Differential diagnosis of gallbladder polypoid lesions using contrast-enhanced ultrasound

  • Haruo Miwa
  • Kazushi NumataEmail author
  • Kazuya Sugimori
  • Katsuyuki Sanga
  • Akane Hirotani
  • Shun Tezuka
  • Yoshihiro Goda
  • Kuniyasu Irie
  • Tomohiro Ishii
  • Takashi Kaneko
  • Katsuaki Tanaka
  • Shin Maeda



The purpose of the study is to evaluate the utility of contrast-enhanced ultrasound (CEUS) for the differential diagnosis of gallbladder polypoid lesions (GPLs).


Thirty-six patients with GPLs (17 with gallbladder cancer, 19 with benign polyps) who underwent CEUS were enrolled in the study. The mean age of patients was 65.7 ± 12.6 years. Perflubutane-based contrast agent and high-mechanical index mode, which can eliminate the background B-mode and provide precise visualization of tumor vessels, were used for CEUS, and two blinded readers evaluated the images, retrospectively.


Patient age and size of malignant GPLs (72.4 ± 9.4 years and 23.4 ± 7.5 mm) were significantly greater than those for benign lesions (59.6 ± 12.3 years and 12.4 ± 2.9 mm) (P < 0.01, respectively), and the receiver operating characteristic analysis showed the cut-off value as over 65 years and 16 mm. Univariate analysis showed that heterogeneity in B-mode (80% [12/15]), sessile shape (76% [13/17]), dilated vessel (71% [12/17]), irregular vessel (82% [14/17]), and heterogeneous enhancement (59% [10/17]) on CEUS were significantly correlated with malignant GPLs (P < 0.01, respectively). On CEUS, the diagnostic criterion for malignant GPLs was defined as having one or more of the above four features because of the highest accuracy. Sensitivity, specificity, and accuracy for malignant GBLs were 88%, 68%, and 78% for patient age; 76%, 89%, and 83% for size of GPLs; 80%, 68%, and 74% for B-mode; and 94%, 89%, and 92% for CEUS, respectively.


CEUS is useful for the differential diagnosis of malignant and benign GPLs.


Contrast-enhanced ultrasound Gallbladder cancer Gallbladder polyp Sonazoid 



The present study did not receive any funding support.

Compliance with ethical standards

Conflict of interest

All authors declare relevant conflicts of interest to disclose.

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. The study was approved by the Yokohama City University Certified Institutional Review Board.

