Journal of Diagnostics Concepts & Practice >

2023 , Vol. 22 >Issue 01: 68 - 74

DOI: https://doi.org/10.16150/j.1671-2870.2023.01.011

Review articles

Application of contrast-enhanced ultrasound in diagnosis of gallbladder protrusion lesions

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  • 1. Department of Ultrasound, Xinrui Hospital of Xinwu District, Wuxi city, Jiangsu Province（Department of Ultrasonography, Wuxi Branch of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medical）, Wuxi Jiangsu214028, China
    2. Department of Ultrasonography, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medical, Shanghai 200025, China

Received date: 2021-05-20

  Online published: 2023-07-06

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Abstract

Gallbladder protrusion lesions(GPL) have two types:neoplastic lesions and non-neoplastic lesions. Neoplastic lesions include gallbladder adenoma and gallbladder carcinoma, while non-neoplastic lesions include cholesterol polyps, inflammatory polyps, gallbladder adenomyosis， etc. Conventional ultrasound examination is the preferred imaging examination for diagnosing GPL, however its diagnostic capacity is not satisfied. With the progress of medical technology, the value of contrast-enhanced ultrasound(CEUS) in the diagnosis of some GPL has been recognized. Different types of GPL present different degrees of enhancement, regression characteristics, enhancement modes, vascular architecture, and continuity of gallbladder wall in the arterial and venous phases of CEUS. Many studies at home and abroad believe that CEUS plays an important role in the diagnosis and differential diagnosis of GPL. When the contrast medium reaches its peak, the enhanced homogeneity of the lesions has the highest diagnostic efficiency in differentiating gallbladder adenoma from cholesterol polyps with diameter over 1 cm. Its sensitivity, specificity, positive predictive value, negative predictive value, accuracy and Youden’s J statistic are 100%, 90.9%, 92.9%, 100%, 95.8% and 0.91, respectively. The display rate of CEUS for the characteristic structure of gallbladder adenomyosis, the sinus, increases from 22.0% of conventional ultrasound to 56.1%.The sensitivity and specificity of CEUS in the diagnosis of gallbladder adenoma were 84.6% and 87.0%, respectively. CEUS has high sensitivity, specificity and negative predictive value in the diagnosis of xanthogranulomatous cholecystitis, which are 90%, 93% and 94% respectively.Irregular focus shape, dendritic vessels and low enhancement in venous phase are three specific signs of CEUS that suggests gallbladder adenocarcinoma. Combined with any two or three above signs, the specificity of CEUS for diagnosing gallbladder cancer may reach 92.4%. In the diagnosis of GPL,CUES may display certain characteristic manifestation and is worthy of clinical application.

Key words： Gallbladder protrusion lesions; Contrast-enhanced ultrasound; Cholesterol polyp; Gallbladder carcinoma

Cite this article

FENG Meijing, REN Xinping . Application of contrast-enhanced ultrasound in diagnosis of gallbladder protrusion lesions[J]. Journal of Diagnostics Concepts & Practice, 2023 , 22(01) : 68 -74 . DOI: 10.16150/j.1671-2870.2023.01.011

