Skip to main content
Log in

Vascular evaluation using transabdominal ultrasound for gallbladder polyps

  • Special Feature: Review Article
  • Everything you need to know about ultrasound for diagnosis of gallbladder diseases
  • Published:
Journal of Medical Ultrasonics Aims and scope Submit manuscript

Abstract

Ultrasound (US) is a cost-effective and noninvasive procedure without radiation exposure, with real-time evaluation and high spatial resolution. Although it is useful for the detection of gallbladder (GB) polyps, including gallbladder cancer, adenoma, and benign polyps, conventional US is insufficient for differential diagnosis because it is not capable of evaluating hemodynamic information, unlike computed tomography or magnetic resonance imaging. With recent technological advances in US equipment and contrast agents, Doppler imaging and contrast-enhanced ultrasonography (CEUS) are being used to characterize GB polyps, and several reports on evaluation of the vascularity of GB polyp have been published. In this review, we aimed to report the latest developments in the hemodynamic diagnosis of GB polyps based on previous reports, with an emphasis on CEUS, and to evaluate the efficacy for differential diagnosis. The information in this article is expected to enable early diagnosis and prompt surgical treatment for gallbladder cancer.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

References

  1. Myers RP, Shaffer EA, Beck PL. Gallbladder polyps: epidemiology, natural history and management. Can J Gastroenterol. 2002;16:187–94.

    PubMed  Google Scholar 

  2. Sharma A, Sharma KL, Gupta A, et al. Gallbladder cancer epidemiology, pathogenesis and molecular genetics: recent update. World J Gastroenterol. 2017;23:3978–98.

    PubMed  PubMed Central  Google Scholar 

  3. Moriguchi H, Tazawa J, Hayashi Y, et al. Natural history of polypoid lesions in the gall bladder. Gut. 1996;39:860–2.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Inui K, Yoshino J, Miyoshi H. Diagnosis of gallbladder tumors. Intern Med. 2011;50:1133–6.

    PubMed  Google Scholar 

  5. Piehler JM, Crichlow RW. Primary carcinoma of the gallbladder. Surg Gynecol Obstet. 1978;147:929–42.

    CAS  PubMed  Google Scholar 

  6. Lazcano-Ponce EC, Miquel JF, Munoz N, et al. Epidemiology and molecular pathology of gallbladder cancer. CA Cancer J Clin. 2001;51:349–64.

    CAS  PubMed  Google Scholar 

  7. Naito Y, Okabe Y, Kawahara A, et al. Usefulness of lavage cytology during endoscopic transpapillary catheterization into the gallbladder in the cytological diagnosis of gallbladder disease. Diagn Cytopathol. 2009;37:402–6.

    PubMed  Google Scholar 

  8. Persley KM. Gallbladder polyps. Curr Treat Options Gastroenterol. 2005;8:105–8.

    PubMed  Google Scholar 

  9. Lee KF, Wong J, Li JC, et al. Polypoid lesions of the gallbladder. Am J Surg. 2004;188:186–90.

    PubMed  Google Scholar 

  10. Boulton RA, Adams DH. Gallbladder polyps: when to wait and when to act. Lancet. 1997;349:817.

    CAS  PubMed  Google Scholar 

  11. Bhatt NR, Gillis A, Smoothey CO, et al. Evidence based management of polyps of the gall bladder: a systematic review of the risk factors of malignancy. Surgeon. 2016;14:278–86.

    PubMed  Google Scholar 

  12. Terzi C, Sokmen S, Seckin S, et al. Polypoid lesions of the gallbladder: report of 100 cases with special reference to operative indications. Surgery. 2000;127:622–7.

    CAS  PubMed  Google Scholar 

  13. Xu HX. Contrast-enhanced ultrasound in the biliary system: potential uses and indications. World J Radiol. 2009;1:37–44.

    PubMed  PubMed Central  Google Scholar 

  14. Wiles R, Thoeni RF, Barbu ST, et al. 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. 2017;3856–3866.

    PubMed  PubMed Central  Google Scholar 

  15. Furukawa H, Kosuge T, Shimada K, et al. Small polypoid lesions of the gallbladder: differential diagnosis and surgical indications by helical computed tomography. Arch Surg. 1998;133:735–9.

