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Jenssen C, Lorentzen T, Dietrich CF, Lee JY, Chaubal N, Choi BI, Rosenberg J, Gutt C, Nolsøe CP. Incidental Findings of Gallbladder and Bile Ducts-Management Strategies: General Aspects, Gallbladder Polyps and Gallbladder Wall Thickening-A World Federation of Ultrasound in Medicine and Biology (WFUMB) Position Paper. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2355-2378. [PMID: 36058799 DOI: 10.1016/j.ultrasmedbio.2022.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 06/02/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
The World Federation of Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings with a series of position papers to give advice on characterization and management. The biliary system (gallbladder and biliary tree) is the third most frequent site for incidental findings. This first part of the position paper on incidental findings of the biliary system is related to general aspects, gallbladder polyps and other incidental findings of the gallbladder wall. Available evidence on prevalence, diagnostic work-up, malignancy risk, follow-up and treatment is summarized with a special focus on ultrasound techniques. Multiparametric ultrasound features of gallbladder polyps and other incidentally detected gallbladder wall pathologies are described, and their inclusion in assessment of malignancy risk and decision- making on further management is suggested.
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Affiliation(s)
- Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland GmbH, Strausberg/Wriezen, Germany; Brandenburg Institute for Clinical Ultrasound (BICUS) at Medical University Brandenburg "Theodor Fontane", Neuruppin, Germany
| | - Torben Lorentzen
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland.
| | - Jae Young Lee
- Department of Radiology, Medical Research Center, Seoul National University, College of Medicine, Seoul, Korea
| | - Nitin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research Centre, Mumbai, India
| | - Buyng Ihn Choi
- Department of Radiology, Medical Research Center, Seoul National University, College of Medicine, Seoul, Korea
| | - Jacob Rosenberg
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Carsten Gutt
- Department of Surgery, Klinikum Memmingen, Memmingen, Germany
| | - Christian P Nolsøe
- Center for Surgical Ultrasound, Department of Surgery, Zealand University Hospital, Køge, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen, Copenhagen, Denmark
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Yu MH, Kim YJ, Park HS, Jung SI. Benign gallbladder diseases: Imaging techniques and tips for differentiating with malignant gallbladder diseases. World J Gastroenterol 2020; 26:2967-2986. [PMID: 32587442 PMCID: PMC7304100 DOI: 10.3748/wjg.v26.i22.2967] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/27/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023] Open
Abstract
Benign gallbladder diseases usually present with intraluminal lesions and localized or diffuse wall thickening. Intraluminal lesions of the gallbladder include gallstones, cholesterol polyps, adenomas, or sludge and polypoid type of gallbladder cancer must subsequently be excluded. Polyp size, stalk width, and enhancement intensity on contrast-enhanced ultrasound and degree of diffusion restriction may help differentiate cholesterol polyps and adenomas from gallbladder cancer. Localized gallbladder wall thickening is largely due to segmental or focal gallbladder adenomyomatosis, although infiltrative cancer may present similarly. Identification of Rokitansky-Aschoff sinuses is pivotal in diagnosing adenomyomatosis. The layered pattern, degree of enhancement, and integrity of the wall are imaging clues that help discriminate innocuous thickening from gallbladder cancer. High-resolution ultrasound is especially useful for analyzing the layering of gallbladder wall. A diffusely thickened wall is frequently seen in inflammatory processes of the gallbladder. Nevertheless, it is important to check for coexistent cancer in instances of acute cholecystitis. Ultrasound used alone is limited in evaluating complicated cholecystitis and often requires complementary computed tomography. In chronic cholecystitis, preservation of a two-layered wall and weak wall enhancement are diagnostic clues for excluding malignancy. Magnetic resonance imaging in conjunction with diffusion-weighted imaging helps to differentiate xathogranulomatous cholecystitis from gallbladder cancer by identifying the presence of fat and degree of diffusion restriction. Such distinctions require a familiarity with typical imaging features of various gallbladder diseases and an understanding of the roles that assorted imaging modalities play in gallbladder evaluations.
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Affiliation(s)
- Mi Hye Yu
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, South Korea
| | - Young Jun Kim
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, South Korea
| | - Hee Sun Park
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, South Korea
| | - Sung Il Jung
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, South Korea
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Tian J, Xu L. Color Doppler Twinkling Artifact in Diagnosis of Tuberculous Pleuritis: A Comparison with Gray-Scale Ultrasonography and Computed Tomography. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1291-1295. [PMID: 29549975 DOI: 10.1016/j.ultrasmedbio.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 06/08/2023]
Abstract
The aim of this study was to determine whether twinkling artifact (TA) detected on color Doppler ultrasonography can effectively determine the presence of pleural calcification compared with computed tomography (CT) and differentiate tuberculous pleuritis (TP) and cancerous pleuritis (CP). One hundred six cases of TP and 26 cases of CP were scanned using gray-scale ultrasonography (GSU) and TA to determine the presence of pleural calcification. With CT as the reference standard, 63.3% and 79.6% of patients with pleural calcification were identified with GSU and TA, respectively. The detection rate of TA was higher than that of GSU (p = 0.039). For the whole study population, 37.1% were identified as having pleural calcification with CT, significantly higher than the proportion detected with GSU (25.8%, p = 0.001), but not different from that detected with TA (41.7%, p = 0.327). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of TA were 79.6%, 80.7%, 80.3%, 70.9% and 87.0%, respectively. The detection rate of TA was significantly higher than that of GSU (p <0.001). When GSU was combined with TA (GSUTA), the positive rate in the TP group was significantly higher than that in the CP group (χ2 < 0.001). In conclusion, TA is comparable to CT and more sensitive than GSU in the detection of pleural calcification. Evaluation for GSUTA on pleura may help to differentiate TP from CP.
