Skip to main content

Advertisement

SpringerLink
Log in

Quantitative contrast-enhanced US helps differentiating neoplastic vs non-neoplastic gallbladder polyps

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To differentiate between large (≥ 1 cm in diameter) gallbladder (GB) non-neoplastic and neoplastic polyps using quantitative analysis of contrast-enhanced ultrasound (CEUS) findings.

Methods

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.

Results

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.

Conclusions

Quantitative analysis of CEUS findings could be valuable in differentiating GB neoplastic polyps from non-neoplastic polyps.

Key Points

• 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

AUC:

Area under the curve

CEUS:

Contrast-enhanced ultrasound

FT:

Fall time

GB:

Gallbladder

MTT:

Mean transit time

ROC:

Receiver operating characteristic

ROI:

Region of interest

RT:

Rise time

TIC:

Time-intensity curve

TTP:

Time to peak enhancement

References

  1. Myers RP, Shaffer EA, Beck PL (2002) Gallbladder polyps: epidemiology, natural history and management. Can J Gastroenterol 16:187–194

    Article  PubMed  Google Scholar 

  2. Inui K, Yoshino J, Miyoshi H (2011) Diagnosis of gallbladder tumors. Intern Med 50:1133–1136

    Article  PubMed  Google Scholar 

  3. Sugiyama M, Atomi Y, Yamato T (2000) Endoscopic ultrasonography for differential diagnosis of polypoid gall bladder lesions: analysis in surgical and follow up series. Gut 46:250–254

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Yang HL, Sun YG, Wang Z (1992) Polypoid lesions of the gallbladder: diagnosis and indications for surgery. Br J Surg 79:227–229

    Article  CAS  PubMed  Google Scholar 

  5. Shinkai H, Kimura W, Muto T (1998) Surgical indications for small polypoid lesions of the gallbladder. Am J Surg 175:114–117

    Article  CAS  PubMed  Google Scholar 

  6. Terzi C, Sokmen S, Seckin S, Albayrak L, Ugurlu M (2000) Polypoid lesions of the gallbladder: report of 100 cases with special reference to operative indications. Surgery 127:622–627

    Article  CAS  PubMed  Google Scholar 

  7. Cha BH, Hwang JH, Lee SH et al (2011) Pre-operative factors that can predict neoplastic polypoid lesions of the gallbladder. World J Gastroenterol 17:2216–2222

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kubota K, Bandai Y, Noie T, Ishizaki Y, Teruya M, Makuuchi M (1995) How should polypoid lesions of the gallbladder be treated in the era of laparoscopic cholecystectomy? Surgery 117:481–487

    Article  CAS  PubMed  Google Scholar 

  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 27:3856–3866

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kozuka S, Tsubone N, Yasui A, Hachisuka K (1982) Relation of adenoma to carcinoma in the gallbladder. Cancer 50:2226–2234

    Article  CAS  PubMed  Google Scholar 

  11. Trivedi V, Gumaste VV, Liu S, Baum J (2008) Gallbladder cancer: adenoma-carcinoma or dysplasia-carcinoma sequence? Gastroenterol Hepatol (N Y) 4:735–737

    Google Scholar 

  12. Okamoto M, Okamoto H, Kitahara F et al (1999) Ultrasonographic evidence of association of polyps and stones with gallbladder cancer. Am J Gastroenterol 94:446–450

    Article  CAS  PubMed  Google Scholar 

  13. Boulton RA, Adams DH (1997) Gallbladder polyps: when to wait and when to act. Lancet 349:817

    Article  CAS  PubMed  Google Scholar 

  14. Mishra G, Conway JD (2009) Endoscopic ultrasound in the evaluation of radiologic abnormalities of the liver and biliary tree. Curr Gastroenterol Rep 11:150–154

    Article  PubMed  Google Scholar 

  15. Lee TY, Ko SF, Huang CC et al (2009) Intraluminal versus infiltrating gallbladder carcinoma: clinical presentation, ultrasound and computed tomography. World J Gastroenterol 15:5662–5668

    Article  CAS  PubMed  PubMed Central  Google 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 vi

  17. Badea R, Zaro R, Opincariu I, Chiorean L (2014) Ultrasound in the examination of the gallbladder - a holistic approach: grey scale, Doppler, CEUS, elastography, and 3D. Med Ultrason 16:345–355

    Article  PubMed  Google Scholar 

  18. Hirooka Y, Naitoh Y, Goto H, Furukawa T, Ito A, Hayakawa T (1996) Differential diagnosis of gall-bladder masses using colour Doppler ultrasonography. J Gastroenterol Hepatol 11:840–846

    Article  CAS  PubMed  Google Scholar 

  19. Komatsuda T, Ishida H, Konno K et al (2000) Gallbladder carcinoma: color Doppler sonography. Abdom Imaging 25:194–197

