title: Differentiating between adenomyomatosis and gallbladder cancer: revisiting a comparative study of high-resolution ultrasound, multidetector CT, and MR imaging.
abstract: OBJECTIVE
  To compare the diagnostic performance of high-resolution ultrasound (HRUS) with contrast-enhanced CT and contrast-enhanced magnetic resonance imaging (MRI) with MR cholangiopancreatography (MRCP) to differentiate between adenomyomatosis (ADM) and gallbladder cancer (GBCA).
  
  
  METHODS
  Forty patients with surgically proven ADM (n = 13) or GBCA at stage T2 or lower (n = 27) who previously underwent preoperative HRUS, contrast-enhanced CT, and contrast-enhanced MRI with MRCP were retrospectively included in this study. According to the well-known diagnostic criteria, two reviewers independently analyzed the images from each modality separately with a five-point confidence scale. The interobserver agreement was calculated using weighted κ statistics. A receiver operating characteristic curve analysis was performed and the sensitivity, specificity, and accuracy were calculated for each modality when scores of 1 or 2 indicated ADM.
  
  
  RESULTS
  The interobserver agreement between the two reviewers was good to excellent. The mean Az values for HRUS, multidetector CT (MDCT), and MRI were 0.959, 0.898, and 0.935, respectively, without any statistically significant differences between any of the modalities (p > 0.05). The mean sensitivity of MRI with MRCP (80.8%) was significantly higher than that of MDCT (50.0%) (p = 0.0215). However, the mean sensitivity of MRI with MRCP (80.8%) was not significantly different from that of HRUS (73.1%) (p > 0.05). The mean specificities and accuracies among the three modalities were not significantly different (p > 0.05).
  
  
  CONCLUSIONS
  High-resolution ultrasound and MRI with MRCP have comparable sensitivity and accuracy and MDCT has the lowest sensitivity and accuracy for the differentiation of ADM and GBCA.
authors.affiliation: Department of Radiology and the Institute of Radiation Medicine, Seoul National University Hospital, Seoul 110-744, Korea.
authors.forename: Sang Heum
authors.initials: SH
authors.lastname: Bang
authors.affiliation: Department of Radiology and the Institute of Radiation Medicine, Seoul National University Hospital, Seoul 110-744, Korea.
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Radiology and the Institute of Radiation Medicine, Seoul National University Hospital, Seoul 110-744, Korea.
authors.forename: Hyunsik
authors.initials: H
authors.lastname: Woo
authors.affiliation: Department of Radiology and the Institute of Radiation Medicine, Seoul National University Hospital, Seoul 110-744, Korea.
authors.forename: Ijin
authors.initials: I
authors.lastname: Joo
authors.affiliation: Department of Radiology and the Institute of Radiation Medicine, Seoul National University Hospital, Seoul 110-744, Korea.
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Lee
authors.affiliation: Department of Radiology and the Institute of Radiation Medicine, Seoul National University Hospital, Seoul 110-744, Korea.
authors.forename: Joon Koo
authors.initials: JK
authors.lastname: Han
authors.affiliation: Department of Radiology and the Institute of Radiation Medicine, Seoul National University Hospital, Seoul 110-744, Korea.
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; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods; D003287:Contrast Media; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D005706:Gallbladder Neoplasms / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods; D014463:Ultrasonography / Q000379:methods
chemical_list: D003287:Contrast Media
keywords: Adenomyomatosis; CT; Gallbladder; Gallbladder cancer; High-resolution ultrasound; MRI