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Diagnostic nomogram for gallbladder wall thickening mimicking malignancy: using contrast-enhanced ultrasonography or multi-detector computed tomography?

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Abstract

Objectives

To establish a diagnostic nomogram using contrast-enhanced ultrasonography (CEUS) in gallbladder wall thickening mimicking malignancy and compare with multi-detector computed tomography (MDCT).

Methods

Seventy-two patients with gallbladder wall thickening on B-mode ultrasonography (BUS) were examined by CEUS to develop independent predictors for diagnosing gallbladder carcinoma. Among the 72 cases, 48 patients underwent both CEUS and MDCT. The diagnostic performances of different sets of CEUS criteria and MDCT were compared. A prediction model of malignancy using CEUS was developed. The performance of the nomogram was assessed with respect to its calibration, discrimination, and clinical usefulness.

Results

Multivariate logistic regression indicated that inhomogeneous enhancement in the arterial phase was the strongest independent predictor of malignancy (odds ratio, OR 51.162), followed by interrupted inner layer (OR 19.788), washout time ≤40 s (OR 16.686), and wall thickness >1.6 cm (OR 3.019), which were all selected into the nomogram. Combined with the above significant features, the diagnostic performance of CEUS (AUC = 0.917) was higher than that of MDCT (AUC = 0.788, P = 0.070). The predictive model using CEUS showed good discrimination, with a concordance index of 0.974 (0.950 through internal validation), and good calibration. Decision curve analysis demonstrated that the nomogram was clinically useful.

Conclusions

CEUS could accurately differentiate between malignant and benign gallbladder wall thickening with equivalent efficacy compared to MDCT. The proposed nomogram could be conveniently used to facilitate the preoperative individualized prediction of malignancy in patients with gallbladder wall thickening.

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References

  1. D’Hondt M, Lapointe R, Benamira Z, et al. (2013) Carcinoma of the gallbladder: patterns of presentation, prognostic factors and survival rate. An 11-year single centre experience. Eur J Surg Oncol 39(6):548–553

    Article  PubMed  Google Scholar 

  2. Miller G, Jarnagin WR (2008) Gallbladder carcinoma. Eur J Surg Oncol 34(3):306–312

    Article  CAS  PubMed  Google Scholar 

  3. Vijayakumar A, Vijayakumar A, Patil V, et al. (2013) Early diagnosis of gallbladder carcinoma: an algorithm approach. ISRN Radiol 2013:239424

    PubMed  Google Scholar 

  4. van Breda Vriesman AC, Engelbrecht MR, Smithuis RH, et al. (2007) Diffuse gallbladder wall thickening: differential diagnosis. AJR Am J Roentgenol 188(2):495–501

    Article  PubMed  Google Scholar 

  5. Meacock LM, Sellars ME, Sidhu PS (2010) Evaluation of gallbladder and biliary duct disease using microbubble contrast-enhanced ultrasound. Br J Radiol 83(991):615–627

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Runner GJ, Corwin MT, Siewert B, et al. (2014) Gallbladder wall thickening. AJR Am J Roentgenol 202(1):W1–W12

    Article  PubMed  Google Scholar 

  7. Kim BS, Oh JY, Nam KJ, et al. (2014) Focal thickening at the fundus of the gallbladder: computed tomography differentiation of fundal type adenomyomatosis and localized chronic cholecystitis. Gut Liver 8(2):219–223

    Article  PubMed  Google Scholar 

  8. Dutta U (2012) Gallbladder cancer: can newer insights improve the outcome? J Gastroenterol Hepatol 27(4):642–653

    Article  PubMed  Google Scholar 

  9. Imazu H, Mori N, Kanazawa K, et al. (2014) Contrast-enhanced harmonic endoscopic ultrasonography in the differential diagnosis of gallbladder wall thickening. Dig Dis Sci 59(8):1909–1916

    Article  PubMed  Google Scholar 

  10. Park CH, Chung MJ, Oh TG, et al. (2013) Differential diagnosis between gallbladder adenomas and cholesterol polyps on contrast-enhanced harmonic endoscopic ultrasonography. Surg Endosc 27(4):1414–1421

    Article  PubMed  Google Scholar 

  11. Jang JY, Kim SW, Lee SE, et al. (2009) Differential diagnostic and staging accuracies of high resolution ultrasonography, endoscopic ultrasonography, and multidetector computed tomography for gallbladder polypoid lesions and gallbladder cancer. Ann Surg 250(6):943–949

    Article  PubMed  Google Scholar 

  12. Park KW, Kim SH, Choi SH, et al. (2010) Differentiation of nonneoplastic and neoplastic gallbladder polyps 1 cm or bigger with multi-detector row computed tomography. J Comput Assist Tomogr 34(1):135–139

    Article  PubMed  Google Scholar 

  13. Song ER, Chung WS, Jang HY, et al. (2014) CT differentiation of 1-2-cm gallbladder polyps: benign vs malignant. Abdom Imaging 39(2):334–341

    Article  PubMed  Google Scholar 

  14. Inoue T, Kitano M, Kudo M, et al. (2007) Diagnosis of gallbladder diseases by contrast-enhanced phase-inversion harmonic ultrasonography. Ultrasound Med Biol 33(3):353–361