    Article  CAS  PubMed  Google Scholar 

  20. Numata K, Oka H, Morimoto M et al (2007) Differential diagnosis of gallbladder diseases with contrast-enhanced harmonic gray scale ultrasonography. J Ultrasound Med 26:763–774

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google 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 39:187–210

    Article  PubMed  Google Scholar 

  23. Piscaglia F, Nolsoe C, Dietrich CF et al (2012) The EFSUMB guidelines and recommendations on the clinical practice of contrast enhanced ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall Med 33:33–59

    Article  CAS  PubMed  Google Scholar 

  24. Jakobsen JA, Oyen R, Thomsen HS, Morcos SK, Members of Contrast Media Safety Committee of European Society of Urogenital R (2005) Safety of ultrasound contrast agents. Eur Radiol 15:941–945

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. 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 20:239–248

    Article  PubMed  Google Scholar 

  27. 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:e48371

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Fei X, Lu WP, Luo YK et al (2015) Contrast-enhanced ultrasound may distinguish gallbladder adenoma from cholesterol polyps: a prospective case-control study. Abdom Imaging 40:2355–2363

    Article  PubMed  Google Scholar 

  29. Liu XS, Gu LH, Du J et al (2015) Differential diagnosis of polypoid lesions of the gallbladder using contrast-enhanced sonography. J Ultrasound Med 34:1061–1069

    Article  PubMed  Google Scholar 

  30. Zhang HP, Bai M, Gu JY, He YQ, Qiao XH, Du LF (2018) Value of contrast-enhanced ultrasound in the differential diagnosis of gallbladder lesion. World J Gastroenterol 24:744–751

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Greis C (2011) Quantitative evaluation of microvascular blood flow by contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc 49:137–149

    PubMed  Google Scholar 

  32. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  33. Song ER, Chung WS, Jang HY, Yoon M, Cha EJ (2014) CT differentiation of 1-2-cm gallbladder polyps: benign vs malignant. Abdom Imaging 39:334–341

    Article  PubMed  Google Scholar 

  34. Wang W, Yang ZL, Liu JQ, Jiang S, Miao XY (2012) Identification of CD146 expression, angiogenesis, and lymphangiogenesis as progression, metastasis, and poor-prognosis related markers for gallbladder adenocarcinoma. Tumour Biol 33:173–182

    Article  CAS  PubMed  Google Scholar 

  35. Yoshimitsu K, Honda H, Kaneko K et al (1997) Anatomy and clinical importance of cholecystic venous drainage: helical CT observations during injection of contrast medium into the cholecystic artery. AJR Am J Roentgenol 169:505–510

    Article  CAS  PubMed  Google Scholar 

  36. Lassau N, Koscielny S, Chami L et al (2011) Advanced hepatocellular carcinoma: early evaluation of response to bevacizumab therapy at dynamic contrast-enhanced US with quantification--preliminary results. Radiology 258:291–300

    Article  PubMed  Google 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 281:606–616

    Article  PubMed  Google 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–S38

    Google Scholar 

  39. Lee J, Yun M, Kim KS, Lee JD, Kim CK (2012) Risk stratification of gallbladder polyps (1-2 cm) for surgical intervention with 18F-FDG PET/CT. J Nucl Med 53:353–358

    Article  CAS  PubMed  Google 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 55:359–374

    PubMed  Google Scholar 

Download references

Funding

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.

Author information

Authors and Affiliations

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

    Jae Seok Bae, Se Hyung Kim, Hyo-jin Kang, Jae Young Lee & Joon Koo Han

  2. Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Jae Seok Bae, Se Hyung Kim, Hyo-jin Kang, Jae Young Lee & Joon Koo Han

  3. Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Se Hyung Kim, Jae Young Lee & Joon Koo Han

  4. Department of Pathology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Haeryoung Kim

  5. Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Ji Kon Ryu, Sang Hyub Lee & Woo Hyun Paik

  6. Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Jin-Young Jang & Wooil Kwon

Authors
  1. Jae Seok Bae
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Se Hyung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hyo-jin Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Haeryoung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ji Kon Ryu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jin-Young Jang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sang Hyub Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Woo Hyun Paik
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Wooil Kwon
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jae Young Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Joon Koo Han
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Se Hyung Kim.

Ethics declarations

Guarantor

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.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 15 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bae, J.S., Kim, S.H., Kang, Hj. et al. Quantitative contrast-enhanced US helps differentiating neoplastic vs non-neoplastic gallbladder polyps. Eur Radiol 29, 3772–3781 (2019). https://doi.org/10.1007/s00330-019-06123-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-019-06123-w

Keywords

Search

Navigation