Ultrasonographic Angiography in Gallbladder Diseases

Differential diagnosis between benign and malignant gallbladder diseases with real-time contrast-enhanced ultrasound

The value of contrast-enhanced ultrasound (CEUS) in differential diagnosis between benign and malignant gallbladder diseases was investigated. Thirty-three patients with gallbladder carcinomas and 47 with benign gallbladder diseases underwent CEUS. The lesion enhancement time, enhancement extent, pattern, dynamic change of enhancement and the intactness of gallbladder wall were evaluated. In the early phase at CEUS, hyper-, iso-, hypo-, and non-enhancement were found in 84.8% (28/33), 9.1% (3/33), 6.1% (2/33), and 0% (0/33) of gallbladder carcinomas, and 70.3% (33/47), 17.0% (8/47), 2.1% (1/47), and 10.6% (5/47) of benign diseases (p > 0.05). Hyper-enhancement or iso-enhancement in the early phase and then fading out to hypo-enhancement within 35 s after contrast agent administration was found in 90.9% (30/33) of carcinomas and 17.0% (8/47) of benign lesions (p < 0.001). Destruction of the gallbladder wall intactness was absent in benign diseases, whereas it was present in 28 (84.8%) of the 33 carcinomas (p < 0.001). Destruction of gallbladder wall intactness on CEUS yielded the highest capability in differential diagnosis, with sensitivity, specificity, and Youden's index of 84.8% (28/33), 100% (47/47), and 0.85, respectively. Conventional US made correct original diagnoses in 55 (68.8%) patients, whereas CEUS in 77 (96.3%). Thus, CEUS is useful in differential diagnosis between malignant and benign gallbladder diseases.

The natural history and significance of ultrasonographically defined polypoid lesions of the gallbladder in children

BACKGROUND/PURPOSE

Gallbladder polyps are relatively common in adults and may increase the risk of gallbladder cancer. The increased use of high-quality abdominal ultrasonography has likely led to the increase detection of these lesions in the pediatric population. The aim of the present study was to address the significance of the ultrasonographic finding of a gallbladder polyp in children.

METHODS

This prospective case series of 4 children with ultrasonographically defined gallbladder polyps outlines their presentation and clinical course. A detailed review of the literature and a management approach has been provided.

RESULTS

In the 4 cases, polyps were followed for 2, 5, 72, and 84 months with a clinical follow-up of 7 to 11 years. Three underwent cholecystectomy and only 1 of 3 had a polypoid gallbladder lesion. One child, followed for 7 years, had no change in size, shape, or location of the polyp. This case series adds to the small group of children in the literature with polypoid gallbladder lesions and, to our knowledge, none have developed malignant transformation.

CONCLUSIONS

Clearly more studies on such children are required to further add to our knowledge on the natural history and the appropriate management of these lesions.

Differential diagnosis of gallbladder diseases with contrast-enhanced harmonic gray scale ultrasonography

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.

Usefulness of contrast-enhanced EUS in the diagnosis of upper GI tract diseases

BACKGROUND

We evaluated the usefulness of contrast-enhanced endoscopic ultrasonography (EUS) in the diagnosis of upper gastrointestinal (GI) tract diseases.

METHODS

The subjects were 42 patients with upper GI tract diseases: 4 esophageal carcinomas, 30 gastric carcinomas, 5 gastric myogenic tumors, and 3 gastric ulcers. After the lesion was observed by EUS, air-filled albumin (0.22 mL/kg) was intravenously injected at a rate of 1 mL/sec into the right cubital median vein, and observation was continued for 10 minutes.

RESULTS

Enhancement of the third and fifth layers was observed in all normal esophageal and gastric walls. No esophageal carcinomas were enhanced. Enhancement was observed in 5 gastric carcinomas that had abundant, enlarged, and winding vascular beds. In all esophageal and the other 25 gastric carcinomas, although the tumors per se were not enhanced, enhancement of the third and fifth layers around the lesions clearly demarcated the tumor boundaries. As a result, accuracy for detection of the depth of gastric carcinoma improved from 76.7% for EUS to 90% for contrast-enhanced EUS. All gastric myogenic tumors were enhanced, and irregularly shaped sonolucent areas within these tumors became clear, but we could not distinguish between leiomyoma and leiomyosarcoma.

CONCLUSIONS

Contrast-enhanced EUS is a noninvasive, useful diagnostic method for assessment of the depth of invasion of esophageal and gastric carcinomas.

Contrast-enhanced endoscopic ultrasonography in gallbladder diseases

BACKGROUND

The purpose of this study was to investigate the usefulness of contrast-enhanced endoscopic ultrasonography in gallbladder diseases.

METHODS

Subjects were 38 patients including 12 with adenocarcinoma, 2 adenosquamous carcinoma, 6 cholesterol polyp, 10 cholecystitis, and 8 adenomyomatosis. After endoscopic ultrasonography, sonicated albumin was intravenously injected and the enhanced effect on images of these lesions was determined. For malignancies we compared diagnostic accuracy (T factor, TNM classification) of endoscopic ultrasonography and contrast-enhanced endoscopic ultrasonography. Vascularity as shown by contrast-enhanced endoscopic ultrasonography and angiograms was compared.

RESULTS

Enhancement was observed in 11 patients with adenocarcinoma but not of those with adenosquamous carcinoma or cholesterol polyp. Angiography provided hypervascular images for all cases of adenocarcinoma, but all other lesions were hypovascular. In one case of adenocarcinoma, 3 cases of adenomyomatosis, and 8 cases of cholecystitis, there was a discrepancy between contrast-enhanced endoscopic ultrasonography images and angiograms with regard to vascularity. The accuracy of depth of tumor invasion for endoscopic ultrasonography was 78.6% (11 of 14) versus 92.9% (13 of 14) for contrast-enhanced endoscopic ultrasonography.

CONCLUSION

Contrast-enhanced endoscopic ultrasonography is useful in the diagnosis of gallbladder lesions.

Evaluation of effect of treatment for invasive bladder cancer by ultrasonography with intra-arterial infusion of carbon dioxide microbubbles

RATIONALE AND OBJECTIVES

The purpose of this study was to evaluate the diagnostic usefulness of the ultrasonography with intra-arterial infusion of carbon dioxide microbubbles (CO2) for invasive bladder cancer.

METHODS

Twelve patients with muscle-invading bladder cancer who were treated by concurrent radiotherapy and intra-arterial infusion of daily low dose of cisplatin using an implanted infusion port were included. A total of 30 studies was performed during the treatment to evaluate the visualization of the tumor and effect of the treatment compared with conventional ultrasonography, computed tomography, or cystoscopy.

RESULTS

Satisfactory visualization of the tumor in CO2 ultrasonography was obtained in all patients, in particular in those with flat tumor or prostatic invasion. The enhancement effect of CO2 on the tumor, which was maintained well in the late period of the treatment, made possible evaluation of the therapeutic effect. With respect to the evaluation of local response, disagreement between clinical response and the evaluation of CO2 ultrasonography was observed in two patients with definite differentiation between wall edema and residual tumor after treatment being difficult.

CONCLUSIONS

Carbon dioxide ultrasonography is easy to perform in patients treated with arterial infusion therapy using an implanted infusion port and provides practical information in evaluating therapeutic effect.