title: Differential diagnosis of gallbladder wall thickening: the usefulness of contrast-enhanced ultrasound.
abstract: he purpose of this study was to evaluate the usefulness of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of gallbladder wall (GBW) thickening and determine the predictors of malignant GBW thickening. One hundred fifty-nine patients with GBW thickening, including 76 men and 83 women, from eight institutions were enrolled. CEUS was performed after injection of a sulfur hexafluoride microbubble-based ultrasound contrast agent. Multiple logistic regression analysis was used to reveal independent predictor sassociated with malignant GBW thickening. The final diagnoses were 48 gallbladder carcinomas and 111 benign gallbladder diseases.Maximal thicknesses of the GBW in malignant and benign GB Wthickening were 17.3 ± 5.2 (6 – 30) mm and 8.6 ± 5.1 (4 – 26) mm respectively (p , 0.001). CEUS revealed significant differences in intralesional vessels, enhancement homogeneity, time to hypo-enhancement, inner layer discontinuity, outer layer discontinuity and adjacent liver involvement (all p-values , 0.05) between malignant and benign GBW thickening. Patient age . 46.5 y, focal GBW thickening, inner layer discontinuity and outer layer discontinuity were found to be associated with malignancy by multiple logistic regression analysis (all p-values , 0.05). Receiver operating characteristic curve analysis revealed Az values for patient age, focal GBW thickening, inner wall discontinuity and outer wall discontinuity of 0.709 (95%confidence interval [CI]: 0.627–0.790), 0.714 (95% CI: 0.630–0.798), 0.860 (95%CI: 0.791 – 0.928) and 0.858 (95% CI: 0.783 – 0.933), respectively. CEUS is useful in the differential diagnosis between malignant and benign GBW thickening. Focal GBW thickening, inner wall discontinuity and outer wall discontinuity observed on CEUS are diagnostic clues for malignant GBW thickening.
authors.affiliation: Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tenth People’s Hospital of Tongji University, Shanghai, China.
authors.forename: Jun-Mei
authors.initials: JM
authors.lastname: Xu
authors.forename: Le-Hang
authors.initials: LH
authors.lastname: Guo
authors.forename: Hui-Xiong
authors.initials: HX
authors.lastname: Xu
authors.forename: Shu-Guang
authors.initials: SG
authors.lastname: Zheng
authors.forename: Lin-Na
authors.initials: LN
authors.lastname: Liu
authors.forename: Li-Ping
authors.initials: LP
authors.lastname: Sun
authors.forename: Ming-De
authors.initials: MD
authors.lastname: Lu
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: Ding
authors.initials: D
authors.lastname: Hong
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
mesh_terms: D000328:Adult; D000368:Aged; D002764:Cholecystitis / Q000000981:diagnostic imaging*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging*; D005706:Gallbladder Neoplasms / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D014463:Ultrasonography / Q000379:methods*
chemical_list: D003287:Contrast Media; D013459:Sulfur Hexafluoride