Skip to main content
Erschienen in: European Radiology 7/2019

08.04.2019 | Gastrointestinal

Quantitative contrast-enhanced US helps differentiating neoplastic vs non-neoplastic gallbladder polyps

verfasst von: Jae Seok Bae, Se Hyung Kim, Hyo-jin Kang, Haeryoung Kim, Ji Kon Ryu, Jin-Young Jang, Sang Hyub Lee, Woo Hyun Paik, Wooil Kwon, Jae Young Lee, Joon Koo Han

Erschienen in: European Radiology | Ausgabe 7/2019

Einloggen, um Zugang zu erhalten

Abstract

Objectives

To differentiate between large (≥ 1 cm in diameter) gallbladder (GB) non-neoplastic and neoplastic polyps using quantitative analysis of contrast-enhanced ultrasound (CEUS) findings.

Methods

From September 2017 to May 2018, 29 patients (10 males; median age, 63 years) with GB polyps of ≥ 1 cm in diameter who were undergoing cholecystectomy were consecutively enrolled. All patients underwent preoperative conventional US and CEUS examinations. Quantitative analysis of CEUS findings using time-intensity curves between the two groups was independently performed by two radiologists. The interobserver agreement for the quantitative analysis of the CEUS results was measured using the intraclass correlation coefficient. Receiver operating characteristic analysis was performed to evaluate the diagnostic performance of CEUS examination.

Results

After the cholecystectomy, the patients were classified into the non-neoplastic polyp group (n = 12) and the neoplastic polyp group (n = 17) according to the pathological results. The interobserver agreement for quantitative assessment between the two radiologists was near perfect to substantial. Quantitative assessment of the CEUS findings revealed that the rise time, mean transit time, time to peak, and fall time of non-neoplastic GB polyps were significantly shorter than those of neoplastic polyps (p < 0.001, p = 0.008, p = 0.013, and p = 0.002, respectively). The sensitivity and specificity of the quantitative CEUS parameters for the differentiation between the two groups were 76.5–100% and 75%, respectively, with an area under the curve of 0.765–0.887.

Conclusions

Quantitative analysis of CEUS findings could be valuable in differentiating GB neoplastic polyps from non-neoplastic polyps.