References

[1] YU M H, KIM Y J, PARK H S, et al. Benign gallbladder diseases: Imaging techniques and tips for differentiating with malignant gallbladder diseases[J]. World J Gastroenterol, 2020, 26(22):2967-2986.
[2] 中华医学会外科学分会胆道外科学组, 中国医师协会外科医师分会胆道外科医师委员会. 胆囊良性疾病外科治疗的专家共识(2021版)[J]. 中华外科杂志, 2022, 60(1):4-9.
[2] Branch of Biliary Surgery, Chinese Society of Surgery, Chinese Medical Association, Chinese Medical Doctor Association in Chinese Committee of Biliary Surgeons. Consensus on the surgical management of benign gallbladder diseases(2021 edition)[J]. Chin J Surg, 2022, 60(1):4-9.
[3] BABU B I, DENNISON A R, GARCEA G. Management and diagnosis of gallbladder polyps: a systematic review[J]. Langenbecks Arch Surg, 2015, 400(4):455-462.
[4] KASLE D, RAHNEMAI-AZAR A A, BIBI S, et al. Carcinoma in situ in a 7 mm gallbladder polyp: Time to change current practice?[J]. World J Gastrointest Endosc, 2015, 7(9):912-915.
[5] NEGR?O DE FIGUEIREDO G, MUELLER-PELTZER K, ZENGEL P, et al. Diagnostic performance of contrasten-hanced ultrasound (CEUS) for the evaluation of gallbladder diseases1[J]. Clin Hemorheol Microcirc, 2018, 69(1-2):83-91.
[6] NEGR?O DE FIGUEIREDO G, MUELLER-PELTZER K, SCHWARZE V, et al. Performance of contrast-enhanced ultrasound (CEUS) compared to MRI in the diagnostic of gallbladder diseases[J]. Clin Hemorheol Microcirc, 2019, 73(1):85-93.
[7] NEGR?O DE FIGUEIREDO G, MUELLER-PELTZER K, ZENGEL P, et al. Contrast-enhanced ultrasound (CEUS) and gallbladder diseases - A retrospective mono-center analysis of imaging findings with histopathological correlation[J]. Clin Hemorheol Microcirc, 2019, 71(2):151-158.
[8] PISCAGLIA F, NOLS?E C, DIETRICH C F, et al. The EFSUMB Guidelines and recommendations on the clinical practice of contrast enhanced ultrasound (CEUS): update 2011 on non-hepatic applications[J]. Ultraschall Med, 2012, 33(1):33-59.
[9] 徐辉雄, 刘琳娜, 郑曙光, 等. 胆囊超声造影临床应用指南(2012)解读[J]. 中华医学超声杂志(电子版), 2014, 11(2):102-104.
[9] XU H X, LIU L, ZHENG S G, et al. Comments on guideline for callbladder contrast-enhanced ultrasound[J]. Chin J Med Ultrasound(Electron Ed), 2014, 11(2):102-104.
[10] 中国医师协会超声医师分会. 产前超声和超声造影检查指南[M]. 北京: 人民军医出版社, 2013:4.
[10] Sonographer Branch of Chinese Medical Doctor Association. Guidelines for prenatal ultrasound and contrast-enhanced ultrasound[M]. Beijing: People's Military Medical Publishing House, 2013:4.
[11] SIDHU P S, CANTISANI V, DIETRICH C F, et al. The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: update 2017 (long version)[J]. Ultraschall Med, 2018, 39(2):e2-e44.
[12] XU A, ZHANG Y, HU H, et al. Gallbladder polypoid-lesions: What are they and how should they be treated? A single-center experience based on 1446 cholecystectomy patients[J]. J Gastrointest Surg, 2017, 21(11):1804-1812.
[13] MIWA H, NUMATA K, SUGIMORI K, et al. Differential diagnosis of gallbladder polypoid lesions using contrasten-hanced ultrasound[J]. Abdom Radiol (NY), 2019, 44(4):1367-1378.
[14] 王雪, 刘月洁, 杨力, 等. 超声及超声造影对胆囊较大胆固醇性息肉及腺瘤性息肉的鉴别诊断[J]. 中国超声医学杂志, 2019, 35(8):720-723.
[14] WANG X, LIU Y J, YANG L, et al. The value of multi-modal ultrasound in the differential diagnosis of larger cholesterol polyps and adenomatous polyps of gallbladder[J]. Chin J Ultrasound Med, 2019, 35(8):720-723.
[15] YUAN H X, CAO J Y, KONG W T, et al. Contrast-enhanced ultrasound in diagnosis of gallbladder adenoma[J]. Hepatobiliary Pancreat Dis Int, 2015, 14(2):201-207.
[16] GOLSE N, LEWIN M, RODE A, et al. Gallbladder adenomyomatosis: diagnosis and management[J]. J Visc Surg, 2017, 154(5):345-353.
[17] PANG L, ZHANG Y, WANG Y, et al. Pathogenesis of gallbladder adenomyomatosis and its relationship with early-stage gallbladder carcinoma: an overview[J]. Braz J Med Biol Res, 2018, 51(6):e7411.
[18] YUAN H X, WANG W P, GUAN P S, et al. Contrast-enhanced ultrasonography in differential diagnosis of focal gallbladder adenomyomatosis and gallbladder cancer[J]. Clin Hemorheol Microcirc, 2018, 70(2):201-211.
[19] 苏晖, 张波, 刘翠云, 等. 超声造影对胆囊腺肌症的诊断价值[J]. 中华医学超声杂志(电子版), 2016, 13(5):389-392.
[19] SU H, ZHANG B, LIU C Y, et al. Value of contrast enhanced ultrasound in the diagnosis of gallbladder adenomyomatosis[J]. Chin J Med Ultrasound (Electron Ed), 2016, 13(5):389-392.
[20] DONG Y, XU B, CAO Q, et al. Incidentally detected focal fundal gallbladder wall thickening: Differentiation contrast enhanced ultrasound features with high-resolution linear transducers[J]. Clin Hemorheol Microcirc, 2020, 74(3):315-325.
