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Kin T, Motoya M, Hayashi T, Takahashi K, Katanuma A. Transabdominal ultrasound evaluation of vascularity of gallbladder lesions: particularly those with wall thickening. J Med Ultrason (2001) 2024; 51:429-436. [PMID: 38879837 DOI: 10.1007/s10396-024-01467-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/17/2024] [Indexed: 07/26/2024]
Abstract
Gallbladder wall thickening is relatively common in clinical settings, and for appropriate diagnosis, the size, shape, internal structure, surface contour, and vascularity of the gallbladder wall must be evaluated. Morphological evaluation is the most important; however, some gallbladder lesions resemble gallbladder cancer in imaging studies, making differential diagnosis challenging. Vascular evaluation is indispensable for a precise diagnosis in these cases. In this review, we present the current status of vascular evaluation using US and diagnosis using vascular imaging for gallbladder lesions, including those presenting with wall thickening. To date, several ultrasound imaging techniques have been developed to assess vascularity, including Doppler imaging with high sensitivity, use of contrast agents, and microvascular imaging using a novel filter for Doppler imaging. Although conventional color Doppler imaging is rarely used for the diagnosis of gallbladder lesions, the efficacy of contrast-enhanced ultrasound in assessing the vascularity, enhancement pattern, or timing of enhancement/washout has been reported. Presence of multiple irregular microvessels has been speculated to indicate malignancy. However, few reports on microvessels have been published, and further studies are required for the precise diagnosis of gallbladder lesions with microvascular evaluation.
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Affiliation(s)
- Toshifumi Kin
- Center for Gastroenterology, Teine-Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan.
| | - Masayo Motoya
- Center for Gastroenterology, Teine-Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Tsuyoshi Hayashi
- Center for Gastroenterology, Teine-Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Kuniyuki Takahashi
- Center for Gastroenterology, Teine-Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine-Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
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Matsubara H, Suzuki H, Naitoh T, Urano F, Kiura N. Usefulness of contrast-enhanced ultrasonography for biliary tract disease. J Med Ultrason (2001) 2023:10.1007/s10396-023-01338-3. [PMID: 37523000 DOI: 10.1007/s10396-023-01338-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/26/2023] [Indexed: 08/01/2023]
Abstract
Conventional ultrasonography (US) for biliary tract disease shows high time and spatial resolution. In addition, it is simple and minimally invasive, and is selected as a first-choice examination procedure for biliary tract disease. Currently, contrast-enhanced US (CEUS), which facilitates the more accurate assessment of lesion blood flow in comparison with color and power Doppler US, is performed using a second-generation ultrasonic contrast agent. Such agents are stable and provide a timeline for CEUS diagnosis. Gallbladder lesions are classified into three types: gallbladder biliary lesion (GBL), gallbladder polypoid lesion (GPL), and gallbladder wall thickening (GWT). Bile duct lesions can also be classified into three types: bile duct biliary lesion (BBL), bile duct polypoid lesion (BDPL), and bile duct wall thickening (BDWT). CEUS facilitates the differentiation of GBL/BBL from tumorous lesions based on the presence or absence of blood vessels. In the case of GPL, it is important to identify a vascular stalk attached to the lesion. In the case of GWT, the presence or absence of a non-contrast-enhanced area, the Rokitansky-Aschoff sinus, and continuity of a contrast-enhanced gallbladder wall layer are important for differentiation from gallbladder cancer. In the case of BDWT, it is useful to evaluate the contour of the contrast-enhanced medial layer of the bile duct wall for differentiating IgG4-related sclerosing cholangitis from primary sclerosing cholangitis. CEUS for ampullary carcinoma accurately reflects histopathological findings of the lesion. Evaluating blood flow in the lesion, continuity of the gallbladder wall, and contour of the bile duct wall via CEUS provides useful information for the diagnosis of biliary tract disease.
