Computed Tomographic Findings in 50 Cases of Gall Bladder Carcinoma

Abstract

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...

Spectrum of CT findings in gall bladder carcinoma patients in north Indian population

“…cholelithiasis in 28 patients (57.1%), ascites and pleural effusion in 15 cases (30.6%) and peritoneal involvement was seen in 10 cases (20.4%). These findings in our study were comparable to the data reported by George et al (2007) in which infiltration into liver was seen in 36 (72%) cases, while infiltration into the adjacent structures such as duodenum, pancreas and omentum was seen in 23 (46%) cases at the time of diagnosis [14].…”

“…In the study conducted by George et al (2007) focal or diffuse wall thickening was appreciated in 12 (24%) cases and in our study the focal/diffuse wall thickening was observed in 16.3% cases [14].…”

“…Gore et al (2002) study reported intraluminal polyploidal mass in the GB in approximately 25% cases whereas George et al (2007) study reported intraluminal polyploidal mass in 10(20%) of cases [11,14]. These polypoidal intraluminal masses showed homogenous enhancement on the contrast-enhanced images.…”

Role of Triple Phase MDCT in the Characterisation of Liver Lesions

“…16 Gallbladder wall calcification and gall stones were observed in 8 cases (56%). The percentage of incidence of gall stones in our study was similar to the findings of Lt Col George et al who noted 50% incidence of gall stones in carcinoma gallbladder.…”

“…Both GB wall calcification and gall stone are implicated as an aetiological factor in the pathogenesis of gallbladder carcinoma. 16 Kumar et al had described that liver is the most frequently involved organ by direct contiguous spread (65% of cases) followed by the colon (15%), duodenum (15%) and pancreas (6%). 17 In our study, most of the lesions were hypodense on plain study (100 %) and showed enhancement in arterial phase and portal venous phase which was predominantly peripheral in all the cases and no delayed phase enhancement was noted.…”