title: Utility of contrast-enhanced harmonic EUS in the diagnosis of malignant gallbladder polyps (with videos).
abstract: BACKGROUND
  The differential diagnosis between benign and malignant polyps of the gallbladder (GB) is often challenging.
  
  
  OBJECTIVE
  To evaluate whether contrast-enhanced harmonic EUS (CEH-EUS) might be an accurate method for discriminating malignant GB polyps from benign polyps.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Tertiary care medical center.
  
  
  METHODS
  Ninety-three patients with GB polyps larger than 10 mm in diameter that were detected by conventional EUS underwent CEH-EUS for evaluation of microvasculature.
  
  
  METHODS
  CEH-EUS was performed using a radial echoendoscope and the extended pure harmonic detection mode.
  
  
  METHODS
  The abilities of conventional EUS and CEH-EUS to diagnose malignant polyp were compared. Two blinded reviewers classified the perfusion images into 3 categories: diffuse enhancement, perfusion defect, or nonenhancement. The vessel images were categorized as having a regular spotty vessel, an irregular vessel, or no vessels.
  
  
  RESULTS
  An irregular vessel pattern determined by CEH-EUS aided in the diagnosis of malignant polyps with a sensitivity and specificity of 90.3% and 96.6%, respectively. The presence of perfusion defects, determined by CEH-EUS, was calculated to diagnose malignant polyps with a sensitivity and specificity of 90.3% and 94.9%, respectively. Based on the definitely determined diagnosis, sensitivity and specificity for CEH-EUS were 93.5% and 93.2% versus 90.0% and 91.1% for conventional EUS. In 8 cases, management changed after CEH-EUS.
  
  
  CONCLUSIONS
  A tertiary medical center with a limited number of patients.
  
  
  CONCLUSIONS
  The presence of irregular intratumoral vessels or perfusion defects seen on CEH-EUS may be sensitive and accurate predictors of malignant GB polyps. CEH-EUS offers slightly improved diagnostic accuracy compared with EUS.
authors: Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Jun-Ho
authors: JH
authors: Choi
authors: Dong-Wan
authors: DW
authors: Seo
authors: Joon Hyuk
authors: JH
authors: Choi
authors: Do Hyun
authors: DH
authors: Park
authors: Sang Soo
authors: SS
authors: Lee
authors: Sung Koo
authors: SK
authors: Lee
authors: Myung-Hwan
authors: MH
authors: Kim
mesh_terms: D000236:Adenoma / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology; D000328:Adult; D000368:Aged; D001808:Blood Vessels / Q000000981:diagnostic imaging; D002277:Carcinoma / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D019160:Endosonography / Q000379:methods*; D005260:Female; D005706:Gallbladder Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D011127:Polyps / Q000000981:diagnostic imaging* / Q000473:pathology; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013459:Sulfur Hexafluoride
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride
keywords: CEH; CI; GB; SD; confidence interval; contrast-enhanced harmonic; gallbladder; standard deviation