Contrast-enhanced ultrasonography improves the diagnostic specificity for gallbladder-confined focal tumors

Purpose: To investigate the value of contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of malignant and benign focal gallbladder diseases confined to the gallbladder wall. Methods: From July 2006 to May 2016, 88 patients (mean age 48.8 years; age range 18-77 years) were enrolled. All patients had focal gallbladder lesions confined to the gallbladder wall according to CEUS examination. The conventional ultrasound and CEUS characteristics of the lesions were evaluated, and diagnostic performance was evaluated via receiver-operating characteristic (ROC) analysis. Results: Multiple logistic regression analysis showed that three characteristics, an irregular shape, branched intralesional vessels and hypo-enhancement in the late phase, were features indicating a malignant gallbladder disease (all P < 0.05). When combining any two of these three features, diagnostic specificity improved from 51.5%-77.3% to 92.4% (P < 0.05 for all), and the area under the ROC (AUROC) curve improved from 0.735-0.874 to 0.917, without a significant loss of sensitivity. Conclusions: CEUS features have greater specificity than those from conventional US for the differentiation of benign and malignant gallbladder diseases confined to the gallbladder wall, without a loss of sensitivity.