    Article  PubMed  Google Scholar 

  15. Xie XH, Xu HX, Xie XY, et al. (2010) Differential diagnosis between benign and malignant gallbladder diseases with real-time contrast-enhanced ultrasound. Eur Radiol 20(1):239–248

    Article  PubMed  Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

  17. Liu LN, Xu HX, Lu MD, et al. (2012) Contrast-enhanced ultrasound in the diagnosis of gallbladder diseases: a multi-center experience. PLOS ONE 7(10):e48371

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Kim KA, Park CM, Park SW, et al. (2002) Contrast-enhanced power Doppler US: is it useful in the differentiation of gallbladder disease? Clin Imaging 26(5):319–324

    Article  PubMed  Google Scholar 

  19. 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

    Article  PubMed  Google Scholar 

  20. Claudon M, Dietrich CF, Choi BI, et al. (2013) Guidelines and good clinical practice recommendations for Contrast Enhanced Ultrasound (CEUS) in the liver—update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol 39(2):187–210

    Article  PubMed  Google Scholar 

  21. 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(1):28–44

    Article  CAS  PubMed  Google Scholar 

  22. Yun EJ, Cho SG, Park S, et al. (2004) Gallbladder carcinoma and chronic cholecystitis: differentiation with two-phase spiral CT. Abdom Imaging 29(1):102–108

    Article  CAS  PubMed  Google Scholar 

  23. Kim SJ, Lee JM, Lee JY, et al. (2008) Analysis of enhancement pattern of flat gallbladder wall thickening on MDCT to differentiate gallbladder cancer from cholecystitis. AJR Am J Roentgenol 191(3):765–771

    Article  PubMed  Google Scholar 

  24. Huang YQ, Liang CH, He L, et al. (2016) Development and validation of a radiomics nomogram for preoperative prediction of lymph node metastasis in colorectal cancer. J Clin Oncol 34:2157–2164

    Article  PubMed  Google Scholar 

  25. Wang Y, Li J, Xia Y, et al. (2013) Prognostic nomogram for intrahepatic cholangiocarcinoma after partial hepatectomy. J Clin Oncol 31(9):1188–1195

    Article  PubMed  Google Scholar 

  26. Vickers AJ, Elkin EB (2006) Decision curve analysis: a novel method for evaluating prediction models. Med Decis Making 26(6):565–574

    Article  PubMed  PubMed Central  Google Scholar 

  27. Vickers AJ, Cronin AM, Elkin EB, et al. (2008) Extensions to decision curve analysis, a novel method for evaluating diagnostic tests, prediction models and molecular markers. BMC Med Inform Decis Mak 8:53

    Article  PubMed  PubMed Central  Google Scholar 

  28. Zhang JX, Song W, Chen ZH, et al. (2013) Prognostic and predictive value of a microRNA signature in stage II colon cancer: a microRNA expression analysis. Lancet Oncol 14(13):1295–1306

    Article  CAS  PubMed  Google Scholar 

  29. Xu JM, Guo LH, Xu HX, et al. (2014) Differential diagnosis of gallbladder wall thickening: the usefulness of contrast-enhanced ultrasound. Ultrasound Med Biol 40(12):2794–2804

    Article  PubMed  Google Scholar 

  30. Zissin R, Osadchy A, Shapiro-Feinberg M, et al. (2003) CT of a thickened-wall gall bladder. Br J Radiol 76(902):137–143

    Article  CAS  PubMed  Google Scholar 

  31. Bokor D, Chambers JB, Rees PJ, et al. (2001) Clinical safety of SonoVue, a new contrast agent for ultrasound imaging, in healthy volunteers and in patients with chronic obstructive pulmonary disease. Invest Radiol 36(2):104–109

    Article  CAS  PubMed  Google Scholar 

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Author notes

  1. Li-Da Chen and Yang Huang contributed equally to this work.

Authors and Affiliations

  1. Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China

    Li-Da Chen, Yang Huang, Xiao-Hua Xie, Quan-Yuan Shan, Ming Xu, Jin-Ya Liu, Xiao-Yan Xie, Ming-De Lu & Wei Wang

  2. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

    Wei Chen, Ming-De Lu & Shun-Li Shen

  3. Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academic of Medical Science, Guangzhou, China

    Zhi-Qiang Nie

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  1. Li-Da Chen
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  2. Yang Huang
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Corresponding authors

Correspondence to Shun-Li Shen or Wei Wang.

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Funding

This study was funded by the National Nature Science Foundation of China (No: 81301238), Guangdong Science and Technology Foundation (NO.:2016A020215042), Guangdong Medical Scientific Research Foundation (NO. 201611610484333).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Chen, LD., Huang, Y., Xie, XH. et al. Diagnostic nomogram for gallbladder wall thickening mimicking malignancy: using contrast-enhanced ultrasonography or multi-detector computed tomography?. Abdom Radiol 42, 2436–2446 (2017). https://doi.org/10.1007/s00261-017-1162-z

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  • DOI: https://doi.org/10.1007/s00261-017-1162-z

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