CEUS in the differential diagnosis between biliary sludge, benign lesions and malignant lesions (original) (raw)
Related papers
The role of endoscopic ultrasound in the diagnosis of gallbladder diseases
Journal of medical ultrasonics (2001), 2017
Endoscopic ultrasound (EUS) has recently played an increasing role in the diagnosis of gallbladder diseases. This review aims to summarize the role of EUS in the diagnosis of gallbladder lesions. EUS provides high-resolution images that can improve the diagnosis of gallbladder polypoid lesions and microlithiasis, in addition to evaluating gallbladder thickness and staging of gallbladder carcinoma. Contrast-enhancing agents may be useful for the differential diagnosis of gallbladder lesions, but the evidence of their effectiveness is still limited and further studies are required in this area to establish its usefulness. Endoscopic ultrasound combined with fine needle aspiration has played an increasing role in providing histological diagnosis of gallbladder tumors in addition to gallbladder thickening.
Journal of Ultrasound
Extrahepatic biliary tract and gallbladder neoplastic lesions are relatively rare and hence are often underrepresented in the general clinical recommendations for the routine use of ultrasound (US). Dictated by the necessity of updated summarized review of current literature to guide clinicians, this paper represents an updated position of the Italian Society of Ultrasound in Medicine and Biology (SIUMB) on the use of US and contrast-enhanced ultrasound (CEUS) in extrahepatic biliary tract and gallbladder neoplastic lesions such as extrahepatic cholangiocarcinoma, gallbladder adenocarcinoma, gallbladder adenomyomatosis, dense bile with polypoid-like appearance and gallbladder polyps.
Case reports in gastrointestinal medicine, 2013
The gallbladder is an uncommon site of metastatic cancer. Although ultrasound can be regarded as a first line investigation for the detection of gallbladder lesions, differentiation between benign and malignant tumors usually requires resection. Real-time contrast enhanced ultrasound (CEUS) is a well-established technique for the classification of liver, pancreatic, and renal diseases (Weskott, 2008). The application of CEUS in the diagnosis of gallbladder tumors has rarely been described. We report the application of contrast enhanced ultrasound for the characterization of a gallbladder lesion in a 63-year-old patient with a history of renal cell and rectal cancer.
Evaluation of gallbladder and biliary duct disease using microbubble contrast-enhanced ultrasound
British Journal of Radiology, 2010
Ultrasound examination of the gallbladder is accepted as the primary imaging modality in the assessment of gallbladder disease, with inherent superiority in comparison to other imaging modalities. Contrast-enhanced ultrasound is established as a reliable tool in the detection and characterisation of focal liver lesions. It is less well recognised in gallbladder and biliary disease but can be a valuable complement to baseline ultrasound examination. Contrast-enhanced ultrasound provides the advantages of real-time, repeatable, multiplanar imaging without compromising patient safety or exposing patients to radiation. It can provide specific information as pathology often becomes more conspicuous following the administration of contrast, allowing detailed assessment of benign and malignant conditions arising in the gallbladder and biliary tree. This review illustrates the application of contrast-enhanced ultrasound in the evaluation of a variety of gallbladder and biliary duct diseases. The examination allows clearer delineation of the disease process and more confident diagnosis.
Gallbladder Lesions Identified on Ultrasound. Lessons from the Last 10 Years
Journal of Gastrointestinal Surgery, 2012
Background Possible mass lesions identified on ultrasound (US) of the gallbladder may prompt an aggressive surgical intervention due to the possibility of a malignant neoplasm. Aim This study aims to utilize a large modern series of patients with gallbladder lesions identified on US to evaluate imaging characteristics consistent with malignancy. Methods A retrospective review was conducted of gallbladder ultrasound reports and clinicopathologic data of patients with a mass identified on US. Results Approximately 59,271 abdominal ultrasounds and 9,117 cholecystectomies were performed between February 2000 and February 2010. We identified 213 patients with a questionable gallbladder neoplasm on ultrasonography who underwent surgical exploration. Median age was 52 years (range=11-87 years) and 147 (69%) were females. Final pathology demonstrated no neoplasm in 130 patients (61%), while 32 patients (15%) had a wall adenomyoma, 36 (17%) had a polyp (five of which were malignant), 14 (7%) had an adenocarcinoma not arising from a polyp, and one patient had a cystic papillary neoplasm. The smaller the lesion, the more likely it was to be a pseudo-mass. For lesions measuring <5 mm on US, 83% had no lesion found on final pathology. Significant predictors of malignancy were age >52 years (p<0.001), presence of gallstones on US (p=0.004), size >9 mm (p<0.001), evidence of invasion at the liver interface (p<0.001), and wall thickening >5 mm (p<0.001). Shape (sessile or penduculated), echogenicity (echogenic or isoechoic), or presence of flow on Doppler were not predictors of malignancy. An US size of ≤9 mm had a negative predictive value of 100% for malignancy. Conclusions Despite improvements in imaging, most apparent lesions measuring <5 mm on US are not identified in the surgical specimen. US size >9 mm, age >52 years, US suggestion of invasion at the liver interface, and wall thickening >5 mm, especially in the presence of gallstones, should raise the suspicion of malignancy.