    CAS  PubMed  Google Scholar 

  16. Maeyama R, Yamaguchi K, Noshiro H, et al. A large inflammatory polyp of the gallbladder masquerading as gallbladder carcinoma. J Gastroenterol. 1998;33:770–4.

    CAS  PubMed  Google Scholar 

  17. Badea R, Zaro R, Opincariu I, et al. Ultrasound in the examination of the gallbladder—a holistic approach: grey scale, Doppler, CEUS, elastography, and 3D. Med Ultrason. 2014;16:345–55.

    PubMed  Google Scholar 

  18. Hederstrom E, Forsberg L. Ultrasonography in carcinoma of the gallbladder. Diagn Diffic Pitfalls Acta Radiol. 1987;28:715–8.

    CAS  Google Scholar 

  19. Fayad LM, Holland GA, Bergin D, et al. Functional magnetic resonance cholangiography (fMRC) of the gallbladder and biliary tree with contrast-enhanced magnetic resonance cholangiography. J Magn Reson Imaging. 2003;18:449–60.

    PubMed  Google Scholar 

  20. Park KW, Kim SH, Choi SH, et al. Differentiation of nonneoplastic and neoplastic gallbladder polyps 1 cm or bigger with multi-detector row computed tomography. J Comput Assist Tomogr. 2010;34:135–9.

    PubMed  Google Scholar 

  21. Furrer MA, Spycher SCJ, Buttiker SM, et al. Comparison of the diagnostic performance of contrast-enhanced ultrasound with that of contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging in the evaluation of renal masses: a systematic review and meta-analysis. Eur Urol Oncol. 2019.

  22. Hirooka Y, Naitoh Y, Goto H, et al. Differential diagnosis of gall-bladder masses using colour Doppler ultrasonography. J Gastroenterol Hepatol. 1996;11:840–6.

    CAS  PubMed  Google Scholar 

  23. Komatsuda T, Ishida H, Konno K, et al. Gallbladder carcinoma: color Doppler sonography. Abdom Imaging. 2000;25:194–7.

    CAS  PubMed  Google Scholar 

  24. Kim KA, Park CM, Park SW, et al. Contrast-enhanced power Doppler US: is it useful in the differentiation of gallbladder disease? Clin Imaging. 2002;26:319–24.

    PubMed  Google Scholar 

  25. Numata K, Oka H, Morimoto M, et al. Differential diagnosis of gallbladder diseases with contrast-enhanced harmonic gray scale ultrasonography. J Ultrasound Med. 2007;26:763–74.

    PubMed  Google Scholar 

  26. Ueno N, Tomiyama T, Tano S, et al. Diagnosis of gallbladder carcinoma with color Doppler ultrasonography. Am J Gastroenterol. 1996;91:1647–9.

    CAS  PubMed  Google Scholar 

  27. Sparchez Z. Tissue harmonic imaging: is it useful in hepatobiliary and pancreatic ultrasonography? Rom J Gastroenterol. 2003;12:239–46.

    PubMed  Google Scholar 

  28. Jiang ZZ, Huang YH, Shen HL, et al. Clinical applications of superb microvascular imaging in the liver, breast, thyroid, skeletal muscle, and carotid plaques. J Ultrasound Med. 2019;38:2811–20.

    PubMed  Google Scholar 

  29. Mu J, Mao Y, Li F, et al. Superb microvascular imaging is a rational choice for accurate Bosniak classification of renal cystic masses. Br J Radiol. 2019;92:20181038.

    PubMed  PubMed Central  Google Scholar 

  30. Ra JC, Lee ES, Park HJ, et al. Efficacy of superb microvascular imaging for diagnosing acute cholecystitis: comparison with conventional ultrasonography. Ultrasound Med Biol. 2018;44:1968–77.

    PubMed  Google Scholar 

  31. Lee DH, Lee JY, Han JK. Superb microvascular imaging technology for ultrasound examinations: initial experiences for hepatic tumors. Eur J Radiol. 2016;85:2090–5.