Key Points

• Quantitative analysis of CEUS findings could be valuable in differentiating gallbladder neoplastic polyps from non-neoplastic polyps.
• Quantitative analysis of CEUS findings in gallbladder polyps provides cut-off values for differentiation between neoplastic polyps and non-neoplastic polyps with near-perfect to substantial interobserver agreement.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Myers RP, Shaffer EA, Beck PL (2002) Gallbladder polyps: epidemiology, natural history and management. Can J Gastroenterol 16:187–194CrossRefPubMed Myers RP, Shaffer EA, Beck PL (2002) Gallbladder polyps: epidemiology, natural history and management. Can J Gastroenterol 16:187–194CrossRefPubMed
2.
Zurück zum Zitat Inui K, Yoshino J, Miyoshi H (2011) Diagnosis of gallbladder tumors. Intern Med 50:1133–1136CrossRefPubMed Inui K, Yoshino J, Miyoshi H (2011) Diagnosis of gallbladder tumors. Intern Med 50:1133–1136CrossRefPubMed
3.
Zurück zum Zitat Sugiyama M, Atomi Y, Yamato T (2000) Endoscopic ultrasonography for differential diagnosis of polypoid gall bladder lesions: analysis in surgical and follow up series. Gut 46:250–254CrossRefPubMedPubMedCentral Sugiyama M, Atomi Y, Yamato T (2000) Endoscopic ultrasonography for differential diagnosis of polypoid gall bladder lesions: analysis in surgical and follow up series. Gut 46:250–254CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Yang HL, Sun YG, Wang Z (1992) Polypoid lesions of the gallbladder: diagnosis and indications for surgery. Br J Surg 79:227–229CrossRefPubMed Yang HL, Sun YG, Wang Z (1992) Polypoid lesions of the gallbladder: diagnosis and indications for surgery. Br J Surg 79:227–229CrossRefPubMed
5.
Zurück zum Zitat Shinkai H, Kimura W, Muto T (1998) Surgical indications for small polypoid lesions of the gallbladder. Am J Surg 175:114–117CrossRefPubMed Shinkai H, Kimura W, Muto T (1998) Surgical indications for small polypoid lesions of the gallbladder. Am J Surg 175:114–117CrossRefPubMed
6.
Zurück zum Zitat Terzi C, Sokmen S, Seckin S, Albayrak L, Ugurlu M (2000) Polypoid lesions of the gallbladder: report of 100 cases with special reference to operative indications. Surgery 127:622–627CrossRefPubMed Terzi C, Sokmen S, Seckin S, Albayrak L, Ugurlu M (2000) Polypoid lesions of the gallbladder: report of 100 cases with special reference to operative indications. Surgery 127:622–627CrossRefPubMed
7.
Zurück zum Zitat Cha BH, Hwang JH, Lee SH et al (2011) Pre-operative factors that can predict neoplastic polypoid lesions of the gallbladder. World J Gastroenterol 17:2216–2222CrossRefPubMedPubMedCentral Cha BH, Hwang JH, Lee SH et al (2011) Pre-operative factors that can predict neoplastic polypoid lesions of the gallbladder. World J Gastroenterol 17:2216–2222CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Kubota K, Bandai Y, Noie T, Ishizaki Y, Teruya M, Makuuchi M (1995) How should polypoid lesions of the gallbladder be treated in the era of laparoscopic cholecystectomy? Surgery 117:481–487CrossRefPubMed Kubota K, Bandai Y, Noie T, Ishizaki Y, Teruya M, Makuuchi M (1995) How should polypoid lesions of the gallbladder be treated in the era of laparoscopic cholecystectomy? Surgery 117:481–487CrossRefPubMed
9.
Zurück zum Zitat Wiles R, Thoeni RF, Barbu ST et al (2017) Management and follow-up of gallbladder polyps: joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery - European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE). Eur Radiol 27:3856–3866CrossRefPubMedPubMedCentral Wiles R, Thoeni RF, Barbu ST et al (2017) Management and follow-up of gallbladder polyps: joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery - European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE). Eur Radiol 27:3856–3866CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Kozuka S, Tsubone N, Yasui A, Hachisuka K (1982) Relation of adenoma to carcinoma in the gallbladder. Cancer 50:2226–2234CrossRefPubMed Kozuka S, Tsubone N, Yasui A, Hachisuka K (1982) Relation of adenoma to carcinoma in the gallbladder. Cancer 50:2226–2234CrossRefPubMed
11.
