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Bao W, Xu A, Ni S, Wang B, Urmi H, Zhao B, You Y, Hu H. Is there a role for growth status in distinguishing gallbladder adenomas from cholesterol polyps? - A retrospective study based on 520 cholecystectomy patients. Scand J Gastroenterol 2021; 56:1450-1455. [PMID: 34461797 DOI: 10.1080/00365521.2021.1970220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Gallbladder adenomas have cancerous potential and occur in 4-8.9% of gallbladder polyps. The growth status (size progression and growth rate during follow-up) of polyps and their effectiveness for predicting adenomas are poorly defined. Herein, we compared adenomas and cholesterol polyps based on the growth status and evaluated the reported risk factors in predicting neoplasm. METHODS We enrolled 520 patients who underwent preoperative ultrasonic follow-up more than 6 months with post-cholecystectomy pathologically confirmed gallbladder polyps. The patients were classified into adenoma and cholesterol polyp groups. Growth status, clinical characteristics, laboratory data, ultrasonic findings were reviewed and compared between the groups. RESULTS Seventy-nine adenomas and 441 cholesterol polyps were analyzed. The mean diameter of adenomas (cholesterol polyps) was 7.24 ± 4.36 mm (6.23 ± 2.88 mm) in the initial and 12.06 ± 4.61 mm (10.05 ± 2.95 mm) in the preoperative examination. The median size progression (range) of polyps in the cholesterol polyps [3 (0, 22)] mm was smaller than that in adenomas [4 (0, 21)] mm (p = .075). The mean growth rate of adenomas (1.07 ± 1.33 mm/6 months) was slightly faster than in cholesterol polyps (0.83 ± 1.04 mm/6 months) (p = .338). The indicators significantly associated with adenomas were age >49.5 years, lack of gallbladder polyps/cholelithiasis family history, polyp size >11.5 mm and solitary polyp (p = .005, p = .027, p = .001, and p = .021, respectively). CONCLUSION Growth status was not a valuable modality to distinguishing gallbladder adenomas from cholesterol polyps. Risk factors such as age, polyp size, and solitary polyp were effective in predicting adenomas.
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Affiliation(s)
- Wenqing Bao
- Tongji University School of Medicine, Gallbladder Diseases Center, Tongji University Affiliated Shanghai East Hospital, Shanghai, China
| | - Anan Xu
- Gallbladder Disease Center, Tongji University Affiliated Shanghai East Hospital, Shanghai, China
| | - Shubin Ni
- Department of General Surgery, Shanghai Seventh People's Hospital, Shanghai, China
| | - Bo Wang
- Gallbladder Disease Center, Tongji University Affiliated Shanghai East Hospital, Shanghai, China
| | - Humaira Urmi
- Gallbladder Disease Center, Tongji University Affiliated Shanghai East Hospital, Shanghai, China
| | - Bin Zhao
- Department of General Surgery, Shanghai Seventh People's Hospital, Shanghai, China
| | - Yongmei You
- Gallbladder Disease Center, Tongji University Affiliated Shanghai East Hospital, Shanghai, China
| | - Hai Hu
- Gallbladder Disease Center, Tongji University Affiliated Shanghai East Hospital, Shanghai, China
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Zhu L, Han P, Lee R, Jiang B, Jiao Z, Li N, Tang W, Fei X. Contrast-enhanced ultrasound to assess gallbladder polyps. Clin Imaging 2021; 78:8-13. [PMID: 33706069 DOI: 10.1016/j.clinimag.2021.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the value of contrast-enhanced ultrasound (CEUS) in distinguishing adenomatous gallbladder polyps from cholesterol gallbladder polyps. METHODS A total of 164 patients with gallbladder polyps were retrospectively analyzed. All patients underwent B-mode ultrasound (US) and CEUS before cholecystectomy. Gallbladder polyps were divided into cholesterol polyp group and adenomatous polyp group according to pathology. Differences in patient's age, gender, maximum polyp size, number, presence of gallstones, vascularity and stalk width measured by US and vascular stalk width measured by CEUS were tested between the two groups. The diagnostic performance of specific US features was evaluated. The independent factors related with adenomatous polyps were analyzed by multiple logistic regression analyses. RESULTS There were 114 cholesterol polyps and 50 adenomatous polyps in 164 patients analyzed in the study. Differences in maximum size, vascularity, and stalk width of the gallbladder polyp were significant between the two groups (p < 0.05), whereas differences in patient's age, gender, number of gallbladder polyp, and presence of gallstones between the two groups were not (p > 0.05). Stalk width was wider than vascular stalk width between the two groups (p < 0.05). Vascular stalk width was also statistically different between the two groups (p < 0.05). The diagnostic performance of vascular stalk width was more significant than stalk width. Only vascular stalk width and vascularity were independent factors related with adenomatous polyps. CONCLUSION Vascular stalk width measured by CEUS is more accurate than stalk width measured by grayscale US in distinguishing adenomatous polyps from cholesterol polyps.
