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Journal of Ultrasound (2018) 21:119–126
https://doi.org/10.1007/s40477-018-0286-5
ORIGINAL ARTICLE
CEUS in the dierential diagnosis between biliary sludge, benign
lesions and malignant lesions
Carla Serra
1
· Cristina Felicani
1
· Elena Mazzotta
1
· Veronica Gabusi
1
· Valentina Grasso
1
· Antonio De Cinque
1
·
Lydia Giannitrapani
2
· Maurizio Soresi
2
Received: 24 October 2017 / Accepted: 30 December 2017 / Published online: 23 February 2018
© Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2018
Abstract
Purpose Conventional grayscale ultrasound (US) is accurate in the diagnosis of gallbladder disease (GD), but in some cases,
it is not decisive. Contrast-enhanced ultrasound (CEUS) improves the diagnostic accuracy of US. The primary objective of
this study is to assess the reliability of CEUS in the diagnosis of sludge; the secondary objective is to assess the ability of
CEUS to diagnose cancer.
Methods We retrospectively reviewed the US of 4137 patients positive for GD. In 43/4137 (1.04%), the use of could not
discriminate between sludge and neoplasms. Then, we evaluated CEUS in only 39 of these patients, and in 4/43 (9%) cases it
was not performable. After CEUS, the absence of enhancement was considered diagnostic for sludge, while contrast washout
within 60 s diagnosed malignant lesions.
Results Among the 39 patients, 16 had biliary sludge and 23 had lesions of the gallbladder wall; 9 of these were carcinomas
and 14 were benign tumors. The absence of enhancement was present in 16/16 patients with sludge and in 0/23 patients with
lesions of the gallbladder (sensitivity and specificity 100%). Washout was within 60 s in 9/9 gallbladder carcinomas and 2/14
benign lesions (sensitivity 100%; specificity 85%).
Conclusions US is confirmed to be accurate in the diagnosis of GD. In doubtful cases, CEUS is very accurate in biliary
sludge diagnosis. An intralesional washout at 60 s is a pattern of malignancy that can orient towards a correct diagnosis, but
it is limited by the presence of false positive results, especially for smaller lesions.
Keywords Gallbladder · Ultrasound · CEUS · Sludge · Benign disease · Malignant disease
Sommario
Scopo L’ecografia convenzionale in scala dei grigi (US) è accurata nella diagnosi delle malattie colecistiche (GD) ma in
alcuni casi non è decisiva. L’ecografia con mezzo di contrasto (CEUS), migliora l’affidabilità diagnostica dell’US. Obiettivo
primario di questo studio è quello di determinare l’affidabilità della CEUS nella diagnosi di fango biliare; obiettivo secondario
definire l’affidabilità della CEUS nella diagnosi di carcinoma della colecisti.
Metodi Abbiamo analizzato retrospettivamente 4137 ecografie di pazienti positive per GD. In 43/4137 (1.04%) l’ecografia
non era capace di discriminare tra fango e neoplasie. La CEUS era valutata in soli 39 pazienti, in 4/43 (9%) dei casi non era
eseguibile. L’assenza di enhancement alla CEUS era considerato diagnostico per sludge, mentre un washout del contrasto
entro 60 secondi era diagnostico per malattie maligne. L’assenza di enhancement era presente in 16/16 pazienti con fango
* Maurizio Soresi
maurizio.soresi@unipa.it
1
Interventional, Diagnostic and Therapeutic Ultrasound Unit,
Department of Organ Insufficiency and Transplantation, S.
Orsola-Malpighi Hospital, Bologna, Italy
2
Division of Internal Medicine, Biomedical Department
of Internal Medicine and Specialties (Di.Bi.M.I.S.),
University of Palermo, Palermo, Italy
@Phil_Robichaud
@deepthiw
@JoseServera