Zurück zum Zitat Trivedi V, Gumaste VV, Liu S, Baum J (2008) Gallbladder cancer: adenoma-carcinoma or dysplasia-carcinoma sequence? Gastroenterol Hepatol (N Y) 4:735–737 Trivedi V, Gumaste VV, Liu S, Baum J (2008) Gallbladder cancer: adenoma-carcinoma or dysplasia-carcinoma sequence? Gastroenterol Hepatol (N Y) 4:735–737
12.
Zurück zum Zitat Okamoto M, Okamoto H, Kitahara F et al (1999) Ultrasonographic evidence of association of polyps and stones with gallbladder cancer. Am J Gastroenterol 94:446–450CrossRefPubMed Okamoto M, Okamoto H, Kitahara F et al (1999) Ultrasonographic evidence of association of polyps and stones with gallbladder cancer. Am J Gastroenterol 94:446–450CrossRefPubMed
13.
14.
Zurück zum Zitat Mishra G, Conway JD (2009) Endoscopic ultrasound in the evaluation of radiologic abnormalities of the liver and biliary tree. Curr Gastroenterol Rep 11:150–154CrossRefPubMed Mishra G, Conway JD (2009) Endoscopic ultrasound in the evaluation of radiologic abnormalities of the liver and biliary tree. Curr Gastroenterol Rep 11:150–154CrossRefPubMed
15.
Zurück zum Zitat Lee TY, Ko SF, Huang CC et al (2009) Intraluminal versus infiltrating gallbladder carcinoma: clinical presentation, ultrasound and computed tomography. World J Gastroenterol 15:5662–5668CrossRefPubMedPubMedCentral Lee TY, Ko SF, Huang CC et al (2009) Intraluminal versus infiltrating gallbladder carcinoma: clinical presentation, ultrasound and computed tomography. World J Gastroenterol 15:5662–5668CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Gore RM, Yaghmai V, Newmark GM, Berlin JW, Miller FH (2002) Imaging benign and malignant disease of the gallbladder. Radiol Clin North Am 40:1307–1323 vi Gore RM, Yaghmai V, Newmark GM, Berlin JW, Miller FH (2002) Imaging benign and malignant disease of the gallbladder. Radiol Clin North Am 40:1307–1323 vi
17.
Zurück zum Zitat Badea R, Zaro R, Opincariu I, Chiorean L (2014) Ultrasound in the examination of the gallbladder - a holistic approach: grey scale, Doppler, CEUS, elastography, and 3D. Med Ultrason 16:345–355CrossRefPubMed Badea R, Zaro R, Opincariu I, Chiorean L (2014) Ultrasound in the examination of the gallbladder - a holistic approach: grey scale, Doppler, CEUS, elastography, and 3D. Med Ultrason 16:345–355CrossRefPubMed
18.
Zurück zum Zitat Hirooka Y, Naitoh Y, Goto H, Furukawa T, Ito A, Hayakawa T (1996) Differential diagnosis of gall-bladder masses using colour Doppler ultrasonography. J Gastroenterol Hepatol 11:840–846CrossRefPubMed Hirooka Y, Naitoh Y, Goto H, Furukawa T, Ito A, Hayakawa T (1996) Differential diagnosis of gall-bladder masses using colour Doppler ultrasonography. J Gastroenterol Hepatol 11:840–846CrossRefPubMed
19.
Zurück zum Zitat Komatsuda T, Ishida H, Konno K et al (2000) Gallbladder carcinoma: color Doppler sonography. Abdom Imaging 25:194–197CrossRefPubMed Komatsuda T, Ishida H, Konno K et al (2000) Gallbladder carcinoma: color Doppler sonography. Abdom Imaging 25:194–197CrossRefPubMed
20.
Zurück zum Zitat Numata K, Oka H, Morimoto M et al (2007) Differential diagnosis of gallbladder diseases with contrast-enhanced harmonic gray scale ultrasonography. J Ultrasound Med 26:763–774CrossRefPubMed Numata K, Oka H, Morimoto M et al (2007) Differential diagnosis of gallbladder diseases with contrast-enhanced harmonic gray scale ultrasonography. J Ultrasound Med 26:763–774CrossRefPubMed
21.
Zurück zum Zitat Inoue T, Kitano M, Kudo M et al (2007) Diagnosis of gallbladder diseases by contrast-enhanced phase-inversion harmonic ultrasonography. Ultrasound Med Biol 33:353–361CrossRefPubMed Inoue T, Kitano M, Kudo M et al (2007) Diagnosis of gallbladder diseases by contrast-enhanced phase-inversion harmonic ultrasonography. Ultrasound Med Biol 33:353–361CrossRefPubMed
22.
Zurück zum Zitat Claudon M, Dietrich CF, Choi BI et al (2013) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver - update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol 39:187–210CrossRefPubMed Claudon M, Dietrich CF, Choi BI et al (2013) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver - update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol 39:187–210CrossRefPubMed
