Mohd Khalid MBBS, MD, Presenter: Nothing to Disclose

To compare the diagnostic performance of conventional and contrast-enhanced ultrasonography in characterizing gallbladder lesions.

40 patients with gallbladder disease were examined using conventional ultrasonography (USG) followed by contrast-specific harmonic imaging mode (CEUS) after injection of Perflutren-lipid microsphere suspension. Lesions were characterized based on their echogenicity, enhancement pattern in the early and late vascular phases (heterogeneous or homogeneous enhancement and hyper, iso, hypo or non-enhancing in relation to adjacent normal liver), intralesional vascularity (branched, linear, dotted or none) and intactness of underlying gallbladder wall. Final diagnosis was established by histopathology and the results were analyzed statistically.

There was an obvious female preponderance (67.5%) among the patients examined. Gallbladder malignancy (adenocarcinoma) was diagnosed in 12 patients (30%), all of whom were above the age of 40 years. USG detected 18 patients with chronic cholecystitis, 2 with inflammatory polyps and 10 cases of malignancy with sensitivity, specificity, accuracy, negative predictive value (NPV) and positive predictive value (PPV) of 83.33%, 82.14%, 82.5%, 92% and 66.67%, respectively with regards to diagnosis of malignancy. Based on CEUS findings, a diagnosis of chronic cholecystitis was made in 24 patients, inflammatory polyp in 4, adenomyomatosis in 1 and malignant lesion in 11 with sensitivity, specificity, accuracy, NPV and PPV of 91.67%, 100%, 97.5%, 96.55% and 100%. Heterogeneous enhancement was observed in a majority of the malignant lesions (91.67%) in comparison to 39.28% among benign lesions. Malignant lesions had a predominant branched intralesional vascular pattern (58.23%) as opposed to a predominant dotted pattern in benign lesions (87.5%). Gallbladder wall disruption was seen in all the patients with malignant lesions (100%), while only one patient (3.57%) with benign disease (chronic cholecystitis) demonstrated the same.

Contrast-enhanced ultrasound may be a useful tool in the evaluation of gallbladder disease, particularly of malignant lesions.

This study emphasizes the superiority of CEUS in the evaluation of gallbladder lesions in a population which shows a high incidence of malignancy using Perflutren-lipid microsphere suspension.      

Khalid, M, A Comparative Study of Conventional Ultrasonography (USG) and Contrast-enhanced Ultrasonography (CEUS) in the Diagnosis of Gallbladder Diseases- A Study from Northern India.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14012474.html