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Affiliation(s)
- Lianhua Zhu
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Peng Han
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Regis Lee
- Department of Ultrasound in Research and Education, Rocky Vista University, 255 East Center Street, Room C286, Ivins, UT 84738, USA
| | - Bo Jiang
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Ziyu Jiao
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Nan Li
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Wenbo Tang
- Department of Hepatobiliary Surgery, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Xiang Fei
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China.
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Abukhiran I, Jasser J, Farhat I, Boukhar S. Case of a Large Pedunculated Biliary Cholesterol Polyp With Osseous Metaplasia. Cureus 2020; 12:e12357. [PMID: 33520551 PMCID: PMC7839809 DOI: 10.7759/cureus.12357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Cholesterol polyps are the most common benign gallbladder polyps and are usually seen in a background of cholesterolosis. Rarely, they can harbor foci of osseous metaplasia, which is an event of uncertain clinical significance that might be confused with cholelithiasis clinically or radiologically. Herein we report the case of a 78-year-old female with a 1.8-cm pedunculated polyp arising in the gallbladder body. Histologic examination showed microscopic foci of osseous metaplasia, characterized by heterotropic bone trabeculae rimmed by osteoblasts and surrounded by osteoclast giant cells. To the best of our knowledge, this case is the third case report of a cholesterol polyp with osseous metaplasia in the English literature. We also review the relative pathogenesis, clinical and pathologic findings, and previous reports.
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Affiliation(s)
- Ibrahim Abukhiran
- Pathology and Laboratory Medicine, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Judy Jasser
- Pathology and Laboratory Medicine, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Ilham Farhat
- Pathology and Laboratory Medicine, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Sarag Boukhar
- Pathology and Laboratory Medicine, University of Iowa Hospitals and Clinics, Iowa City, USA
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Martin E, Gill R, Debru E. Diagnostic accuracy of transabdominal ultrasonography for gallbladder polyps: systematic review. Can J Surg 2018; 61:200-207. [PMID: 29806818 PMCID: PMC5973908 DOI: 10.1503/cjs.011617] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Previous research has shown variable but generally poor accuracy of transabdominal ultrasonography in the diagnosis of gallbladder polyps. We performed a systematic review of the literature with the aim of helping surgeons interpret and apply these findings in the preoperative assessment and counselling of their patients. METHODS We searched PubMed, MEDLINE and the Cochrane database using the keywords "gallbladder," "polyp," "ultrasound," "pathology" and "diagnosis" for English-language articles published after 1990 with the full-text article available through our institutional subscriptions. Polyps were defined as immobile features that on transabdominal ultrasonography appear to arise from the mucosa and that lack an acoustic shadow, and pseudopolyps were defined as features such as inflammation, hyperplasia, cholesterolosis and adenomyomatosis that convey no risk of malignant transformation. RESULTS The search returned 1816 articles, which were narrowed down to 14 primary sources involving 15 497 (range 23-13 703) patients who had preoperative transabdominal ultrasonography, underwent cholecystectomy and had postoperative pathology results available. Among the 1259 patients in whom a gallbladder polyp was diagnosed on ultrasonography, 188 polyps were confirmed as true polyps on pathologic examination, and 81 of these were found to be malignant. Of the 14 238 patients for whom a polyp was not seen on ultrasonography, 38 had a true polyp on pathologic examination, none of which were malignant. For true gallbladder polyps, transabdominal ultrasonography had a sensitivity of 83.1%, specificity of 96.3%, positive predictive value of 14.9% (7.0% for malignant polyps) and negative predictive value of 99.7%. CONCLUSION Transabdominal ultrasonography has a high false-positive rate (85.1%) for the diagnosis of gallbladder polyps. Further study of alternative imaging modalities and reevaluation of existing management guidelines are warranted.