23.
Zurück zum Zitat Piscaglia F, Nolsoe C, Dietrich CF et al (2012) The EFSUMB guidelines and recommendations on the clinical practice of contrast enhanced ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall Med 33:33–59CrossRefPubMed Piscaglia F, Nolsoe C, Dietrich CF et al (2012) The EFSUMB guidelines and recommendations on the clinical practice of contrast enhanced ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall Med 33:33–59CrossRefPubMed
24.
Zurück zum Zitat Jakobsen JA, Oyen R, Thomsen HS, Morcos SK, Members of Contrast Media Safety Committee of European Society of Urogenital R (2005) Safety of ultrasound contrast agents. Eur Radiol 15:941–945CrossRefPubMed Jakobsen JA, Oyen R, Thomsen HS, Morcos SK, Members of Contrast Media Safety Committee of European Society of Urogenital R (2005) Safety of ultrasound contrast agents. Eur Radiol 15:941–945CrossRefPubMed
25.
Zurück zum Zitat Meacock LM, Sellars ME, Sidhu PS (2010) Evaluation of gallbladder and biliary duct disease using microbubble contrast-enhanced ultrasound. Br J Radiol 83:615–627CrossRefPubMedPubMedCentral Meacock LM, Sellars ME, Sidhu PS (2010) Evaluation of gallbladder and biliary duct disease using microbubble contrast-enhanced ultrasound. Br J Radiol 83:615–627CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Xie XH, Xu HX, Xie XY et al (2010) Differential diagnosis between benign and malignant gallbladder diseases with real-time contrast-enhanced ultrasound. Eur Radiol 20:239–248CrossRefPubMed Xie XH, Xu HX, Xie XY et al (2010) Differential diagnosis between benign and malignant gallbladder diseases with real-time contrast-enhanced ultrasound. Eur Radiol 20:239–248CrossRefPubMed
27.
Zurück zum Zitat Liu LN, Xu HX, Lu MD et al (2012) Contrast-enhanced ultrasound in the diagnosis of gallbladder diseases: a multi-center experience. PLoS One 7:e48371CrossRefPubMedPubMedCentral Liu LN, Xu HX, Lu MD et al (2012) Contrast-enhanced ultrasound in the diagnosis of gallbladder diseases: a multi-center experience. PLoS One 7:e48371CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Fei X, Lu WP, Luo YK et al (2015) Contrast-enhanced ultrasound may distinguish gallbladder adenoma from cholesterol polyps: a prospective case-control study. Abdom Imaging 40:2355–2363CrossRefPubMed Fei X, Lu WP, Luo YK et al (2015) Contrast-enhanced ultrasound may distinguish gallbladder adenoma from cholesterol polyps: a prospective case-control study. Abdom Imaging 40:2355–2363CrossRefPubMed
29.
Zurück zum Zitat Liu XS, Gu LH, Du J et al (2015) Differential diagnosis of polypoid lesions of the gallbladder using contrast-enhanced sonography. J Ultrasound Med 34:1061–1069CrossRefPubMed Liu XS, Gu LH, Du J et al (2015) Differential diagnosis of polypoid lesions of the gallbladder using contrast-enhanced sonography. J Ultrasound Med 34:1061–1069CrossRefPubMed
30.
Zurück zum Zitat Zhang HP, Bai M, Gu JY, He YQ, Qiao XH, Du LF (2018) Value of contrast-enhanced ultrasound in the differential diagnosis of gallbladder lesion. World J Gastroenterol 24:744–751CrossRefPubMedPubMedCentral Zhang HP, Bai M, Gu JY, He YQ, Qiao XH, Du LF (2018) Value of contrast-enhanced ultrasound in the differential diagnosis of gallbladder lesion. World J Gastroenterol 24:744–751CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat Greis C (2011) Quantitative evaluation of microvascular blood flow by contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc 49:137–149PubMed Greis C (2011) Quantitative evaluation of microvascular blood flow by contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc 49:137–149PubMed
32.
Zurück zum Zitat Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefPubMed Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefPubMed
33.
Zurück zum Zitat Song ER, Chung WS, Jang HY, Yoon M, Cha EJ (2014) CT differentiation of 1-2-cm gallbladder polyps: benign vs malignant. Abdom Imaging 39:334–341CrossRefPubMed Song ER, Chung WS, Jang HY, Yoon M, Cha EJ (2014) CT differentiation of 1-2-cm gallbladder polyps: benign vs malignant. Abdom Imaging 39:334–341CrossRefPubMed
