Korean J Radiol.  2014 Apr;15(2):226-234. 10.3348/kjr.2014.15.2.226.

Differentiating between Adenomyomatosis and Gallbladder Cancer: Revisiting a Comparative Study of High-Resolution Ultrasound, Multidetector CT, and MR Imaging

• Bang SH
• Lee JY
• Woo H
• Joo I
• Lee ES
• Han JK
• Choi BI

• KMID: 1705577
• DOI: http://doi.org/10.3348/kjr.2014.15.2.226

Abstract

OBJECTIVE
To compare the diagnostic performance of high-resolution ultrasound (HRUS) with contrast-enhanced CT and contrast-enhanced magnetic resonance imaging (MRI) with MR cholangiopancreatography (MRCP) to differentiate between adenomyomatosis (ADM) and gallbladder cancer (GBCA).
MATERIALS AND METHODS
Forty patients with surgically proven ADM (n = 13) or GBCA at stage T2 or lower (n = 27) who previously underwent preoperative HRUS, contrast-enhanced CT, and contrast-enhanced MRI with MRCP were retrospectively included in this study. According to the well-known diagnostic criteria, two reviewers independently analyzed the images from each modality separately with a five-point confidence scale. The interobserver agreement was calculated using weighted kappa statistics. A receiver operating characteristic curve analysis was performed and the sensitivity, specificity, and accuracy were calculated for each modality when scores of 1 or 2 indicated ADM.
RESULTS
The interobserver agreement between the two reviewers was good to excellent. The mean Az values for HRUS, multidetector CT (MDCT), and MRI were 0.959, 0.898, and 0.935, respectively, without any statistically significant differences between any of the modalities (p > 0.05). The mean sensitivity of MRI with MRCP (80.8%) was significantly higher than that of MDCT (50.0%) (p = 0.0215). However, the mean sensitivity of MRI with MRCP (80.8%) was not significantly different from that of HRUS (73.1%) (p > 0.05). The mean specificities and accuracies among the three modalities were not significantly different (p > 0.05).
CONCLUSION
High-resolution ultrasound and MRI with MRCP have comparable sensitivity and accuracy and MDCT has the lowest sensitivity and accuracy for the differentiation of ADM and GBCA.

Keyword

Gallbladder; Adenomyomatosis; Gallbladder cancer; High-resolution ultrasound; CT; MRI

MeSH Terms

Adenomyoma/*diagnosis
Adult
Aged
Aged, 80 and over
Cholangiopancreatography, Magnetic Resonance/methods
Contrast Media/diagnostic use
Diagnosis, Differential
Diagnostic Imaging/*methods
Female
Gallbladder Neoplasms/*diagnosis
Humans
Magnetic Resonance Imaging/methods
Male
Middle Aged
Observer Variation
ROC Curve
Retrospective Studies
Sensitivity and Specificity
Tomography, X-Ray Computed/methods
Ultrasonography/methods
Contrast Media

Figure

• 

  Fig. 1 Fundal adenomyoma of gallbladder in 62-year-old male. A. MR image with thick-slab, T2-weighted fast spin-echo sequence shows typical "pearl necklace sign" at fundus of gallbladder (arrows). B. CT image during portal venous phase demonstrates fundal abnormality with enhancing epithelium and multiple intramural cystic lesions (Rosary sign) (arrows). C. High resolution ultrasound image showing multiple intramural cysts (arrows) within thickened wall at fundus.

• 

  Fig. 2 Gallbladder body cancer (pT2) in 81-year-old female. A. MR image with T2-weighted single-shot fast spin-echo sequence shows segmental thickening (arrows) without evidence of intramural cysts at body of gallbladder. B. CT image during portal venous phase shows segmental wall thickening with strong contrast enhancement at body (arrows). C. High-resolution ultrasound image showing segmental wall thickening (arrowheads) without evidence of intramural cysts or intramural echogenic material deposition at body. Asterisks (*) indicate sludge. D. High-resolution ultrasound image in patient with segmental adenomyomatosis shows multiple cysts and echogenic materials (arrows) within thickened walls. This image clearly shows difference between adenomyomatosis and cancer on ultrasound image.

• 

  Fig. 3 Bar graph displaying mean sensitivities, specificities, and accuracies of high-resolution ultrasound (HRUS), CT, and MRI for diagnosis of adenomyomatosis of gallbladder.

• 

  Fig. 4 Fundal adenomyoma in 72-year-old female. A. CT image during portal venous phase showing focal wall thickening with heterogeneous contrast enhancement (arrow) at fundus of GB. B. High-resolution ultrasound image showing focal thickening at fundus (arrowheads) containing cystic lesion (arrow), indicating presence of dilated intramural Rokitansky-Aschoff sinuses. C. MR image with thick-slab, T2-weighted fast spin-echo sequence demonstrating focal high signal intensity lesion (arrow), indicating presence of dilated intramural Rokitansky-Aschoff sinuses at fundus. GB = gallbladder

• 

  Fig. 5 Adenomyomatosis in GB fundus in 61-year-old female. A. CT image during portal venous phase showing marked wall thickening with strong contrast enhancement (arrow) at fundus of GB. There is no evidence of intramural cysts. B. T1-weighted MR image during portal venous phase also shows diffuse thickening at fundus with strong contrast enhancement (arrow). There is no evidence of intramural cysts on T2-weighted images (not shown). C. High-resolution ultrasound image shows diffuse wall thickening at fundus with multiple intramural deposition of echogenic materials (arrows) which represent intramural cholesterol crystal deposition. This finding favors diagnosis of adenomyomatosis more than GB cancer. GB = gallbladder

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