Differential Diagnosis of Gallbladder Wall Thickening: The Usefulness of Contrast-Enhanced Ultrasound |
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Authors: | Jun-Mei Xu Le-Hang Guo Hui-Xiong Xu Shu-Guang Zheng Lin-Na Liu Li-Ping Sun Ming-De Lu Xiao-Yan Xie Wen-Ping Wang Bing Hu Kun Yan Hong Ding Shao-Shan Tang Lin-Xue Qian Bao-Ming Luo |
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Institution: | 1. Department of Medical Ultrasound, Shanghai Tenth People''s Hospital, Tenth People''s Hospital of Tongji University, Shanghai, China;2. Department of Medical Ultrasonics, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China;3. Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China;4. Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People''s Hospital, Shanghai, China;5. Department of Ultrasound, Peking University School of Oncology, Beijing Cancer Institute, Beijing, China;6. Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China;7. Department of Ultrasound, Second Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China |
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Abstract: | The 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 predictors associated 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 GBW thickening 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 intra-lesional 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. |
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Keywords: | Gallbladder Wall thickening Contrast-enhanced ultrasound Differential diagnosis Chronic cholecystitis Gallbladder carcinoma |
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