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Contrast enhanced ultrasound versus multiphasic contrast enhanced computed tomography in evaluation of gallbladder lesions

  • Hepatobiliary
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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Aim

To compare the diagnostic performance of contrast enhanced ultrasound (CEUS) and multiphasic contrast enhanced computed tomography (CECT) in differentiating benign and malignant gallbladder (GB) lesions.

Methods

This prospective ethical review board approved study comprised consecutive patients with GB lesions who underwent CEUS and multiphasic CECT at a tertiary care referral center. The enhancement patterns at CEUS and CT were compared. The quantitative CEUS parameters including arrival time (AT), AT in liver, time to peak enhancement, and washout time (WT) were assessed. The diagnostic performance of CEUS and CT features was calculated using receiver operating characteristic analysis. A subgroup analysis was performed for patients with GB wall thickening. Multivariate analysis was performed to identify features significantly associated with malignancy.

Results

Over the study period, 30 patients (mean age, 52.8 ± 12.2 years, 17 females) with GB lesions were evaluated. Benign and malignant diseases were present in 13 and 17 patients, respectively. There was excellent agreement between CEUS and CT findings. Among the quantitative CEUS features, only WT was significantly associated with malignancy in the overall group (p < 0.001) and wall thickening subgroup (p = 0.007). WT within 53.5 s and 51.5 s had sensitivity of 88.2% and 81.8% and specificity of 84.5% and 100% in diagnosing malignant lesions in the overall group (AUC 0.900) and the wall thickening subgroup (area under curve, AUC 0.927), respectively. At multivariate analysis, features that were significantly associated with malignant lesions in the overall group were disruption of GB wall (CEUS), intralesional non-enhancing areas (CEUS), liver involvement (CEUS or CT), and arterial phase hyperenhancement (CT) in the overall group and disruption of GB wall (CEUS), WT (CEUS), and liver involvement (CEUS or CT) in the wall thickening subgroup.

Conclusion

CEUS is a useful adjunct to CT in evaluation of GB lesions. Its utilization in patients with GB wall thickening may improve detection of malignancy.

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References

  1. Kalra N, Suri S, Gupta R, Natarajan SK, Khandelwal N, Wig JD, Joshi K. MDCT in the staging of gallbladder carcinoma. AJR Am J Roentgenol. 2006 Mar;186(3):758-62.

    Article  Google Scholar 

  2. Hundal R, Shaffer EA. Gallbladder cancer: epidemiology and outcome. Clin Epidemiol. 2014 Mar 7;6:99-109.

    Google Scholar 

  3. Kumar R, Srinivasan R, Gupta N, Dey P, Rajwanshi A, Nijhawan R, et al. Spectrum of gallbladder malignancies on fine-needle aspiration cytology: 5 years retrospective single institutional study with emphasis on uncommon variants. Diagn Cytopathol 2017;45(1):36–42.

    Article  Google Scholar 

  4. Dutta U, Bush N, Kalsi D, Popli P, Kapoor VK. Epidemiology of gallbladder cancer in India. Chin Clin Oncol. 2019;8:33.

    Article  Google Scholar 

  5. Gupta P, Kumar M, Sharma V, Dutta U, Sandhu MS. Evaluation of gallbladder wall thickening: a multimodality imaging approach. Expert Rev Gastroenterol Hepatol. 2020;14:463-473

    Article  CAS  Google Scholar 

  6. Gupta P, Marodia Y, Bansal A et al. Imaging-based algorithmic approach to gallbladder wall thickening. World J Gastroenterol. 2020;26:6163-6181.

    Article  CAS  Google Scholar 

  7. Nicolau C, Ripollés T. Contrast-enhanced ultrasound in abdominal imaging. Abdom Imaging. 2012;37(1):1-19.

    Article  Google Scholar 

  8. Liu X, Jang HJ, Khalili K, Kim TK, Atri M. Successful Integration of Contrast-enhanced US into Routine Abdominal Imaging. Radiographics. 2018 38(5):1454-1477.

    Article  Google Scholar 

  9. Gupta P, Koshi S, Sinha SK, Sharma V, Mandavdhare H, Samanta J, Dutta U, Kochhar R. Contrast-Enhanced Ultrasound is a Useful Adjunct to Doppler Ultrasound in the Initial Assessment of Patients Suspected of Budd Chiari Syndrome. Curr Probl Diagn Radiol. 2021;50(5):646-649.

    Article  Google Scholar 

  10. Cokkinos DD, Antypa E, Kalogeropoulos I, Tomais D, Ismailos E, Matsiras I, Benakis S, Piperopoulos PN. Contrast-enhanced ultrasound performed under urgent conditions. Indications, review of the technique, clinical examples and limitations. Insights Imaging. 2013;4(2):185-98.

    Article  Google Scholar 

  11. Zhang HP, Bai M, Gu JY, He YQ, Qiao XH, Du LF. Value of contrast-enhanced ultrasound in the differential diagnosis of gallbladder lesion. World J Gastroenterol. 2018;24(6):744-751.