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Affiliation(s)
- Erin Martin
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - Richdeep Gill
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - Estifanos Debru
- From the Department of Surgery, University of Calgary, Calgary, Alta
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Abstract
The article provides an overview of current views on the involvement of the liver, gallbladder, and pancreas in patients with overweight and obesity. It considers the general issues of the pathogenesis of these conditions, their clinical features and diagnostic methods.
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Polypoid lesions of the gallbladder: analysis of 1204 patients with long-term follow-up. Surg Endosc 2016; 31:2776-2782. [PMID: 28039652 DOI: 10.1007/s00464-016-5286-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 10/05/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Polypoid lesions of the gallbladder (PLG) are common, and most are benign. Few lesions are found to be malignant, but are not preoperatively distinguished as such using common imaging modalities. Therefore, we compared characteristics of benign and malignant PLGs in depth. METHODS We enrolled 1204 consecutive patients diagnosed with PLG at Taipei Veterans General Hospital between January 2004 and December 2013. Patients underwent either surgery or regular follow-up with various imaging modalities for at least 24 months. The mean follow-up duration was 72 ± 32 months. RESULTS Of 1204 patients, 194 underwent surgical treatment and 1010, regular follow-up. In addition, 73 % patients were asymptomatic. The mean PLG size was 6.9 ± 7.7 (range 0.8-129) mm; the PLGs of 337 patients (28 %) grew during their follow-up periods. The majority of PLGs (90.4 %) were single lesions, and 10.5 % of patients had associated gallstones. The PLGs of 20.1 % of surgical patients were malignant. Malignant PLGs were found in 32.4 % of patients ≥50 years old and in 4.7 % of those <50 years old (p < 0.001). Right quadrant abdominal pain, epigastric pain, and body weight loss were the three most common symptoms associated with malignancy. Malignant PLGs were significantly larger than benign lesions (means: 27.5 ± 18.4 mm vs. 12.3 ± 12.3 mm, respectively, p < 0.001). Notably, the size of 5 % of malignant PLGs was 3-5 mm, and that of 8 % was 5-10 mm. The negative predictive value for gallbladder malignancy was 92.8 % based on a size ≥10 mm and 100 % based on a size ≥3 mm. CONCLUSIONS Our study reassesses the PLG size that warrants more aggressive intervention. Cholecystectomy remains mandatory for PLGs > 10 mm, but should also be considered a definitive diagnostic and treatment modality for PLGs with diameters of 3-10 mm.
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Conjugated bile acids in gallbladder bile and serum as potential biomarkers for cholesterol polyps and adenomatous polyps. Int J Biol Markers 2016; 31:e73-9. [PMID: 26541419 DOI: 10.5301/jbm.5000173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2015] [Indexed: 01/15/2023]
Abstract
PURPOSE To identify conjugated bile acids in gallbladder bile and serum as possible biomarkers for cholesterol polyps (CPs) and adenomatous polyps (APs). METHODS Gallbladder bile samples and serum samples were collected from 18 patients with CPs (CP group), 9 patients with APs (AP group), and 20 patients with gallstones (control group) from March to November, 2013. High performance liquid chromatography (HPLC) assay with ultraviolent detection was used to detect the concentration of 8 conjugated bile acids (glycocholic acid, GCA; taurocholic acid, TCA; glycochenodeoxycholic acid, GCDCA; taurochenodeoxycholic acid, TCDCA; glycodeoxycholic acid, GDCA; taurodeoxycholic acid, TDCA; taurolithocholic acid, TLCA; tauroursodeoxycholic acid, TUDCA) in bile samples and serum samples. The diagnostic efficacy of serum GCA, GCDCA and TCDCA was evaluated. RESULTS These 8 conjugated bile acids in gallbladder bile and serum were completely identified within 10 minutes with good linearity (correlation coefficient: R>0.9900; linearity range: 3.91-500 µg/mL). Among these conjugated bile acids, the levels of gallbladder bile GCDCA and TCDCA in the CP group were significantly higher than those in the AP group (p<0.05). Furthermore, serum GCDCA and TCDCA as well as GCA were significantly higher in the AP group than the CP group (p<0.05). Serum GCDCA alone (≤12 µg/mL) had relatively better diagnostic efficacy than the other conjugated bile acids. CONCLUSIONS The levels of serum GCA, GCDCA and TCDCA may be valuable for differentiation of APs and CPs.
