title: Xanthogranulomatous cholecystitis: diagnostic performance of US, CT, and MRI for differentiation from gallbladder carcinoma.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the diagnostic performance of HRUS, CT, and MRI for differentiating xanthogranulomatous cholecystitis (XGC) from gallbladder (GB) cancer.
  
  
  METHODS
  Patients with surgically proven XGC (n = 40) and GB cancer (n = 44), who had undergone at least one HRUS (n = 43), CT (n = 82), or MRI (n = 34) examination between 2000 and 2012, were included. Two radiologists retrospectively graded the likelihood of XGC or GB cancer using a 5-point confidence scale; they also assessed the imaging features. Statistical analyses were performed using ROC, ANOVA, and Fisher's exact test.
  
  
  RESULTS
  Diagnostic performance of MRI was better than HRUS for differentiating XGC from GB cancer (AUCs = 0.867 and 0.911 vs. AUCs = 0.818 and 0.86). However, HRUS showed a better performance than CT (AUCs = 0.818 and 0.86 vs. AUCs = 0.806 and 0.84) with moderate to excellent agreement (κ = 0.48-0.83). Statistically common findings for XGC included non-focal thickening, smooth GB wall, presence of intramural nodules, type I enhancement of wall, transient hepatic attenuation difference, and continuity of mucosa (p < 0.05). Co-existence of gallstones (OR = 16.5), non-focal thickening (OR = 14.7), and collapsed lumen (OR = 13.0) on HRUS, and type I enhancement on CT (OR = 3.52) were independently associated with XGC (p < 0.05).
  
  
  CONCLUSIONS
  Although MRI showed a better performance than both HRUS and CT, HRUS showed a better performance than CT. The co-existence of gallstones, non-focal thickening, and collapsed lumen on HRUS was independently associated with XGC.
authors.affiliation: Department of Radiology, Seoul National University Hospital, Seoul, South Korea.|Department of Radiology, Cung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Korea.
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Lee
authors.affiliation: Department of Radiology, Seoul National University Hospital, Seoul, South Korea. Jhkim2008@gmail.com.|Institute of Radiation Medicine, Seoul National University College of Medicine, 101, Daehang-no, Chongno-gu, Seoul, 110-744, Korea. Jhkim2008@gmail.com.
authors.forename: Jung Hoon
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Ijin
authors.initials: I
authors.lastname: Joo
authors.affiliation: Department of Radiology, Seoul National University Hospital, Seoul, South Korea.|Institute of Radiation Medicine, Seoul National University College of Medicine, 101, Daehang-no, Chongno-gu, Seoul, 110-744, Korea.
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Radiology, Seoul National University Hospital, Seoul, South Korea.|Institute of Radiation Medicine, Seoul National University College of Medicine, 101, Daehang-no, Chongno-gu, Seoul, 110-744, Korea.
authors.forename: Joon Koo
authors.initials: JK
authors.lastname: Han
authors.affiliation: Department of Radiology, Seoul National University Hospital, Seoul, South Korea.|Institute of Radiation Medicine, Seoul National University College of Medicine, 101, Daehang-no, Chongno-gu, Seoul, 110-744, Korea.|Department of Radiology, Cung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Korea.
authors.forename: Byung Ihn
authors.initials: BI
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002764:Cholecystitis / Q000175:diagnosis*; D002765:Cholecystography; D003937:Diagnosis, Differential; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging / Q000473:pathology; D005706:Gallbladder Neoplasms / Q000175:diagnosis*; D006099:Granuloma / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler; D014973:Xanthomatosis / Q000175:diagnosis*
keywords: Cholecystitis; Gallbladder neoplasm; Magnetic resonance imaging; Multidetector computed tomography; Ultrasonography