Manoj Mathur1, Jasvir Singh2, Devinder Pal Singh3, Navneet Kaur4, Saryu Gupta5, Samrin Haq2. 1. Associate Professor, Department of Radiology, Government Medical College, Patiala, Punjab, India. 2. Junior Resident, Department of Radiology, Government Medical College, Patiala, Punjab, India. 3. Professor and Head, Department of Surgery, Government Medical College, Patiala, Punjab, India. 4. Associate Professor, Department of Pathology, Government Medical College, Patiala, Punjab, India. 5. Assistant Professor, Department of Radiology, Government Medical College, Patiala, Punjab, India.
Abstract
INTRODUCTION: Gall bladder Wall Thickening (GWT) is caused by wide spectrum of diseases. Initially Ultrasound (USG) was used as imaging modality for screening of acute abdomen because of its high sensitivity and real time character. Now, Computed Tomography (CT) is used because of its high temporal and spatial resolution. AIM: Evaluation of GWT and its enhancement patterns on contrast enhanced CT scan in a bid to differentiate benign from malignant causes and to correlate the imaging features with clinical and histopathological findings. MATERIALS AND METHODS: It was a hospital based prospective study in which USG was done as an initial modality for screening and Multi Detector Computed Tomography (MDCT) scan was done later on for detailed evaluation of enhancement patterns of GWT. The study cases were then divided into five CT patterns according to enhancement patterns. The diagnostic performance of MDCT was compared with histopathological and serological findings. Relevant history, clinical examination and routine investigations were done. RESULTS: The one layered pattern with a heterogeneously enhancing thick layered pattern (Type 1) was significantly associated with gall bladder cancer (p<0.001). The sensitivity and specificity of Type 1 enhancement pattern on CT for predicting the Gall Bladder (GB) malignancy were 90.476% and 97.43% respectively. The positive and negative predictive values were 95% and 95%, respectively. Focal wall thickening, irregular margin character and hepatic infiltration by GWT and lymphadenopathy were other findings that predict malignancy (p-value<0.05). CONCLUSION: MDCT enhancement patterns of a thickened GB wall and associated findings were helpful in differentiating malignant GWT from benign GWT.
INTRODUCTION: Gall bladder Wall Thickening (GWT) is caused by wide spectrum of diseases. Initially Ultrasound (USG) was used as imaging modality for screening of acute abdomen because of its high sensitivity and real time character. Now, Computed Tomography (CT) is used because of its high temporal and spatial resolution. AIM: Evaluation of GWT and its enhancement patterns on contrast enhanced CT scan in a bid to differentiate benign from malignant causes and to correlate the imaging features with clinical and histopathological findings. MATERIALS AND METHODS: It was a hospital based prospective study in which USG was done as an initial modality for screening and Multi Detector Computed Tomography (MDCT) scan was done later on for detailed evaluation of enhancement patterns of GWT. The study cases were then divided into five CT patterns according to enhancement patterns. The diagnostic performance of MDCT was compared with histopathological and serological findings. Relevant history, clinical examination and routine investigations were done. RESULTS: The one layered pattern with a heterogeneously enhancing thick layered pattern (Type 1) was significantly associated with gall bladder cancer (p<0.001). The sensitivity and specificity of Type 1 enhancement pattern on CT for predicting the Gall Bladder (GB) malignancy were 90.476% and 97.43% respectively. The positive and negative predictive values were 95% and 95%, respectively. Focal wall thickening, irregular margin character and hepatic infiltration by GWT and lymphadenopathy were other findings that predict malignancy (p-value<0.05). CONCLUSION: MDCT enhancement patterns of a thickened GB wall and associated findings were helpful in differentiating malignant GWT from benign GWT.
Authors: Brian H Ching; Benjamin M Yeh; Antonio C Westphalen; Bonnie N Joe; Aliya Qayyum; Fergus V Coakley Journal: AJR Am J Roentgenol Date: 2007-07 Impact factor: 3.959