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Analysis of enhancement pattern of flat gallbladder wall thickening on MDCT to differentiate gallbladder cancer from cholecystitis

 Soo Jin Kim  ;  Jeong Min Lee  ;  Jae Young Lee  ;  Se Hyung Kim  ;  Joon Koo Han  ;  Byung Ihn Choi  ;  Jin Young Choi 
 AMERICAN JOURNAL OF ROENTGENOLOGY, Vol.191(1) : 765-771, 2008 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Cholecystitis/diagnostic imaging* ; Cholecystography/methods* ; Diagnosis, Differential ; Female ; Gallbladder Neoplasms/diagnostic imaging* ; Humans ; Male ; Middle Aged ; Radiographic Image Enhancement/methods* ; Reproducibility of Results ; Sensitivity and Specificity ; Tomography, X-Ray Computed/methods*
biliary tree ; cholecystitis ; flat gallbladder wall thickening ; gallbladder cancer ; gallbladder wall thickening ; MDCT
OBJECTIVE: The objective of our study was to determine the diagnostic value of analyzing the pattern of gallbladder wall enhancement on MDCT to characterize diffuse gallbladder wall thickening as benign or malignant.

MATERIALS AND METHODS: MDCT scans obtained during the portal venous phase in 78 patients with gallbladder wall thickening caused by various pathologic conditions were retrospectively reviewed by two blinded observers. The CT features of benign and malignant gallbladder wall thickening were compared by means of univariate and multivariate analyses. The study cases were then divided into five patterns according to enhancement pattern. Using these five patterns, two radiologists reviewed the MDCT images and recorded their diagnostic confidence for differentiating benign versus malignant cause on a 5-point scale. The diagnostic performance of CT was evaluated by each observer using a receiver operating characteristic curve analysis.

RESULTS: The thicknesses of the inner and outer layers ("thick" enhancing inner layer > or = 2.6 mm, "thin" outer layer < or = 3.4 mm), strong enhancement of the inner wall, and irregular contour of the affected wall were significant predictors for a malignant cause of gallbladder wall thickening (p < 0.001). The two-layer pattern with a strongly enhancing thick inner layer and weakly enhancing or nonenhancing outer layer and the one-layer pattern with a heterogeneously enhancing thick layer were patterns that were significantly associated with gallbladder cancer (p < 0.05). When we consider those two enhancing patterns as a sign of malignancy, the diagnostic accuracy of MDCT was 89.1% and 87.6% for the two observers, respectively.

CONCLUSION: Analyzing the enhancement pattern of a thickened gallbladder wall on MDCT is helpful in differentiating gallbladder cancer from benign inflammatory diseases.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Choi, Jin Young(최진영) ORCID logo https://orcid.org/0000-0002-9025-6274
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