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CT diagnosis of gallbladder adenomyomatosis: importance of enhancing mucosal epithelium, the “cotton ball sign”

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

A Correction to this article was published on 04 July 2018

This article has been updated

ABSTRACT

Objectives

To determine the diagnostic value of the cotton ball sign and other CT features in patients with gallbladder (GB) wall thickenings (WTs).

Methods

Three blinded readers reviewed the preoperative CT and MR images of 101 patients with pathologically confirmed GB adenomyomatosis (GA) (n = 34) and other benign (n = 29), malignant (n = 41), and premalignant (n = 2) GBWTs. Three readers analysed the morphological features of GBWT and presence of the “cotton ball sign”, defined as fuzzy grey dots in GBWT or a dotted outer border of the inner enhancing layer on contrast-enhanced (CE) CT. In addition, the “pearl necklace sign” on MR was analysed.

Results

In the GA group (n = 34), prevalence of the cotton ball sign and pearl necklace sign was 74% (25/34) and 44% (15/34), respectively. Presence of the cotton ball sign, smooth contour of the mucosa, double-layering enhancement, and enhancement degree weaker than the renal cortex on CT images were significant predictors of benign GBWT (p < 0.01). When differentiating GA from GB malignancy or premalignancy, accuracy of the cotton ball sign and pearl necklace sign was 81% (62/77) and 74% (57/77), respectively.

Conclusion

The cotton ball sign on CE-CT showed higher sensitivity and comparable specificity to those of the pearl necklace sign in differentiating GA from malignancy.

Key Points

• Prevalence of the cotton ball sign on CT was 74% in gallbladder adenomyomatosis.

• The cotton ball sign was useful in differentiating gallbladder adenomyomatosis from gallbladder cancer.

• The cotton ball sign was more sensitive than the pearl necklace sign for adenomyomatosis diagnosis.

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Change history

  • 04 July 2018

    The original version of this article, published on 09 April 2018, unfortunately contained a mistake. The following correction has therefore been made in the original: The presentation of Fig. 2 was incorrect, “Cotton ball sign” was mistakenly named “Polka-dot sign”.

Abbreviations

CE:

Contrast enhanced

CT:

Computed tomography

GA:

Gallbladder adenomyomatosis

GB:

Gallbladder

GBWT:

Gallbladder wall thickening

GRE:

Gradient echo sequence

HU:

Hounsfield unit

MDCT:

Multi-detector computed tomography

MRCP:

Magnetic resonance cholangiopancreatography

MRI:

Magnetic resonance imaging

PVP:

Portal venous phase

RAS:

Rokitansky-Aschoff sinus

US:

Ultrasound

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Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Hyun Kyung Yang

    Present address: The Joint Department of Medical Imaging, Mount Sinai Hospital-University Health Network-Women’s College Hospital, University of Toronto, Toronto, ON, Canada

Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea

    Hyun Kyung Yang, Jeong Min Lee & Joon Koo Han

  2. Department of Radiology, Seoul National University College of Medicine, Seoul, Korea

    Jeong Min Lee & Joon Koo Han

  3. Department of Radiology, Konkuk University School of Medicine, Seoul, Korea

    Mi Hye Yu

  4. Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Korea

    Sang Min Lee

  5. Department of Radiology, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea

    Jinyoung Park

  6. Department of Pathology, National Cancer Center, Goyang, Gyeonggi-do, Korea

    Na Young Han

  7. Department of Pathology, Seoul National University Hospital, Seoul, Korea

    Kyoungbun Lee

  8. Department of Surgery, Seoul National University Hospital, Seoul, Korea

    Jin-Young Jang

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Correspondence to Jeong Min Lee.

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The scientific guarantor of this publication is Jeong Min Lee.

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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.

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Written informed consent was waived by the Institutional Review Board.

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• retrospective

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Yang, H.K., Lee, J.M., Yu, M.H. et al. CT diagnosis of gallbladder adenomyomatosis: importance of enhancing mucosal epithelium, the “cotton ball sign”. Eur Radiol 28, 3573–3582 (2018). https://doi.org/10.1007/s00330-018-5412-4

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  • DOI: https://doi.org/10.1007/s00330-018-5412-4

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