title: Contrast-enhanced ultrasound in the diagnosis of gallbladder diseases: a multi-center experience.
abstract: OBJECTIVE
  To assess the usefulness of contrast-enhanced ultrasound (CEUS) in differentiating malignant from benign gallbladder (GB) diseases.
  
  
  METHODS
  This study had institutional review board approval. 192 patients with GB diseases from 9 university hospitals were studied. After intravenous bonus injection of a phospholipid-stabilized shell microbubble contrast agent, lesions were scanned with low acoustic power CEUS. A multiple logistic regression analysis was performed to identify diagnostic clues from 17 independent variables that enabled differentiation between malignant and benign GB diseases. Receiver operating characteristic (ROC) curve analysis was performed.
  
  
  RESULTS
  Among the 17 independent variables, multiple logistic regression analysis showed that the following 4 independent variables were associated with the benign nature of the GB diseases, including the patient age, intralesional blood vessel depicted on CEUS, contrast washout time, and wall intactness depicted on CEUS (all P<0.05). ROC analysis showed that the patient age, intralesional vessels on CEUS, and the intactness of the GB wall depicted on CEUS yielded an area under the ROC curve (Az) greater than 0.8 in each and Az for the combination of the 4 significant independent variables was 0.915 [95% confidence interval (CI): 0.857-0.974]. The corresponding Az, sensitivity, and specificity for the age were 0.805 (95% CI: 0.746-0.863), 92.2%%, and 59.6%; for the intralesional vessels on CEUS were 0.813 (95% CI: 0.751-0.875), 59.8%, and 98.0%; and for the GB wall intactness were 0.857 (95% CI: 0.786-0.928), 78.4%, and 92.9%. The cut-off values for benign GB diseases were patient age <53.5 yrs, dotted intralesional vessels on CEUS and intact GB wall on CEUS.
  
  
  CONCLUSIONS
  CEUS is valuable in differentiating malignant from benign GB diseases. Branched or linear intralesional vessels and destruction of GB wall on CEUS are the CEUS features highly suggestive of GB malignancy and the patient age >53.5 yrs is also a clue for GB malignancy.
authors.affiliation: Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Shanghai, China.
authors.forename: Lin-Na
authors.initials: LN
authors.lastname: Liu
authors.forename: Hui-Xiong
authors.initials: HX
authors.lastname: Xu
authors.forename: Ming-De
authors.initials: MD
authors.lastname: Lu
authors.forename: Xiao-Yan
authors.initials: XY
authors.lastname: Xie
authors.forename: Wen-Ping
authors.initials: WP
authors.lastname: Wang
authors.forename: Bing
authors.initials: B
authors.lastname: Hu
authors.forename: Kun
authors.initials: K
authors.lastname: Yan
authors.forename: Hong
authors.initials: H
authors.lastname: Ding
authors.forename: Shao-Shan
authors.initials: SS
authors.lastname: Tang
authors.forename: Lin-Xue
authors.initials: LX
authors.lastname: Qian
authors.forename: Bao-Ming
authors.initials: BM
authors.lastname: Luo
authors.forename: Yan-Ling
authors.initials: YL
authors.lastname: Wen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D005705:Gallbladder Diseases / Q000000981:diagnostic imaging*; D005706:Gallbladder Neoplasms / Q000000981:diagnostic imaging; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media