Quantitative contrast-enhanced US helps differentiating neoplastic vs non-neoplastic gallbladder polyps
- 48 Downloads
To differentiate between large (≥ 1 cm in diameter) gallbladder (GB) non-neoplastic and neoplastic polyps using quantitative analysis of contrast-enhanced ultrasound (CEUS) findings.
From September 2017 to May 2018, 29 patients (10 males; median age, 63 years) with GB polyps of ≥ 1 cm in diameter who were undergoing cholecystectomy were consecutively enrolled. All patients underwent preoperative conventional US and CEUS examinations. Quantitative analysis of CEUS findings using time-intensity curves between the two groups was independently performed by two radiologists. The interobserver agreement for the quantitative analysis of the CEUS results was measured using the intraclass correlation coefficient. Receiver operating characteristic analysis was performed to evaluate the diagnostic performance of CEUS examination.
After the cholecystectomy, the patients were classified into the non-neoplastic polyp group (n = 12) and the neoplastic polyp group (n = 17) according to the pathological results. The interobserver agreement for quantitative assessment between the two radiologists was near perfect to substantial. Quantitative assessment of the CEUS findings revealed that the rise time, mean transit time, time to peak, and fall time of non-neoplastic GB polyps were significantly shorter than those of neoplastic polyps (p < 0.001, p = 0.008, p = 0.013, and p = 0.002, respectively). The sensitivity and specificity of the quantitative CEUS parameters for the differentiation between the two groups were 76.5–100% and 75%, respectively, with an area under the curve of 0.765–0.887.
Quantitative analysis of CEUS findings could be valuable in differentiating GB neoplastic polyps from non-neoplastic polyps.
• Quantitative analysis of CEUS findings could be valuable in differentiating gallbladder neoplastic polyps from non-neoplastic polyps.
• Quantitative analysis of CEUS findings in gallbladder polyps provides cut-off values for differentiation between neoplastic polyps and non-neoplastic polyps with near-perfect to substantial interobserver agreement.
KeywordsContrast media Ultrasonography Gallbladder Polyps
Area under the curve
Mean transit time
Receiver operating characteristic
Region of interest
Time to peak enhancement
This research was supported by the Research Resettlement Fund for the new faculty of Seoul National University and from the Seoul National University Hospital Research Fund No. 05-2016-0060.
Compliance with ethical standards
The scientific guarantor of this publication is Joon Koo Han.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• diagnostic or prognostic study
• performed at one institution
- 9.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
- 11.Trivedi V, Gumaste VV, Liu S, Baum J (2008) Gallbladder cancer: adenoma-carcinoma or dysplasia-carcinoma sequence? Gastroenterol Hepatol (N Y) 4:735–737Google Scholar
- 16.Gore RM, Yaghmai V, Newmark GM, Berlin JW, Miller FH (2002) Imaging benign and malignant disease of the gallbladder. Radiol Clin North Am 40:1307–1323 viGoogle Scholar
- 22.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 39:187–210CrossRefGoogle Scholar
- 31.Greis C (2011) Quantitative evaluation of microvascular blood flow by contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc 49:137–149Google Scholar
- 37.Quaia E, Sozzi M, Angileri R, Gennari AG, Cova MA (2016) Time-intensity curves obtained after microbubble injection can be used to differentiate responders from nonresponders among patients with clinically active Crohn disease after 6 weeks of pharmacologic treatment. Radiology 281:606–616CrossRefGoogle Scholar
- 38.Tranquart F, Mercier L, Frinking P, Gaud E, Arditi M (2012) Perfusion quantification in contrast-enhanced ultrasound (CEUS)--ready for research projects and routine clinical use. Ultraschall Med 33 Suppl(1):S31–S38Google Scholar
- 40.Zheng SG, Xu HX, Liu LN et al (2013) Contrast-enhanced ultrasound versus conventional ultrasound in the diagnosis of polypoid lesion of gallbladder: a multi-center study of dynamic microvascularization. Clin Hemorheol Microcirc 55:359–374Google Scholar