title: Differentiation of adenomyomatosis of the gallbladder from early-stage, wall-thickening-type gallbladder cancer using high-resolution ultrasound.
abstract: OBJECTIVE
  To evaluate the diagnostic performance of transabdominal high-resolution ultrasound (HRUS) for differentiation of adenomyomatosis from early-stage, wall-thickening-type gallbladder (GB) cancer.
  
  
  METHODS
  HRUS was defined as the addition of high megahertz imaging to conventional low megahertz imaging with use of state-of-the-art imaging technology. HRUS findings were retrospectively compared in 45 patients with adenomyomatosis and 28 patients with stage T1/T2 wall-thickening-type GB cancer. For evaluating HRUS performance in the differential diagnosis of adenomyomatosis from GB cancer, receiver operating characteristic curve analysis was used with a five-point confidence scale independently scored by three blinded radiologists who also analysed morphological abnormalities.
  
  
  RESULTS
  The area under the receiver operating characteristic curve (A (z)) values of HRUS in the diagnosis of adenomyomatosis were 0.948, 0.915 and 0.917 for reviewers 1, 2 and 3. Symmetrical wall thickening, intramural cystic spaces, intramural echogenic foci and twinkling artefacts were significantly associated with adenomyomatosis (P < 0.05), whereas irregular thickening of the outer wall, focal innermost hyperechoic layer (IHL) discontinuity, IHL irregularity, IHL thickening greater than 1 mm, loss of multilayer pattern in the GB wall, and intralesional vascularity were significantly associated with cancer (P < 0.05). The sensitivity, specificity and accuracy of intramural cystic spaces/echogenic foci for the diagnosis of adenomyomatosis were 80.0 %, 85.7 % and 82.2 %.
  
  
  CONCLUSIONS
  This study showed that HRUS can be helpful for distinguishing adenomyomatosis from early-stage, wall-thickening-type GB cancer.
authors.affiliation: Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea.
authors.forename: Ijin
authors.initials: I
authors.lastname: Joo
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Jung Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Soo Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Min A
authors.initials: MA
authors.lastname: Kim
authors.forename: Joon Koo
authors.initials: JK
authors.lastname: Han
authors.forename: Byung Ihn
authors.initials: BI
authors.lastname: Choi
mesh_terms: D018194:Adenomyoma / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging* / Q000473:pathology*; D005706:Gallbladder Neoplasms / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*