Contrast enhanced ultrasound versus multiphasic contrast enhanced computed tomography in evaluation of gallbladder lesions

Abstract

Aim: To compare the diagnostic performance of contrast enhanced ultrasound (CEUS) and multiphasic contrast enhanced computed tomography (CECT) in differentiating benign and malignant gallbladder (GB) lesions.

Methods: This prospective ethical review board approved study comprised consecutive patients with GB lesions who underwent CEUS and multiphasic CECT at a tertiary care referral center. The enhancement patterns at CEUS and CT were compared. The quantitative CEUS parameters including arrival time (AT), AT in liver, time to peak enhancement, and washout time (WT) were assessed. The diagnostic performance of CEUS and CT features was calculated using receiver operating characteristic analysis. A subgroup analysis was performed for patients with GB wall thickening. Multivariate analysis was performed to identify features significantly associated with malignancy.

Results: Over the study period, 30 patients (mean age, 52.8 ± 12.2 years, 17 females) with GB lesions were evaluated. Benign and malignant diseases were present in 13 and 17 patients, respectively. There was excellent agreement between CEUS and CT findings. Among the quantitative CEUS features, only WT was significantly associated with malignancy in the overall group (p < 0.001) and wall thickening subgroup (p = 0.007). WT within 53.5 s and 51.5 s had sensitivity of 88.2% and 81.8% and specificity of 84.5% and 100% in diagnosing malignant lesions in the overall group (AUC 0.900) and the wall thickening subgroup (area under curve, AUC 0.927), respectively. At multivariate analysis, features that were significantly associated with malignant lesions in the overall group were disruption of GB wall (CEUS), intralesional non-enhancing areas (CEUS), liver involvement (CEUS or CT), and arterial phase hyperenhancement (CT) in the overall group and disruption of GB wall (CEUS), WT (CEUS), and liver involvement (CEUS or CT) in the wall thickening subgroup.

Conclusion: CEUS is a useful adjunct to CT in evaluation of GB lesions. Its utilization in patients with GB wall thickening may improve detection of malignancy.

Keywords: Cancer; Computed tomography; Contrast enhanced ultrasound; Gallbladder.