonography. J Ultrasound Med 26(6):763–774
Kim KA, Park CM, Park SW et al (2002) Contrast-enhanced power Doppler US: is it useful in differentiation of gallbladder disease? Clin Imaging 26(5):319–324
Hattori M, Inui K, Yoshino J et al (2007) Usefulness of contrast-enhanced ultrasonography in the differential diagnosis of polypoid gallbladder lesions. Nippon Shokakibyo Gakkai Zasshi 104(6):790–798
Schneider M (1999) SonoVue, a new ultrasound contrast agent. Eur Radiol 9:S347–S348
Claudon M, Cosgrove D, Albrecht T et al (2008) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS)—update 2008. Ultraschall Med 29:28–44
Hirooka Y, Naitoh Y, Goto H et al (1998) Contrast-enhanced endoscopic ultrasonography in gallbladder diseases. Gastrointest Endosc 48:406–410
Kato T, Tsukamoto Y, Naitoh Y et al (1994) Ultrasonographic angiography in gallbladder diseases. Acta Radiol 35:606–613
Zins M, Boulay-Coletta I, Molinié V et al (2006) Imaging of a thickened-wall gallbladder. J Radiol 87:479–493
Acknowledgements
This work was supported in part by grant NCET-06-0723 from Chinese Ministry of Education and grant 2008-2-10 of Public Welfare Research Special Project from Chinese Ministry of Science and Technology.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Xie, XH., Xu, HX., Xie, XY. et al. Differential diagnosis between benign and malignant gallbladder diseases with real-time contrast-enhanced ultrasound. Eur Radiol 20, 239–248 (2010). https://doi.org/10.1007/s00330-009-1538-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-009-1538-8