Contrast enhanced sonography of the gallbladder: A tool in the diagnosis of cholecystitis?

Adamietz, Boris; Wenkel, Evelyn; Uder, Michael; Meyer, Thomas; Schneider, Ines; Dimmler, Arno; Bautz, W.; Janka, Rolf

doi:10.1016/j.ejrad.2006.09.006

Cited by 29 publications

(19 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The two non-operated cases were then discharged without further complications after 16 and 8 days of hospitalization, respectively. These findings are in keeping with the data from literature showing early arterial contrast enhancement with a late phase wash out, while adjacent liver parenchyma is still enhanced as far as portalearly venous phases are ongoing in patients with acute uncomplicated cholecystitis [26,30].…”

Section: Discussionsupporting

confidence: 93%

“…Although the CEUS study has been used to evaluate acute and chronic gallbladder disease, data about its usefulness in the detection of inflammatory complications of acute cholecystitis are sparse [10,[24][25][26][27][28][29][30]. Few reports focus on the diagnostic aid of a CEUS study in the detection of complicated acute cholecystitis such as gangrenous changes or perforation.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Contrast-enhanced ultrasonography to diagnose complicated acute cholecystitis

et al. 2015

View full text Add to dashboard Cite

Gangrenous cholecystitis and perforation are severe complications of acute cholecystitis, which have a challenging preoperative diagnosis. Early identification allows better surgical management. Contrast-enhanced computed tomography (ceCT) is the current diagnostic gold standard. Contrast-enhanced ultrasonography (CEUS) is a promising tool for the diagnosis of gallbladder perforation, but data from the literature concerning efficacy are sparse. The aim of the study was to evaluate CEUS findings in pathologically proven complicated cholecystitis (gangrenous, perforated gallbladder, pericholecystic abscess). A total of 8 patients submitted to preoperative CEUS, and with subsequent proven acute complicated cholecystitis at surgical inspection and pathological analysis, were retrospectively identified. The final diagnosis was gangrenous/phlegmonous cholecystitis (n. 2), phlegmonous/ulcerative changes plus pericholecystic abscess (n. 2), perforated plus pericholecystic abscess (n. 3), or perforated plus pericholecystic biliary collection (n. 1). Conventional US findings revealed irregularly thickened gallbladder walls in all 8 patients, with vaguely defined walls in 7 patients, four of whom also had striated wall thickening. CEUS revealed irregular enhancing gallbladder walls in all patients. A distinct wall defect was seen in six patients, confirmed as gangrenous/phlegmonous cholecystitis at pathology in all six, and in four as perforation at macroscopic surgical inspection. CEUS is a non-invasive easily repeatable technique that can be performed at the bedside, and is able to accurately diagnose complicated/perforated cholecystitis. Despite the limited sample size in the present case series, CEUS appears as a promising tool for the management of patients with the clinical possibility of having an acute complicated cholecystitis.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced ultrasonography to diagnose complicated acute cholecystitis

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Hematoxylin-eosin stain (×100) in diagnosis of gallbladder diseases remains unclear [1][2][3]. Conventional US can make definite diagnosis in most gallbladder diseases, whereas it is insufficient to determine the nature of some complicated gallbladder diseases [2][3][14][15][16][17][18]. Most of the gallbladder cancers present as either a solid mass that occupies the whole gallbladder or a focal polypoid lesion on conventional US.…”

Section: Discussionmentioning

confidence: 99%

“…After the conventional US and CEUS examinations, the author who performed the examinations made the original diagnoses according to the literature [14][15][16][17][18]: (1) gallbladder carcinoma-a solid mass that occupies the whole gallbladder, a sessile polypoid mass or diffuse wall thickening, intralesional hypervascularity, infiltration to adjacent liver on conventional US, and branch-like flow pattern or hyper-enhancement during the early phase on CEUS; (2) cholesterol polyp-a pedicle polypoid lesion, a tiny echogenic spot or an aggregation of echogenic spots within the lesion, no or scarce vascularity on conventional US, and hyper-enhancement during the early phase on CEUS; (3) adenomyomatosis-focal or diffuse thickened wall, multiple microcysts or comet tail artifact on conventional US, and intactness of wall on CEUS; (4) adenoma-a sessile polypoid mass, iso-or hypo-echoic, no infiltration to adjacent tissue, slightly hypervascularity on conventional US, and hyper-enhancement during the early phase on CEUS; (5) biliary sludge-echogenic on conventional US, and non-enhancement on CEUS; (6) chronic cholecystitis-thickened wall and no infiltration to adjacent tissue on conventional US and CEUS.…”

Section: Original Diagnosismentioning

confidence: 99%

“…Real-time contrast-enhanced ultrasound (CEUS) overcomes the limitations of conventional US and allows improved ability in assessment of intralesional vascularity, which leads to enhanced performance in diagnosing focal liver lesions [9][10][11][12][13]. It is hypothesized that CEUS would also improve the diagnosis for gallbladder lesions, particularly in differential diagnosis between malignant and benign gallbladder diseases [14][15][16][17][18]. In this study, we observed the enhancement patterns of gallbladder diseases on CEUS and investigated its ability in the differential diagnosis between malignant and benign gallbladder diseases with real-time CEUS.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Differential diagnosis between benign and malignant gallbladder diseases with real-time contrast-enhanced ultrasound

et al. 2009

View full text Add to dashboard Cite

The value of contrast-enhanced ultrasound (CEUS) in differential diagnosis between benign and malignant gallbladder diseases was investigated. Thirty-three patients with gallbladder carcinomas and 47 with benign gallbladder diseases underwent CEUS. The lesion enhancement time, enhancement extent, pattern, dynamic change of enhancement and the intactness of gallbladder wall were evaluated. In the early phase at CEUS, hyper-, iso-, hypo-, and non-enhancement were found in 84.8% (28/33), 9.1% (3/33), 6.1% (2/33), and 0% (0/33) of gallbladder carcinomas, and 70.3% (33/47), 17.0% (8/47), 2.1% (1/47), and 10.6% (5/47) of benign diseases (p > 0.05). Hyper-enhancement or iso-enhancement in the early phase and then fading out to hypo-enhancement within 35 s after contrast agent administration was found in 90.9% (30/33) of carcinomas and 17.0% (8/47) of benign lesions (p < 0.001). Destruction of the gallbladder wall intactness was absent in benign diseases, whereas it was present in 28 (84.8%) of the 33 carcinomas (p < 0.001). Destruction of gallbladder wall intactness on CEUS yielded the highest capability in differential diagnosis, with sensitivity, specificity, and Youden's index of 84.8% (28/33), 100% (47/47), and 0.85, respectively. Conventional US made correct original diagnoses in 55 (68.8%) patients, whereas CEUS in 77 (96.3%). Thus, CEUS is useful in differential diagnosis between malignant and benign gallbladder diseases.

show abstract