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Bhatt NR, Gillis A, Smoothey CO, Awan FN, Ridgway PF. Evidence based management of polyps of the gall bladder: A systematic review of the risk factors of malignancy. Surgeon 2016; 14:278-86. [PMID: 26825588 DOI: 10.1016/j.surge.2015.12.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 11/29/2015] [Accepted: 12/04/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are no evidence-based guidelines to dictate when Gallbladder Polyps (GBPs) of varying sizes should be resected. AIM To identify factors that accurately predict malignant disease in GBP; to provide an evidence-based algorithm for management. METHODS A systematic review following PRISMA guidelines was performed using terms "gallbladder polyps" AND "polypoid lesion of gallbladder", from January 1993 and September 2013. Inclusion criteria required histopathological report or follow-up of 2 years. RTI-IB tool was used for quality analysis. Correlation with GBP size and malignant potential was analysed using Euclidean distance; a logistics mixed effects model was used for assessing independent risk factors for malignancy. RESULTS Fifty-three articles were included in review. Data from 21 studies was pooled for analysis. Optimum size cut-off for resection of GBPs was 10 mm. Probability of malignancy is approximately zero at size <4.15 mm. Patient age >50 years, sessile and single polyps were independent risk factors for malignancy. For polyps sized 4 mm-10 mm, a risk assessment model was formulated. CONCLUSIONS This review and analysis has provided an evidence-based algorithm for the management of GBPs. Longitudinal studies are needed to better understand the behaviour of polyps <10 mm, that are not at a high risk of malignancy, but may change over time.
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Affiliation(s)
- Nikita R Bhatt
- Department of Surgery, University of Dublin, Trinity College, at the Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - Amy Gillis
- Department of Surgery, University of Dublin, Trinity College, at the Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - Craig O Smoothey
- School of Mechanical and Materials Engineering, University College Dublin, Ireland
| | - Faisal N Awan
- Department of Hepatobiliary Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Paul F Ridgway
- Department of Surgery, University of Dublin, Trinity College, at the Adelaide and Meath Hospital, Tallaght, Dublin, Ireland.
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Kim JS, Lee JK, Kim Y, Lee SM. US characteristics for the prediction of neoplasm in gallbladder polyps 10 mm or larger. Eur Radiol 2015; 26:1134-40. [PMID: 26188659 DOI: 10.1007/s00330-015-3910-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/14/2015] [Accepted: 06/29/2015] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate the characteristics of gallbladder polyps 10 mm or larger to predict a neoplasm in US examinations. MATERIALS AND METHODS Fifty-three patients with gallbladder polyps ≥ 10 mm with follow-up images or pathologic diagnosis were included in the retrospective study. All images and reports were reviewed to determine the imaging characteristics of gallbladder polyps. Univariate and multivariate analyses were used to evaluate predictors for a neoplastic polyp. RESULTS A neoplastic polyp was verified in 12 of 53 patients and the mean size was 13.9 mm. The univariate analysis revealed that adjacent gallbladder wall thickening, larger size (≥15 mm), older age (≥57 years), absence of hyperechoic foci in a polyp, CT visibility, sessile shape, a solitary polyp, and an irregular surface were significant predictors for a neoplastic polyp. In the multivariate analysis, larger size (≥15 mm) was a significant predictor for a neoplastic polyp. CONCLUSION A polyp size ≥15 mm was the strongest predictor for a neoplastic polyp with US. The hyperechoic foci in a polyp and CT visibility would be useful indicators for the differentiation of a neoplastic polyp, in addition to the established predictors. KEY POINTS • A polyp size ≥15 mm is the strongest predictor for a neoplastic polyp with US. • Hyperechoic foci in a polyp and CT visibility are new predictors. • The rate of malignancy is low in polyps even 10 mm or larger (15.1 %).
