Differential diagnosis of gallbladder diseases with contrast-enhanced harmonic gray scale ultrasonography.
OBJECTIVE
We evaluated the usefulness of contrast-enhanced harmonic gray scale ultrasonographic findings for differential diagnosis of gallbladder diseases.


METHODS
We evaluated contrast-enhanced harmonic gray scale ultrasonographic images from 33 patients with 35 polypoid gallbladder disease lesions larger than 10 mm in diameter, consisting of 12 biliary sludge lesions, 8 cholesterol polyps, 1 inflammatory polyp, 2 adenomas, and 12 carcinomas. After a galactosepalmitic acid contrast agent was injected, lesions were scanned by contrast-enhanced harmonic gray scale ultrasonography in 2 phases: early vascular and late vascular.


RESULTS
None of the biliary sludge lesions (n = 12) showed either tumor vessels or tumor enhancement. Lesions showing tumor vessels and tumor enhancement on contrast-enhanced harmonic gray scale ultrasonography were diagnosed as cholesterol polyp, inflammatory polyp, adenoma, or carcinoma. Three (38%) of the 8 cholesterol polyps showed dotted-type tumor vessels. Branched-type tumor vessels were observed in 5 (62%) of the 8 cholesterol polyps, the 1 (100%) inflammatory polyp, both (100%) adenomas, and 3 (25%) of the 12 carcinomas. Tortuous-type tumor vessels were observed in 9 (75%) of the 12 carcinomas. Lesions with tumor enhancement and tortuous-type tumor vessels on contrast-enhanced harmonic gray scale ultrasonography were diagnosed as carcinomas, and the sensitivity, specificity, and accuracy of this diagnosis with the current modality were 75% (9/12), 100% (23/23), and 91% (32/35), respectively.


CONCLUSIONS
Evaluation of tumor vessels on contrast-enhanced harmonic gray scale ultrasonography may be a useful modality for differentiating gallbladder carcinoma from other polypoid gallbladder disease lesions.
Numata
Kazushi
K
Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan. kz-numa@urahp.yokohama-cu.ac.jp
Oka
Hiroyuki
H
Morimoto
Manabu
M
Sugimori
Kazuya
K
Kunisaki
Reiko
R
Nihonmatsu
Hiromi
H
Matsuo
Kenichi
K
Nagano
Yasuhiko
Y
Nozawa
Akinori
A
Tanaka
Katsuaki
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D005705:Gallbladder Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*
D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508