Contrast-enhanced ultrasound (CEUS) and gallbladder diseases - A retrospective mono-center analysis of imaging findings with histopathological correlation

Recent Advances in Endoscopic Ultrasound for Gallbladder Disease Diagnosis

Gallbladder (GB) disease is classified into two broad categories: GB wall-thickening and protuberant lesions, which include various lesions, such as adenomyomatosis, cholecystitis, GB polyps, and GB carcinoma. This review summarizes recent advances in the differential diagnosis of GB lesions, focusing primarily on endoscopic ultrasound (EUS) and related technologies. Fundamental B-mode EUS and contrast-enhanced harmonic EUS (CH-EUS) have been reported to be useful for the diagnosis of GB diseases because they can evaluate the thickening of the GB wall and protuberant lesions in detail. We also outline the current status of EUS-guided fine-needle aspiration (EUS-FNA) for GB lesions, as there have been scattered reports on EUS-FNA in recent years. Furthermore, artificial intelligence (AI) technologies, ranging from machine learning to deep learning, have become popular in healthcare for disease diagnosis, drug discovery, drug development, and patient risk identification. In this review, we outline the current status of AI in the diagnosis of GB.

Value of contrast-enhanced ultrasound in diagnosis and differential diagnosis of polypoid lesions of gallbladder ≥ 1 cm

OBJECTIVES

To evaluate the usefulness of Contrast-enhanced ultrasound (CEUS) in the diagnosis and differential diagnosis of Polypoid lesions of gallbladder (PLGs) ≥ 1 cm.

METHODS

A prospective analysis was performed on 180 patients with PLGs ≥ 1 cm. 175 cases were confirmed by pathological diagnosis and the remaining were confirmed by other imaging findings. The characteristics of lesions on conventional Ultrasonography (US) and CEUS were recorded.

RESULTS

Significant differences were observed in enhancement patterns between benign and malignant PLGs during both arterial (P < 0.001) and venous phases (P < 0.001). The malignant lesions typically yielded a "fast-in and fast-out" enhancement pattern. There was no significant difference in Arrival time (AT) between malignant and benign PLGs. If we consider wash-out time ≤ 40 s as a diagnostic standard for malignant lesions, the sensitivity, specificity, and accuracy were 88.24%, 85.62%, and 86.11%, respectively. Destruction of the Gallbladder (GB) wall was a particularly important indication of malignant PLGs, and the sensitivity, specificity, and accuracy were 93.33%, 92.12%, and 92.22%, respectively. The accuracy of CEUS in the diagnosis of PLGs, as well as malignant and benign lesions, was 92.22%, 92.47%, and 91.17%, respectively.

CONCLUSIONS

The "fast-in and fast-out" enhancement pattern, hyper-enhancement in comparison to the GB wall in the arterial phase, wash-out time ≤ 40 s, GB wall destruction, and hepatic parenchymal infiltration are the characteristic findings of malignant PLGs. Besides, CEUS provides a valuable reference to classify some of the benign lesions.

Emphysematous Cholecystitis and Necrotizing Pancreatitis: Unusual Combination of Critical Pathology in a Healthy Young Patient

Emphysematous cholecystitis (EC) is a rare form of severe cholecystitis, more common among old, frail males, with comorbidities like diabetes mellitus and peripheral vascular disease. The coexistence of emphysematous cholecystitis with necrotizing pancreatitis is extremely uncommon and in the literature, though it has been reported, no case was of a young patient like the one we are describing. He was treated with laparoscopic cholecystectomy, and his pancreatitis managed conservatively.