    Article  CAS  Google Scholar 

  12. Xu JM, Guo LH, Xu HX, Zheng SG, Liu LN, Sun LP, Lu MD, Wang WP, Hu B, Yan K, Hong D, Tang SS, Qian LX, Luo BM. Differential diagnosis of gallbladder wall thickening: the usefulness of contrast-enhanced ultrasound. Ultrasound Med Biol. 2014;40(12):2794-804.

    Article  Google Scholar 

  13. Xie XH, Xu HX, Xie XY, Lu MD, Kuang M, Xu ZF, Liu GJ, Wang Z, Liang JY, Chen LD, Lin MX. Differential diagnosis between benign and malignant gallbladder diseases with real-time contrast-enhanced ultrasound. Eur Radiol. 2010;20(1):239-48.

    Article  Google Scholar 

  14. Chen LD, Huang Y, Xie XH, Chen W, Shan QY, Xu M, Liu JY, Nie ZQ, Xie XY, Lu MD, Shen SL, Wang W. Diagnostic nomogram for gallbladder wall thickening mimicking malignancy: using contrast-enhanced ultrasonography or multi-detector computed tomography? Abdom Radiol (NY). 2017;42(10):2436-2446.

    Article  Google Scholar 

  15. Cheng Y, Wang M, Ma B, Ma X. Potential role of contrast-enhanced ultrasound for the differentiation of malignant and benign gallbladder lesions in East Asia: A meta-analysis and systematic review. Medicine (Baltimore). 2018;97(33):e11808.

    Article  Google Scholar 

  16. Kim SJ, Lee JM, Lee JY, Kim SH, Han JK, Choi BI, Choi JY. Analysis of enhancement pattern of flat gallbladder wall thickening on MDCT to differentiate gallbladder cancer from cholecystitis. AJR Am J Roentgenol. 2008;191(3):765-71.

    Article  Google Scholar 

  17. Liu LN, Xu HX, Lu MD, Xie XY, Wang WP, Hu B, Yan K, Ding H, Tang SS, Qian LX, Luo BM, Wen YL. Contrast-enhanced ultrasound in the diagnosis of gallbladder diseases: a multi-center experience. PLoS One. 2012;7(10):e48371.

    Article  CAS  Google Scholar 

  18. Liang X, Jing X. Meta-analysis of contrast-enhanced ultrasound and contrast-enhanced harmonic endoscopic ultrasound for the diagnosis of gallbladder malignancy. BMC Med Inform Decis Mak. 2020 Sep 17;20(1):235.

    Article  Google Scholar 

  19. Bo X, Chen E, Wang J, Nan L, Xin Y, Wang C, Lu Q, Rao S, Pang L, Li M, Lu P, Zhang D, Liu H, Wang Y. Diagnostic accuracy of imaging modalities in differentiating xanthogranulomatous cholecystitis from gallbladder cancer. Ann Transl Med. 2019 Nov;7(22):627.

    Article  CAS  Google Scholar 

  20. Meacock LM, Sellars ME, Sidhu PS. Evaluation of gallbladder and biliary duct disease using microbubble contrast-enhanced ultrasound. Br J Radiol. 2010;83(991):615-627.

    Article  CAS  Google Scholar 

  21. Sun LP, Guo LH, Xu HX, Liu LN, Xu JM, Zhang YF, Liu C, Bo XW, Xu XH. Value of contrast-enhanced ultrasound in the differential diagnosis between gallbladder adenoma and gallbladder adenoma canceration. Int J Clin Exp Med. 2015 Jan 15;8(1):1115-21.

    PubMed  PubMed Central  Google Scholar 

  22. Yuan Z, Liu X, Li Q, Zhang Y, Zhao L, Li F, Chen T. Is Contrast-Enhanced Ultrasound Superior to Computed Tomography for Differential Diagnosis of Gallbladder Polyps? A Cross-Sectional Study. Front Oncol. 2021 May 24;11:657223.

    Article  Google Scholar 

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Acknowledgements

Dr. Yashi Marodia, Senior Resident, Department of Radiodiagnosis and Imaging for preparing schematic diagram to show the enhancement patterns (Figure 1).

Funding

No funding was received for the article.

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Author notes

  1. Suresh Babu Boddapati and Anupam Lal have contributed equally and share first authorship.

Authors and Affiliations

  1. Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Suresh Babu Boddapati, Anupam Lal, Pankaj Gupta, Naveen Kalra & Manphool Singhal

  2. Departments of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Thakur Deen Yadav & Vikas Gupta

  3. Departments of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Ashim Dass

  4. Departments of Cytopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Radhika Srinivasan

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  1. Suresh Babu Boddapati
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  3. Pankaj Gupta
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Correspondence to Manphool Singhal.

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Boddapati, S.B., Lal, A., Gupta, P. et al. Contrast enhanced ultrasound versus multiphasic contrast enhanced computed tomography in evaluation of gallbladder lesions. Abdom Radiol 47, 566–575 (2022). https://doi.org/10.1007/s00261-021-03364-6

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  • DOI: https://doi.org/10.1007/s00261-021-03364-6

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