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Xanthogranulomatous cholecystitis: diagnostic performance of US, CT, and MRI for differentiation from gallbladder carcinoma

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Abstract

Objectives

The purpose of this study is to evaluate the diagnostic performance of HRUS, CT, and MRI for differentiating xanthogranulomatous cholecystitis (XGC) from gallbladder (GB) cancer.

Materials and Methods

Patients with surgically proven XGC (n = 40) and GB cancer (n = 44), who had undergone at least one HRUS (n = 43), CT (n = 82), or MRI (n = 34) examination between 2000 and 2012, were included. Two radiologists retrospectively graded the likelihood of XGC or GB cancer using a 5-point confidence scale; they also assessed the imaging features. Statistical analyses were performed using ROC, ANOVA, and Fisher’s exact test.

Results

Diagnostic performance of MRI was better than HRUS for differentiating XGC from GB cancer (AUCs = 0.867 and 0.911 vs. AUCs = 0.818 and 0.86). However, HRUS showed a better performance than CT (AUCs = 0.818 and 0.86 vs. AUCs = 0.806 and 0.84) with moderate to excellent agreement (κ = 0.48–0.83). Statistically common findings for XGC included non-focal thickening, smooth GB wall, presence of intramural nodules, type I enhancement of wall, transient hepatic attenuation difference, and continuity of mucosa (p < 0.05). Co-existence of gallstones (OR = 16.5), non-focal thickening (OR = 14.7), and collapsed lumen (OR = 13.0) on HRUS, and type I enhancement on CT (OR = 3.52) were independently associated with XGC (p < 0.05).

Conclusion

Although MRI showed a better performance than both HRUS and CT, HRUS showed a better performance than CT. The co-existence of gallstones, non-focal thickening, and collapsed lumen on HRUS was independently associated with XGC.

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Acknowledgments

We would like to thank Bonnie Hami, MA (USA) for her editorial assistance in the preparation of this manuscript.

Author information

Author notes

  1. Eun Sun Lee & Byung Ihn Choi

    Present address: Department of Radiology, Cung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Korea

Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, Seoul, South Korea

    Eun Sun Lee, Jung Hoon Kim, Ijin Joo, Jae Young Lee, Joon Koo Han & Byung Ihn Choi

  2. Institute of Radiation Medicine, Seoul National University College of Medicine, 101, Daehang-no, Chongno-gu, Seoul, 110-744, Korea

    Jung Hoon Kim, Jae Young Lee, Joon Koo Han & Byung Ihn Choi

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  1. Eun Sun Lee
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Correspondence to Jung Hoon Kim.

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Lee, E.S., Kim, J.H., Joo, I. et al. Xanthogranulomatous cholecystitis: diagnostic performance of US, CT, and MRI for differentiation from gallbladder carcinoma. Abdom Imaging 40, 2281–2292 (2015). https://doi.org/10.1007/s00261-015-0432-x

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  • DOI: https://doi.org/10.1007/s00261-015-0432-x

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