Informed consent

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


  1. 1.
    Piehler JM, Crichlow RW (1978) Primary carcinoma of the gallbladder. Surg Gynecol Obstet 147:929–942PubMedGoogle Scholar
  2. 2.
    Naito Y, Okabe Y, Kawahara A, et al. (2009) Usefulness of lavage cytology during endoscopic transpapillary catheterization into the gallbladder in the cytological diagnosis of gallbladder disease. Diagn Cytopathol 37:402–406CrossRefGoogle Scholar
  3. 3.
    Chantarojanasiri T, Hirooka Y, Kawashima H, et al. (2017) The role of endoscopic ultrasound in the diagnosis of gallbladder diseases. J Med Ultrason 44:63–70CrossRefGoogle Scholar
  4. 4.
    Kozuka S, Tsubone N, Yasui A, Hachisuka K (1982) Relation of adenoma to carcinoma in the gallbladder. Cancer 50:2226–2234CrossRefGoogle Scholar
  5. 5.
    Persley KM (2005) Gallbladder polyps. Curr Treat Options Gastroenterol 8:105–108CrossRefGoogle Scholar
  6. 6.
    Lee KF, Wong J, Li JC, Lai PB (2004) Polypoid lesions of the gallbladder. Am J Surg 188:186–190CrossRefGoogle Scholar
  7. 7.
    Boulton RA, Adams DH (1997) Gallbladder polyps: when to wait and when to act. Lancet 349:817CrossRefGoogle Scholar
  8. 8.
    Bhatt NR, Gillis A, Smoothey CO, Awan FN, Ridgway PF (2016) Evidence based management of polyps of the gall bladder: a systematic review of the risk factors of malignancy. Surgeon 14:278–286CrossRefGoogle Scholar
  9. 9.
    French DG, Allen PD, Ellsmere JC (2013) The diagnostic accuracy of transabdominal ultrasonography needs to be considered when managing gallbladder polyps. Surg Endosc 27:4021–4025CrossRefGoogle Scholar
  10. 10.
    Zielinski MD, Atwell TD, Davis PW, Kendrick ML, Que FG (2009) Comparison of surgically resected polypoid lesions of the gallbladder to their pre-operative ultrasound characteristics. J Gastrointest Surg 13:19–25CrossRefGoogle Scholar
  11. 11.
    Song ER, Chung WS, Jang HY, Yoon M, Cha EJ (2014) CT differentiation of 1-2-cm gallbladder polyps: benign vs malignant. Abdom Imaging 39:334–341CrossRefGoogle Scholar
  12. 12.
    Watanabe R, Matsumura M, Chen CJ, Kaneda Y, Fujimaki M (2005) Characterization of tumor imaging with microbubble-based ultrasound contrast agent, sonazoid, in rabbit liver. Bio Pharm Bull 28:972–977CrossRefGoogle Scholar
  13. 13.
    Luo W, Numata K, Morimoto M, et al. (2009) Clinical utility of contrast-enhanced three-dimensional ultrasound imaging with Sonazoid: findings on hepatocellular carcinoma lesions. Eur J Radiol 72:425–431CrossRefGoogle Scholar
  14. 14.
    Miwa H, Numata K, Sugimori K, et al. (2014) Differential diagnosis of solid pancreatic lesions using contrast-enhanced three-dimensional ultrasonography. Abdom Imaging 39:988–999CrossRefGoogle Scholar
  15. 15.
    Runner GJ, Corwin MT, Siewert B, Eisenberg RL (2014) Gallbladder wall thickening. Am J Roentgenol 202:W1–w12CrossRefGoogle Scholar
  16. 16.
    Mellnick VM, Menias CO, Sandrasegaran K, et al. (2015) Polypoid lesions of the gallbladder: disease spectrum with pathologic correlation. Radiographics 35:387–399CrossRefGoogle Scholar
  17. 17.
    Wiles R, Thoeni RF, Barbu ST, et al. (2017) Management and follow-up of gallbladder polyps : Joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery - European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE). Eur Radiol 27:3856–3866CrossRefGoogle Scholar
  18. 18.
    Kimura K, Fujita N, Noda Y, Kobayashi G, Ito K (2001) Differential diagnosis of large-sized pedunculated polypoid lesions of the gallbladder by endoscopic ultrasonography: a prospective study. J Gastroenterol 36:619–622CrossRefGoogle Scholar
  19. 19.
    Kondo S, Nimura Y, Kamiya J, et al. (2002) Mode of tumor spread and surgical strategy in gallbladder carcinoma. Langenbecks Arch Surg 387:222–228CrossRefGoogle Scholar
  20. 20.
    Xu JM, Guo LH, Xu HX, et al. (2014) Differential diagnosis of gallbladder wall thickening: the usefulness of contrast-enhanced ultrasound. Ultrasound Med Biol 40:2794–2804CrossRefGoogle Scholar
  21. 21.
    Negrao de Figueiredo G, Mueller-Peltzer K, Zengel P, et al. (2018) Diagnostic performance of contrast-enhanced ultrasound (CEUS) for the evaluation of gallbladder diseases. Clin Hemorheol Microcirc 69:83–91CrossRefGoogle Scholar
  22. 22.
    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 20:239–248CrossRefGoogle Scholar
  23. 23.
    Numata K, Oka H, Morimoto M, et al. (2007) Differential diagnosis of gallbladder diseases with contrast-enhanced harmonic gray scale ultrasonography. J Ultrasound Med 26:763–774CrossRefGoogle Scholar
  24. 24.
    Numata K, Luo W, Morimoto M, et al. (2010) Contrast enhanced ultrasound of hepatocellular carcinoma. World J Radiol 2(2):68–82CrossRefGoogle Scholar
  25. 25.
    Choi JH, Seo DW, Choi JH, et al. (2013) Utility of contrast-enhanced harmonic EUS in the diagnosis of malignant gallbladder polyps (with videos). Gastrointest Endosc 78:484–493CrossRefGoogle Scholar
  26. 26.
    Kamata K, Takenaka M, Kitano M, et al. (2018) Contrast-enhanced harmonic endoscopic ultrasonography for differential diagnosis of localized gallbladder lesions. Dig Endosc 30:98–106CrossRefGoogle Scholar
  27. 27.
    Yuan HX, Cao JY, Kong WT, et al. (2015) Contrast-enhanced ultrasound in diagnosis of gallbladder adenoma. Hepat Pancreat Dis Int 14:201–207CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Gastroenterological CenterYokohama City University Medical CenterYokohamaJapan
  2. 2.Division of GastroenterologyYokohama City University Graduate School of MedicineYokohamaJapan

Personalised recommendations