Gallbladder Disorders Detected by Ultrasound
Open Journal of Medical Imaging, 2014
Patients who have disease of the biliary tract commonly present with acute right upper quadrant pain, nausea or vomiting, mid-epigastric pain, and/or jaundice. Etiologies include inflammation with or without infection, noninflammatory disorders, and benign or malignant neoplasms of the gallbladder or bile ducts. Ultrasound (US) is now accepted as the initial imaging modality of choice for the work-up of suspected biliary tract disease. A retrospective study was carried out at King Abdulaziz University Hospital to discuss the protocol of ultrasound scanning in demonstrating incidence and complication of Gall-bladder (GB) pathologies. Known cases of GB pathologies (100 patients) were surveyed by ultrasound using spatial digital iU22 Philips Convex probe 3.5 MHz. All patients were evaluated with ultrasonogphy following the international scanning guidelines and protocols. The age of the patients is between (9 -90) years, 68 Patients (68%) were females and 32 patients (32%) were males. Range of age group of accumulation for gallstone presence was (35 -50) years in females and above 50 years in males. Incidence of gallbladder pathologies are 59% (female 46% and 13% male). Incidence of gallstone is 37%, and ratio of incidence is between male to female 1:3. Other pathologies of gallbladder were found to be acute cholecystities 12%, chronic cholocystities 5%, sludge 2%, carcinoma of the Gall-bladder 1%, Gall-bladder polyps 1% and Emphysematous choleycystities 1%. Ultransonography is a single imaging modality sufficient for evaluation of patient with suspected gallbladder pathologies (gallstone) which can provide information about the presence of gallstone and more over about site and cause of biliary tract obstruction. Ultrasound is highly sensitive and specific means for diagnosis of the gallbladder disorders.
Contrast enhanced sonography of the gallbladder: A tool in the diagnosis of cholecystitis?
European Journal of Radiology, 2007
To evaluate if contrast enhanced sonography (CES) can help to detect gallbladder inflammation and differentiate between acute and chronic cholecystitis. Materials and methods: Thirty-three patients with clinical suspicion of acute cholecystitis were examined with CES before cholecystectomy. Thirty patients with no history of gallbladder disease served as control. CES was performed using 2.5 mL SonoVue. A small mechanical index was chosen (0.1). The enhancement pattern of the gallbladder was ranked in a three-point scale: no enhancement, low enhancement and strong enhancement. 28/33 patients underwent surgery. Sonographic findings were compared to histological results. Results: In 16/20 cases with histological proven acute cholecystitis, the gallbladder wall showed a strong enhancement. Low enhancement was found in four patients with acute and in six patients with chronic cholecystitis. The gallbladder wall of two patients with chronic inflammation and all patients (30/30) of the control group showed no enhancement. Conclusion: CES is a feasible tool for detecting gallbladder inflammation. Differentiating between acute and chronic cholecystitis seems to be possible.
Medical Ultrasonography, 2014
Ultrasonography (US) is the essential imaging method in gallbladder examination being the most widespread and inexpensive technique. The method is indicated both in congenital and acquired disorders, inflammatory, tumoral, or degenerative pathology. Besides the basic technique (grey scale US), new sophisticated techniques exist: DopplerUS, i.v. contrast enhanced harmonic examination, tridimensional US, elastography. Each technique provides specific information, while their combination helps, in most cases, to establish the accurate non-invasive diagnosis. However, the US findings should be correlated with the patient's clinical exam and other imaging methods. This paper is a synthesis of literature combined with our own experience, aiming to present the US features of gallbladder pathology and the correlations within the clinical picture and other imaging methods. Relevant images for this integrative approach are presented. The final conclusion is the necessity for a correlation of all clinical and imaging data in order to obtain an accurate diagnosis.
Ultrasonography in the diagnosis of gallbladder disease
Canadian family physician Médecin de famille canadien, 1983
Ultrasonography is the technique of choice in diagnosing gallbladder calculi. In the mid-1970s ultrasound was only accurate enough to use as an adjunct to oral cholecystography but refinements such as gray scale and real-time imaging mean that in experienced hands it has a sensitivity of 96% and a specificity of 93%. Sonography is also the test of choice in the initial evaluation of jaundiced patients. It is an excellent technique for distinguishing between obstructive and nonobstructive jaundice, although it is less accurate in demonstrating the cause of the obstruction. Ultrasound is painless and relatively inexpensive, and has several advantages over oral cholecystography; it doesn't depend on contrast material, causes no adverse reactions or side-effects, is safe during pregnancy, does not expose the patient to radiation, and is less time-consuming.