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Affiliation(s)
- Jin Sil Kim
- Department of Radiology and Medical Research Institute, School of Medicine, Ewha Womans University, 911-1 Mok-dong, Yangcheon-gu, Seoul, 158-710, Korea
| | - Jeong Kyong Lee
- Department of Radiology and Medical Research Institute, School of Medicine, Ewha Womans University, 911-1 Mok-dong, Yangcheon-gu, Seoul, 158-710, Korea.
| | - Yookyung Kim
- Department of Radiology and Medical Research Institute, School of Medicine, Ewha Womans University, 911-1 Mok-dong, Yangcheon-gu, Seoul, 158-710, Korea
| | - Sang Min Lee
- Department of Radiology and Medical Research Institute, School of Medicine, Ewha Womans University, 911-1 Mok-dong, Yangcheon-gu, Seoul, 158-710, Korea
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Liu XS, Gu LH, Du J, Li FH, Wang J, Chen T, Zhang YH. Differential diagnosis of polypoid lesions of the gallbladder using contrast-enhanced sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1061-1069. [PMID: 26014326 DOI: 10.7863/ultra.34.6.1061] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the usefulness of real-time contrast-enhanced sonography and microvascular imaging for differential diagnosis of neoplastic and non-neoplastic polypoid lesions of the gallbladder. METHODS Real-time contrast-enhanced sonography and microvascular imaging were performed in 128 patients with polypoid lesions of the gallbladder larger than 6 mm in diameter. The enhancement patterns, microvascular imaging types, and kinetic parameters were analyzed on contrast-enhanced sonography. The maximum diameters of the lesions measured by conventional and contrast-enhanced sonography were also recorded and subjected to a comparative analysis. RESULTS Among the 128 patients, histologic diagnoses were obtained in 83 (27 neoplastic lesions and 56 non-neoplastic lesions), which constituted the study group. On contrast-enhanced sonography, mild enhancement and absence of contrast were more easily found in non-neoplastic lesions (12 [21.4%]), whereas all neoplastic lesions showed marked enhancement (27 [100%]; P = .006). Of the 27 neoplastic lesions, 6 malignant tumors showed a perfusion defect on contrast-enhanced sonography, whereas none of the non-neoplastic lesions showed a perfusion defect (P = .003). The microvascular architecture of the lesions was categorized into 4 types: spotty, linear, branched, and spinous, and there were significant differences between the groups (P< .001). In a kinetic evaluation, none of the parameters reached statistical significance (all P> .05). There was a discrepancy in maximum diameters between conventional and contrast-enhanced sonography in both groups but the discrepancy was significantly greater in the non-neoplastic group (P = .026). CONCLUSIONS Contrast-enhanced sonography is a useful imaging technique and an adjunct to conventional sonography for differential diagnosis of neoplastic and non-neoplastic polypoid lesions of the gallbladder.
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Affiliation(s)
- Xue-Song Liu
- Departments of Ultrasound (X.-S.L., L.-H.G., J.D., F.-H.L.) and Biliary and Pancreatic Surgery (J.W., T.C., Y.-H.Z.), Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Li-Hong Gu
- Departments of Ultrasound (X.-S.L., L.-H.G., J.D., F.-H.L.) and Biliary and Pancreatic Surgery (J.W., T.C., Y.-H.Z.), Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jing Du
- Departments of Ultrasound (X.-S.L., L.-H.G., J.D., F.-H.L.) and Biliary and Pancreatic Surgery (J.W., T.C., Y.-H.Z.), Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Feng-Hua Li
- Departments of Ultrasound (X.-S.L., L.-H.G., J.D., F.-H.L.) and Biliary and Pancreatic Surgery (J.W., T.C., Y.-H.Z.), Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
| | - Jian Wang
- Departments of Ultrasound (X.-S.L., L.-H.G., J.D., F.-H.L.) and Biliary and Pancreatic Surgery (J.W., T.C., Y.-H.Z.), Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Tao Chen
- Departments of Ultrasound (X.-S.L., L.-H.G., J.D., F.-H.L.) and Biliary and Pancreatic Surgery (J.W., T.C., Y.-H.Z.), Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yun-He Zhang
- Departments of Ultrasound (X.-S.L., L.-H.G., J.D., F.-H.L.) and Biliary and Pancreatic Surgery (J.W., T.C., Y.-H.Z.), Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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