    PubMed  Google Scholar 

  32. Matsumoto N, Ogawa M, Miura T, et al. B-flow imaging of vascular structure for the diagnosis of liver tumor. J Med Ultrason. 2001;2013:409–15.

    Google Scholar 

  33. Xie XH, Xu HX, Xie XY, et al. Differential diagnosis between benign and malignant gallbladder diseases with real-time contrast-enhanced ultrasound. Eur Radiol. 2010;20:239–48.

    PubMed  Google Scholar 

  34. Liu LN, Xu HX, Lu MD, et al. Contrast-enhanced ultrasound in the diagnosis of gallbladder diseases: a multi-center experience. PLoS ONE. 2012;7:e48371.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Nihonmatsu H, Numata K, Fukuda H, et al. Low mechanical index contrast mode versus high mechanical index contrast mode: which is a more sensitive method for detecting Sonazoid microbubbles in the liver of normal subjects? J Med Ultrason. 2001;2016:211–7.

    Google Scholar 

  36. Sun LP, Guo LH, Xu HX, et al. Value of contrast-enhanced ultrasound in the differential diagnosis between gallbladder adenoma and gallbladder adenoma canceration. Int J Clin Exp Med. 2015;8:1115–21.

    PubMed  PubMed Central  Google Scholar 

  37. Yuan HX, Cao JY, Kong WT, et al. Contrast-enhanced ultrasound in diagnosis of gallbladder adenoma. Hepatobiliary Pancreat Dis Int. 2015;14:201–7.

    PubMed  Google Scholar 

  38. Bae JS, Kim SH, Kang HJ, et al. Quantitative contrast-enhanced US helps differentiating neoplastic vs non-neoplastic gallbladder polyps. Eur Radiol. 2019;29:3772–811.

    PubMed  Google Scholar 

  39. Fei X, Lu WP, Luo YK, et al. Contrast-enhanced ultrasound may distinguish gallbladder adenoma from cholesterol polyps: a prospective case-control study. Abdom Imaging. 2015;40:2355–63.

    PubMed  Google Scholar 

  40. Correas JM, Bridal L, Lesavre A, et al. Ultrasound contrast agents: properties, principles of action, tolerance, and artifacts. Eur Radiol. 2001;11:1316–28.

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  42. Claudon M, Cosgrove D, Albrecht T, et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS)—update 2008. Ultraschall Med. 2008;29:28–44.

    CAS  PubMed  Google Scholar 

  43. Numata K, Luo W, Morimoto M, et al. Contrast enhanced ultrasound of hepatocellular carcinoma. World J Radiol. 2010;2:68–82.

    PubMed  PubMed Central  Google Scholar 

  44. Tanaka H, Iijima H, Higashiura A, et al. New malignant grading system for hepatocellular carcinoma using the Sonazoid contrast agent for ultrasonography. J Gastroenterol. 2014;49:755–63.

    CAS  PubMed  Google Scholar 

  45. Zhai HY, Liang P, Yu J, et al. Comparison of Sonazoid and SonoVue in the diagnosis of focal liver lesions: a preliminary study. J Ultrasound Med. 2019;38:2417–25.

    PubMed  Google Scholar 

  46. Watanabe R, Matsumura M, Munemasa T, et al. Mechanism of hepatic parenchyma-specific contrast of microbubble-based contrast agent for ultrasonography: microscopic studies in rat liver. Invest Radiol. 2007;42:643–51.

    CAS  PubMed  Google Scholar 

  47. Miwa H, Numata K, Sugimori K, et al. Differential diagnosis of gallbladder polypoid lesions using contrast-enhanced ultrasound. Abdom Radiol. 2019;44:1367–78.

    Google Scholar 

  48. Wang W, Fei Y, Wang F. Meta-analysis of contrast-enhanced ultrasonography for the detection of gallbladder carcinoma. Med Ultrason. 2016;18:281–32828.