[21] SUN L P, GUO L H, XU H X, et al. Value of contrast-enhanced ultrasound in the differential diagnosis between gallbladder adenoma and gallbladder adenoma canceration[J]. Int J Clin Exp Med, 2015, 8(1):1115-1121.
[22] 任卫东, 常才. 超声诊断学[M]. 北京: 人民卫生出版社, 2015:249-250.
[22] REN W D, CHANG C. Ultrasonic diagnostics[M]. Beijing: People's Medical Publishing House, 2015:249-250.
[23] FEI X, LU W P, LUO Y K, et al. Contrast-enhanced ultrasound may distinguish gallbladder adenoma from cholesterol polyps: a prospective case-control study[J]. Abdom Imaging, 2015, 40(7):2355-2363.
[24] ZHANG H P, BAI M, GU J Y, et al. Value of contrast-enhanced ultrasound in the differential diagnosis of gallbladder lesion[J]. World J Gastroenterol, 2018, 24(6):744-751.
[25] BEHZADMEHR R, SALARZAEI M. Is contrast enhanced ultrasonography an accurate way to diagnose gallbladder adenoma? A systematic review and meta-analysis[J]. J Med Imaging Radiat Sci, 2021, 52(1):127-136.
[26] FEI X, LI N, ZHU L, et al. Value of high frame rate contrast-enhanced ultrasound in distinguishing gallbladder adenoma from cholesterol polyp lesion[J]. Eur Radiol, 2021, 31(9):6717-6725.
[27] 洪运虎, 王桂林, 劳海燕, 等. 黄色肉芽肿性胆囊炎的常规超声及超声造影表现[J]. 中国超声医学杂志, 2018, 34(8):761-764.
[27] HONG Y H, WANG G L, LAO H Y, et al. Xanthorranulomatous cholecystitis: conventional and contrast-enhanced ultrasonographic diagnosiss[J]. Chin J Ultrasound Med, 2018, 34(8):761-764.
[28] BO X, CHEN E, WANG J, et al. Diagnostic accuracy of imaging modalities in differentiating xanthogranulomatous cholecystitis from gallbladder cancer[J]. Ann Transl Med, 2019, 7(22):627.
[29] 武文卿, 黄备建, 陆清, 等. 黄色肉芽肿性胆囊炎超声造影影像学特征分析[J]. 中国临床医学, 2020, 27(3):493-496.
[29] WU W Q, HUANG B J, LU Q, et al. Contrast-enhanced ultrasonography of xanthogranulomatous cholecystitis[J]. Chin J Clin Med, 2020, 27(3):493-496.
[30] YUAN H X, WANG W P, WEN J X, et al. Xanthogranulomatous cholecystitis: contrast-enhanced ultrasound features and differential diagnosis from wall-thickening gallbladder carcinoma[J]. Discov Med, 2016, 21(114):89-98.
[31] SHEN H X, SONG H W, XU X J, et al. Clinical epidemiological survey of gallbladder carcinoma in northwes-tern China, 2009-2013: 2379 cases in 17 centers[J]. Chronic Dis Transl Med, 2017, 3(1):60-66.
[32] PANG L, ZHANG Y, WANG Y, et al. Pathogenesis of gallbladder adenomyomatosis and its relationship with early-stage gallbladder carcinoma: an overview[J]. Braz J Med Biol Res, 2018, 51(6):e7411.
[33] 郑茹瑜, 丁建民, 周燕, 等. 超声造影在诊断厚壁型胆囊癌中的应用[J]. 中国医学影像学杂志, 2020, 28(3):210-214.
[33] ZHENG D Y, DING J M, ZHOU Y, et al. Contrast-enhanced ultrasound in the diagnosis of thick-walled gallbladder carcinoma[J]. Chin J Med Imag, 2020, 28(3):210-214.
[34] KONG W T, SHEN H Y, QIU Y D, et al. Application of contrast enhanced ultrasound in gallbladder lesion: is it helpful to improve the diagnostic capabilities?[J]. Med Ultrason, 2018, 20(4):420-426.
[35] XIE X H, XU H X, XIE X Y, et al. Differential diagnosis between benign and malignant gallbladder diseases with real-time contrast-enhanced ultrasound[J]. Eur Radiol, 2010, 20(1):239-248.
[36] SERRA C, FELICANI C, MAZZOTTA E, et al. CEUS in the differential diagnosis between biliary sludge, benign lesions and malignant lesions[J]. J Ultrasound, 2018, 21(2):119-126.
[37] WANG W, FEI Y, WANG F. Meta-analysis of contrasten-hanced ultrasonography for the detection of gallbladder carcinoma[J]. Med Ultrason, 2016, 18(3):281-228.
[38] 史艳平, 张秀秀, 樊文文, 等. 超声造影与增强CT诊断胆囊占位性病变的对比研究[J]. 临床超声医学杂志, 2019, 21(11):841-844.
[38] SHI Y P, ZHANG X X, FAN W W, et al. Comparative study of contrast-enhanced ultrasound and enhanced CT in gallbladder space-occupying lesions[J]. Med Ultrason, 2016, 18(3):281-228.
[39] 张道建, 张德祥, 王吉文, 等. 超声造影对胆囊癌与黄色肉芽肿性胆囊炎的鉴别诊断价值[J]. 外科理论与实践, 2020, 25(4):322-325.
[39] ZHANG D J, ZHANG D C, WANG J E, et al. Contrasten-hanced ultrasound in differential diagnosis of gallbladder cancer from xanthogranulomatous chole-cystitis[J]. J Surg Concept Pract, 2020, 25(4):322-325.
[40] 费翔, 罗渝昆. 胆囊超声造影指南解读与图像分析[J]. 中华医学超声杂志(电子版), 2018, 15(1):5-9.
[40] FEI X, LUO Y K. Interpretation and image analysis of gallbladder ultrasound guidelines[J]. Chin J Med Ultrasound(Electron Ed), 2018, 15(01):5-9.
[41] DONG Y, LIU L, CAO Q, et al. Differential diagnosis of focal gallbladder lesions: The added value of contrast enhanced ultrasound with liner transducers[J]. Clin Hemorheol Microcirc, 2020, 74(2):167-178.
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