Original Article Introduction C arcinoma of the gall bladder (GB) is the fifth most common malignancy of the gastrointestinal tract and the commonest malignancy of the biliary tree [1,2]. It occurs primarily in the sixth to seventh decade of life and is four to five times more common in women [2,3]. Ultrasonography (USG) and computed tomography (CT) have revolutionized the diagnosis and management of carcinoma GB. Magnetic Resonance Imaging (MRI) is utilized only in inoperable cases with obstructive jaundice for delineation of the biliary tract anatomy in patients considered for palliative stenting [3].USG in patients of carcinoma GB has certain limitations such as interference by bowel gas, limited depth resolution and inadequate visualization of parts of the gallbladder in the region of posterior acoustic shadowing in the presence of calculi. CT scan overcomes these drawbacks and provides definite information regarding invasion of the tumour into the adjacent organs, distant metastasis, delineation of the biliary tree and portal vein involvement. We present our experience of CT findings in 50 histologically proven cases of carcinoma GB. Material and MethodsThis retrospective study reviewed CT examination findings in 50 histopathologically proven (from operative specimen or fine needle aspiration cytology) cases of carcinoma GB over a period of two years. The patients presented with a wide spectrum of complaints ranging from dyspepsia, abdominal pain to clinically palpable lump abdomen and obstructive jaundice. All the patients were subjected to helical CT scan examination on a GE HiSpeed CT/i scanner.The CT protocol of 5mm helical CT sections in the axial plane at table speed of 5 mm/sec (pitch 1.0) with kV 120 and mA 280 was used. Breath-hold periods varied from 10 to 16 seconds with intervening breathing time of 8 seconds. The CT scan technique employed in our patients included a preliminary survey scan of the abdomen from levels of the diaphragm to the iliac crest after orally administered one litre of iodinated contrast (800 ml administered 45 minutes prior to and 200ml given just prior to the scan) for opacification of bowel during customized breath-hold phase. This was followed by repeat evaluation of the abdomen during dynamic intravenous injection of 80 ml of non-ionic iodinated contrast medium (300 mg Iodine/ml) for studying the lesional enhancement and vascular structures. Intravenous contrast medium was administered at the rate of 2 ml/sec using a pressure injector at 150 psi using a scan delay of 30 seconds to commence imaging. Suspected cases of duodenal involvement were subjected to targeted area scanning with patient in right decubitus position. ResultsThere was definite female preponderance with male: female Computed Tomographic Findings in 50 Cases of Gall Bladder CarcinomaLt Col RA George * , Col SC Godara + , Lt Col P Dhagat # , Maj PP Som ** Abstract Background : A retrospective assessment of contrast enhanced computed tomography (CECT) scan findings in histopathologically proven cases of c...

contrast medium having additional properties of selective uptake and biliary excretion by hepatocytes. Our study was designed as a pilot study to evaluate the utility of Gd-BOPTA in detection and characterization of focal liver lesions. Methods: Fifty-three consecutive patients with focal liver lesions (excluding only simple hepatic cysts) detected on ultrasonography and CT abdomen, were prospectively subjected to standardized MRI protocol for the liver, using Gd-BOPTA as the intravenous contrast medium. An additional T1W axial scan of the liver was incorporated in the study protocol, at a delay of 2 h post-contrast, in all patients. Results: In the study population, the combination of USG and contrast enhanced CT abdomen findings were adequate to reach a definitive diagnosis in 70% of the patients. The liver specificity of Gd-BOPTA contributed to improved lesional characterization in 9/50 patients (18%) on the delayed phase images. Conclusion: The study revealed that the liver specific properties of Gd-BOPTA can be used to obtain additional information to improve characterization of focal hepatic lesions, when delayed phase scans are included in the study protocol.ª 2012, Armed Forces Medical Services (AFMS). All rights reserved.

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