    PubMed  Google Scholar 

  49. Kim SY, Cho JH, Kim EJ, et al. The efficacy of real-time colour Doppler flow imaging on endoscopic ultrasonography for differential diagnosis between neoplastic and non-neoplastic gallbladder polyps. Eur Radiol. 2018;28:1994–2002.

    PubMed  Google Scholar 

  50. Numata K. Advances in ultrasound systems for hepatic lesions in Japan. J Med Ultrason. 2001;2015:297–301.

    Google Scholar 

  51. Zhang HP, Bai M, Gu JY, et al. Value of contrast-enhanced ultrasound in the differential diagnosis of gallbladder lesion. World J Gastroenterol. 2018;24:744–51.

    CAS  PubMed  PubMed Central  Google Scholar 

  52. Kong WT, Shen HY, Qiu YD, et al. Application of contrast enhanced ultrasound in gallbladder lesion: is it helpful to improve the diagnostic capabilities? Med Ultrason. 2018;20:420–6.

    PubMed  Google Scholar 

  53. Sidhu PS, Cantisani V, Dietrich CF, et al. The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: update 2017 (short version). Ultraschall Med. 2018;39:154–80.

    PubMed  Google Scholar 

  54. Luo W. Differentiation of focal liver lesions using three-dimensional ultrasonography: retrospective and prospective studies. World J Gastroenterol. 2010;16:2109.

    PubMed  PubMed Central  Google Scholar 

  55. Miwa H, Numata K, Sugimori K, et al. Differential diagnosis of solid pancreatic lesions using contrast-enhanced three-dimensional ultrasonography. Abdom Imaging. 2014;39:988–99.

    PubMed  PubMed Central  Google Scholar 

  56. Luo W, Numata K, Morimoto M, et al. Three-dimensional contrast-enhanced sonography of vascular patterns of focal liver tumors: pilot study of visualization methods. Am J Roentgenol. 2009;192:165–73.

    Google Scholar 

  57. Kim SH, Lee JM, Lee KH, et al. Four-dimensional volume contrast ultrasound imaging of the gallbladder compared with tissue harmonic imaging: preliminary experience. Eur Radiol. 2004;14:1657–64.

    PubMed  Google Scholar 

  58. Zhuang B, Li W, Wang W, et al. Contrast-enhanced ultrasonography improves the diagnostic specificity for gallbladder-confined focal tumors. Abdom Radiol. 2018;43:1134–42.

    Google Scholar 

  59. Gerstenmaier JF, Hoang KN, Gibson RN. Contrast-enhanced ultrasound in gallbladder disease: a pictorial review. Abdom Radiol. 2016;41:1640–52.

    CAS  Google Scholar 

  60. Cheng Y, Wang M, Ma B, et al. Potential role of contrast-enhanced ultrasound for the differentiation of malignant and benign gallbladder lesions in East Asia: a meta-analysis and systematic review. Medicine. 2018;97:e11808.

    PubMed  PubMed Central  Google Scholar 

  61. Serra C, Felicani C, Mazzotta E, et al. CEUS in the differential diagnosis between biliary sludge, benign lesions and malignant lesions. J Ultrasound. 2018;21:119–26.

    PubMed  PubMed Central  Google Scholar 

  62. Wang JH, Liu BJ, Xu HX, et al. Clinical, pathological and sonographic characteristics of unexpected gallbladder carcinoma. Int J Clin Exp Med. 2015;8:11109–16.

    PubMed  PubMed Central  Google Scholar 

  63. Aldridge MC, Bismuth H. Gallbladder cancer: the polyp-cancer sequence. Br J Surg. 1990;77:363–4.

    CAS  PubMed  Google Scholar 

  64. Mellnick VM, Menias CO, Sandrasegaran K, et al. Polypoid lesions of the gallbladder: disease spectrum with pathologic correlation. Radiographics 2015;35:387–99.

    PubMed  Google Scholar 

  65. Kim HC, Yang DM, Jin W, et al. Color Doppler twinkling artifacts in various conditions during abdominal and pelvic sonography. J Ultrasound Med. 2010;29:621–32.

    PubMed  Google Scholar 

  66. Babu BI, Dennison AR, Garcea G. Management and diagnosis of gallbladder polyps: a systematic review. Langenbeck’s Arch Surg. 2015;400:455–62.