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Affiliation(s)
- Hiroshi Matsubara
- Department of Gastroenterology, Toyohashi Municipal Hospital, 50 Hakkennishi, Aotake, Toyohashi, Aichi, 441-8570, Japan.
| | - Hirotaka Suzuki
- Department of Gastroenterology, Toyohashi Municipal Hospital, 50 Hakkennishi, Aotake, Toyohashi, Aichi, 441-8570, Japan
| | - Takehito Naitoh
- Department of Gastroenterology, Toyohashi Municipal Hospital, 50 Hakkennishi, Aotake, Toyohashi, Aichi, 441-8570, Japan
| | - Fumihiro Urano
- Department of Gastroenterology, Toyohashi Municipal Hospital, 50 Hakkennishi, Aotake, Toyohashi, Aichi, 441-8570, Japan
| | - Nobuyuki Kiura
- Department of Gastroenterology, Toyohashi Municipal Hospital, 50 Hakkennishi, Aotake, Toyohashi, Aichi, 441-8570, Japan
- Department of Radiology, Toyohashi Municipal Hospital, 50 Hakkennishi, Aotake, Toyohashi, Aichi, 441-8570, Japan
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Imaging patterns of wall thickening type of gallbladder cancer. Clin Exp Hepatol 2022; 8:255-266. [PMID: 36683868 PMCID: PMC9850297 DOI: 10.5114/ceh.2022.122285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/24/2022] [Indexed: 01/01/2023] Open
Abstract
Gallbladder cancer (GBC) has a high incidence in certain geographical regions. Morphologically, GBC presents as a mass replacing the gallbladder, a polypoidal lesion, or wall thickening. The incidence of preoperative diagnosis of wall thickening type of GBC is less well studied. The patterns of mural involvement and extramural spread are not well described in the literature. Additionally, wall thickening in the gallbladder does not always indicate malignancy and can be secondary to inflammatory or benign gallbladder diseases and extracholecystic causes and systemic pathologies. Objective reporting of gallbladder wall thickening will help us appreciate GBC's early features. In this review, we illustrate the imaging patterns of wall thickening type of GBC.
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Jenssen C, Lorentzen T, Dietrich CF, Lee JY, Chaubal N, Choi BI, Rosenberg J, Gutt C, Nolsøe CP. Incidental Findings of Gallbladder and Bile Ducts-Management Strategies: General Aspects, Gallbladder Polyps and Gallbladder Wall Thickening-A World Federation of Ultrasound in Medicine and Biology (WFUMB) Position Paper. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2355-2378. [PMID: 36058799 DOI: 10.1016/j.ultrasmedbio.2022.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 06/02/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
The World Federation of Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings with a series of position papers to give advice on characterization and management. The biliary system (gallbladder and biliary tree) is the third most frequent site for incidental findings. This first part of the position paper on incidental findings of the biliary system is related to general aspects, gallbladder polyps and other incidental findings of the gallbladder wall. Available evidence on prevalence, diagnostic work-up, malignancy risk, follow-up and treatment is summarized with a special focus on ultrasound techniques. Multiparametric ultrasound features of gallbladder polyps and other incidentally detected gallbladder wall pathologies are described, and their inclusion in assessment of malignancy risk and decision- making on further management is suggested.
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Affiliation(s)
- Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland GmbH, Strausberg/Wriezen, Germany; Brandenburg Institute for Clinical Ultrasound (BICUS) at Medical University Brandenburg "Theodor Fontane", Neuruppin, Germany
| | - Torben Lorentzen
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland.
| | - Jae Young Lee
- Department of Radiology, Medical Research Center, Seoul National University, College of Medicine, Seoul, Korea
| | - Nitin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research Centre, Mumbai, India
| | - Buyng Ihn Choi
- Department of Radiology, Medical Research Center, Seoul National University, College of Medicine, Seoul, Korea
| | - Jacob Rosenberg
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Carsten Gutt
- Department of Surgery, Klinikum Memmingen, Memmingen, Germany
| | - Christian P Nolsøe
- Center for Surgical Ultrasound, Department of Surgery, Zealand University Hospital, Køge, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen, Copenhagen, Denmark
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