title: Diagnosis of gallbladder diseases by contrast-enhanced phase-inversion harmonic ultrasonography.
abstract: We evaluated the usefulness of contrast-enhanced ultrasonography(US) for detecting and differentiating gallbladder lesions. Contrast-enhanced coded phase-inversion harmonic US was performed on 90 patients with gallbladder abnormalities. After administering Levovist, we observed the gallbladders in real time. Contrast-enhanced coded phase-inversion harmonic ultrasonography was compared with B-mode US and contrast-enhanced computer tomography (CT) with regard to the sensitivity and specificity in depicting the elevated gallbladder lesions. Furthermore, we assessed how the vascular patterns of the elevated gallbladder lesions depicted by contrast-enhanced US correlated with the diagnosis. Contrast-enhanced US efficiently discriminated true lesions from biliary sludge, unlike B-mode US. Consequently, contrast-enhanced US was more specific (100%) than B-mode US (81%), although their sensitivities were similar (98% and 96%, respectively). Contrast-enhanced US was also more sensitive that contrast-enhanced CT (98% versus 79%), although the two methods were equally sensitive (100% versus 95%). We classified the vascular patterns of the abnormalities depicted by contrast-enhanced US in the 90 cases into types 1 to 4, which represent branch-like, heterogeneous, homogeneous, and avascular patterns, respectively. All type 1 and 2 lesions were over 10 mm in size while most (88%) type 3 lesions were 10 mm or less in size. While the majority of carcinomas (86%) were type 1 or 2, three benign lesions also showed these patterns. Thus, the vascular pattern may simply reflect the size of the lesion and therefore its usefulness in diagnosing gallbladder lesions may be limited. Nevertheless, contrast-enhanced US is clearly superior to the other techniques in discriminating biliary sludge from other lesions.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kinki University School of Medicine, Osaka-Sayama, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Inoue
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kitano
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sakamoto
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Kawasaki
authors.forename: Chikao
authors.initials: C
authors.lastname: Yasuda
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Maekawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D005704:Gallbladder / Q000098:blood supply / Q000000981:diagnostic imaging; D005705:Gallbladder Diseases / Q000000981:diagnostic imaging*; D005706:Gallbladder Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D045423:Microbubbles; D008875:Middle Aged; D011127:Polyps / Q000000981:diagnostic imaging; D011134:Polysaccharides / Q000008:administration & dosage; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods; D014463:Ultrasonography / Q000379:methods
chemical_list: D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508