    Google Scholar 

  67. Konstantinidis IT, Bajpai S, Kambadakone AR, et al. Gallbladder lesions identified on ultrasound. Lessons from the last 10 years. J Gastrointest Surg. 2012;16:549–53.

    PubMed  Google Scholar 

  68. Harvey CJ, Blomley MJ, Eckersley RJ, et al. Developments in ultrasound contrast media. Eur Radiol. 2001;11:675–89.

    CAS  PubMed  Google Scholar 

  69. Numata K, Tanaka K, Kiba T, et al. Contrast-enhanced, wide-band harmonic gray scale imaging of hepatocellular carcinoma: correlation with helical computed tomographic findings. J Ultrasound Med. 2001;20:89–988.

    CAS  PubMed  Google Scholar 

  70. Xu JM, Guo LH, Xu HX, et al. Differential diagnosis of gallbladder wall thickening: the usefulness of contrast-enhanced ultrasound. Ultrasound Med Biol. 2014;40:2794–804.

    PubMed  Google Scholar 

  71. Numata K, Morimoto M, Ogura T, et al. Ablation therapy guided by contrast-enhanced sonography with Sonazoid for hepatocellular carcinoma lesions not detected by conventional sonography. J Ultrasound Med. 2008;27:395–406.

    PubMed  Google Scholar 

  72. Luo W, Numata K, Kondo M, et al. Sonazoid-enhanced ultrasonography for evaluation of the enhancement patterns of focal liver tumors in the late phase by intermittent imaging with a high mechanical index. J Ultrasound Med. 2009;28:439–48.

    PubMed  Google Scholar 

  73. Takizawa K, Numata K, Morimoto M, et al. Use of contrast-enhanced ultrasonography with a perflubutane-based contrast agent performed one day after transarterial chemoembolization for the early assessment of residual viable hepatocellular carcinoma. Eur J Radiol. 2013;82:1471–80.

    PubMed  Google Scholar 

  74. Wang W, Yang ZL, Liu JQ, et al. Identification of CD146 expression, angiogenesis, and lymphangiogenesis as progression, metastasis, and poor-prognosis related markers for gallbladder adenocarcinoma. Tumour Biol. 2012;33:173–82.

    PubMed  Google Scholar 

  75. Chen LD, Xu HX, Xie XY, et al. Intrahepatic cholangiocarcinoma and hepatocellular carcinoma: differential diagnosis with contrast-enhanced ultrasound. Eur Radiol. 2010;20:743–53.

    CAS  PubMed  Google Scholar 

  76. Chung YE, Kim KW. Contrast-enhanced ultrasonography: advance and current status in abdominal imaging. Ultrasonography. 2015;34:3–18.

    PubMed  Google Scholar 

  77. Kitano M. Dynamic imaging of pancreatic diseases by contrast enhanced coded phase inversion harmonic ultrasonography. Gut. 2004;53:854–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  78. Miyata T, Kitano M, Omoto S, et al. Contrast-enhanced harmonic endoscopic ultrasonography for assessment of lymph node metastases in pancreatobiliary carcinoma. World J Gastroenterol. 2016;22:3381–91.

    PubMed  PubMed Central  Google Scholar 

  79. Yuan HX, Wang WP, Guan PS, et al. Contrast-enhanced ultrasonography in differential diagnosis of focal gallbladder adenomyomatosis and gallbladder cancer. Clin Hemorheol Microcirc. 2018;70:201–11.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kazushi Numata.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical statements

All procedures followed the ethical standards of the responsible committee on human experimentation (institutional and national) and the Helsinki Declaration of 1964 and later versions.

Informed consent

Informed consent was obtained from all patients for being included in the study.

Additional information

Publisher's Note

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

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Miwa, H., Numata, K., Sugimori, K. et al. Vascular evaluation using transabdominal ultrasound for gallbladder polyps. J Med Ultrasonics 48, 159–173 (2021). https://doi.org/10.1007/s10396-020-01008-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10396-020-01008-8

Keywords

Navigation