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© 2007 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 26:763-774 • 0278-4297

Differential Diagnosis of Gallbladder Diseases With Contrast-Enhanced Harmonic Gray Scale Ultrasonography

Kazushi Numata, MD, Hiroyuki Oka, MD, Manabu Morimoto, MD, Kazuya Sugimori, MD, Reiko Kunisaki, MD, Hiromi Nihonmatsu, MD, Kenichi Matsuo, MD, Yasuhiko Nagano, MD, Akinori Nozawa, MD and Katsuaki Tanaka, MD

Gastroenterological Center (K.N., H.O., M.M., K.S., R.K., H.N., K.M., Y.N., K.T.) and Department of Pathology (A.N.), Yokohama City University Medical Center, Yokohama, Kanagawa, Japan.

Address correspondence to Kazushi Numata, MD, Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan. E-mail: kz-numa{at}urahp.yokohama-cu.ac.jp

Objectives. We evaluated the usefulness of contrast-enhanced harmonic gray scale ultrasonographic findings for differential diagnosis of gallbladder diseases. Methods. We evaluated contrast-enhanced harmonic gray scale ultrasonographic images from 33 patients with 35 polypoid gallbladder disease lesions larger than 10 mm in diameter, consisting of 12 biliary sludge lesions, 8 cholesterol polyps, 1 inflammatory polyp, 2 adenomas, and 12 carcinomas. After a galactosepalmitic acid contrast agent was injected, lesions were scanned by contrast-enhanced harmonic gray scale ultrasonography in 2 phases: early vascular and late vascular. Results. None of the biliary sludge lesions (n = 12) showed either tumor vessels or tumor enhancement. Lesions showing tumor vessels and tumor enhancement on contrast-enhanced harmonic gray scale ultrasonography were diagnosed as cholesterol polyp, inflammatory polyp, adenoma, or carcinoma. Three (38%) of the 8 cholesterol polyps showed dotted-type tumor vessels. Branched-type tumor vessels were observed in 5 (62%) of the 8 cholesterol polyps, the 1 (100%) inflammatory polyp, both (100%) adenomas, and 3 (25%) of the 12 carcinomas. Tortuous-type tumor vessels were observed in 9 (75%) of the 12 carcinomas. Lesions with tumor enhancement and tortuous-type tumor vessels on contrast-enhanced harmonic gray scale ultrasonography were diagnosed as carcinomas, and the sensitivity, specificity, and accuracy of this diagnosis with the current modality were 75% (9/12), 100% (23/23), and 91% (32/35), respectively. Conclusions. Evaluation of tumor vessels on contrast-enhanced harmonic gray scale ultrasonography may be a useful modality for differentiating gallbladder carcinoma from other polypoid gallbladder disease lesions.

Key Words: biliary sludge • cholesterol polyp • contrast-enhanced harmonic gray scale ultrasonography • gallbladder carcinoma

Abbreviations: CT, computed tomography • EUS, endoscopic ultra-sonography • MI, mechanical index

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Copyright © 2007 by the American Institute of Ultrasound in Medicine.