34.
Zurück zum Zitat Wang W, Yang ZL, Liu JQ, Jiang S, Miao XY (2012) Identification of CD146 expression, angiogenesis, and lymphangiogenesis as progression, metastasis, and poor-prognosis related markers for gallbladder adenocarcinoma. Tumour Biol 33:173–182CrossRefPubMed Wang W, Yang ZL, Liu JQ, Jiang S, Miao XY (2012) Identification of CD146 expression, angiogenesis, and lymphangiogenesis as progression, metastasis, and poor-prognosis related markers for gallbladder adenocarcinoma. Tumour Biol 33:173–182CrossRefPubMed
35.
Zurück zum Zitat Yoshimitsu K, Honda H, Kaneko K et al (1997) Anatomy and clinical importance of cholecystic venous drainage: helical CT observations during injection of contrast medium into the cholecystic artery. AJR Am J Roentgenol 169:505–510CrossRefPubMed Yoshimitsu K, Honda H, Kaneko K et al (1997) Anatomy and clinical importance of cholecystic venous drainage: helical CT observations during injection of contrast medium into the cholecystic artery. AJR Am J Roentgenol 169:505–510CrossRefPubMed
36.
Zurück zum Zitat Lassau N, Koscielny S, Chami L et al (2011) Advanced hepatocellular carcinoma: early evaluation of response to bevacizumab therapy at dynamic contrast-enhanced US with quantification--preliminary results. Radiology 258:291–300CrossRefPubMed Lassau N, Koscielny S, Chami L et al (2011) Advanced hepatocellular carcinoma: early evaluation of response to bevacizumab therapy at dynamic contrast-enhanced US with quantification--preliminary results. Radiology 258:291–300CrossRefPubMed
37.
Zurück zum Zitat Quaia E, Sozzi M, Angileri R, Gennari AG, Cova MA (2016) Time-intensity curves obtained after microbubble injection can be used to differentiate responders from nonresponders among patients with clinically active Crohn disease after 6 weeks of pharmacologic treatment. Radiology 281:606–616CrossRefPubMed Quaia E, Sozzi M, Angileri R, Gennari AG, Cova MA (2016) Time-intensity curves obtained after microbubble injection can be used to differentiate responders from nonresponders among patients with clinically active Crohn disease after 6 weeks of pharmacologic treatment. Radiology 281:606–616CrossRefPubMed
38.
Zurück zum Zitat Tranquart F, Mercier L, Frinking P, Gaud E, Arditi M (2012) Perfusion quantification in contrast-enhanced ultrasound (CEUS)--ready for research projects and routine clinical use. Ultraschall Med 33 Suppl(1):S31–S38 Tranquart F, Mercier L, Frinking P, Gaud E, Arditi M (2012) Perfusion quantification in contrast-enhanced ultrasound (CEUS)--ready for research projects and routine clinical use. Ultraschall Med 33 Suppl(1):S31–S38
39.
Zurück zum Zitat Lee J, Yun M, Kim KS, Lee JD, Kim CK (2012) Risk stratification of gallbladder polyps (1-2 cm) for surgical intervention with 18F-FDG PET/CT. J Nucl Med 53:353–358CrossRefPubMed Lee J, Yun M, Kim KS, Lee JD, Kim CK (2012) Risk stratification of gallbladder polyps (1-2 cm) for surgical intervention with 18F-FDG PET/CT. J Nucl Med 53:353–358CrossRefPubMed
40.
Zurück zum Zitat Zheng SG, Xu HX, Liu LN et al (2013) Contrast-enhanced ultrasound versus conventional ultrasound in the diagnosis of polypoid lesion of gallbladder: a multi-center study of dynamic microvascularization. Clin Hemorheol Microcirc 55:359–374PubMed Zheng SG, Xu HX, Liu LN et al (2013) Contrast-enhanced ultrasound versus conventional ultrasound in the diagnosis of polypoid lesion of gallbladder: a multi-center study of dynamic microvascularization. Clin Hemorheol Microcirc 55:359–374PubMed
Metadaten
Titel
Quantitative contrast-enhanced US helps differentiating neoplastic vs non-neoplastic gallbladder polyps
verfasst von
Jae Seok Bae
Se Hyung Kim
Hyo-jin Kang
Haeryoung Kim
Ji Kon Ryu
Jin-Young Jang
Sang Hyub Lee
Woo Hyun Paik
Wooil Kwon
Jae Young Lee
Joon Koo Han
Publikationsdatum
08.04.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
European Radiology / Ausgabe 7/2019
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06123-w

Weitere Artikel der Ausgabe 7/2019

European Radiology 7/2019 Zur Ausgabe

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.