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Affiliation(s)
- Jiakai Tian
- Department of Special Examination, Shandong Provincial Chest Hospital, Shandong, China
| | - Liang Xu
- Department of Radiology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Shandong, China.
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Jamzad A, Setarehdan SK. Noninvasive Prediction of Renal Stone Surface Irregularities by Numerical Analysis of the Color Doppler Twinkling Artifact: An Ex Vivo Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1211-1224. [PMID: 29086450 DOI: 10.1002/jum.14465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/16/2017] [Accepted: 08/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The physical structures of renal stones are highly correlated with their breakability. Noninvasive estimation of stone roughness will be beneficial for management. The intensity of the twinkling artifact appearing at the site of renal stones on Doppler ultrasound imaging is also influenced by the stone's roughness level. This article proposes a quantitative method for roughness prediction of ex vivo renal stones based on a twinkling analysis of their color Doppler images. METHODS Twenty surgically removed renal stones were first spatially modeled by an optical method, and 12 standard roughness measures were extracted from them. Stones were then embedded in an agar-based phantom and Doppler imaged with a calibrated ultrasound system. The images were preprocessed, and 11 twinkling intensities were measured numerically. The twinkling data along with the roughness labels were then analyzed by multiple linear regressions, and finally, a linear roughness predictor was trained for renal stones. RESULTS The core height measure of roughness had the best linear fit to the twinkling data among other roughness parameters. The results of the multiple linear regression analysis indicated a strong linear relationship between twinkling data and stones' roughness, with an R2 value of 83.29% and high statistical significance of F(11,868) = 393.36 and P < .001. CONCLUSIONS It was possible to predict the core roughness of renal stones using the proposed method and the twinkling artifact data acquired from the color Doppler images ex vivo.
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Affiliation(s)
- Amoon Jamzad
- Control and Intelligent Processing Center of Excellence, School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Seyed Kamaledin Setarehdan
- Control and Intelligent Processing Center of Excellence, School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
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Bonatti M, Vezzali N, Lombardo F, Ferro F, Zamboni G, Tauber M, Bonatti G. Gallbladder adenomyomatosis: imaging findings, tricks and pitfalls. Insights Imaging 2017; 8:243-253. [PMID: 28127678 PMCID: PMC5359147 DOI: 10.1007/s13244-017-0544-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/13/2017] [Accepted: 01/17/2017] [Indexed: 12/14/2022] Open
Abstract
Abstract Gallbladder adenomyomatosis (GA) is a benign alteration of the gallbladder wall that can be found in up to 9% of patients. GA is characterized by a gallbladder wall thickening containing small bile-filled cystic spaces (i.e., the Rokitansky–Aschoff sinuses, RAS). The bile contained in RAS may undergo a progressive concentration process leading to crystal precipitation and calcification development. A correct characterization of GA is fundamental in order to avoid unnecessary cholecystectomies. Ultrasound (US) is the imaging modality of choice for diagnosing GA; the use of high-frequency probes and a precise focal depth adjustment enable correct identification and characterization of GA in the majority of cases. Contrast-enhanced ultrasound (CEUS) can be performed if RAS cannot be clearly identified at baseline US: RAS appear avascular at CEUS, independently from their content. Magnetic resonance imaging (MRI) should be reserved for cases that are unclear on US and CEUS. At MRI, RAS can be identified with extremely high sensitivity, but their signal intensity varies widely according to their content. Positron emission tomography (PET) may be helpful for excluding malignancy in selected cases. Computed tomography (CT) and cholangiography are not routinely indicated in the suspicion of GA. Teaching points 1. Gallbladder adenomyomatosis is a common benign lesion (1–9% of the patients). 2. Identification of Rokitansky–Aschoff sinuses is crucial for diagnosing gallbladder adenomyomatosis. 3. Sonography is the imaging modality of choice for diagnosing gallbladder adenomyomatosis. 4. Intravenous contrast material administration increases ultrasound accuracy in diagnosing gallbladder adenomyomatosis. 5. Magnetic resonance is a problem-solving technique for unclear cases.
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Affiliation(s)
- Matteo Bonatti
- Department of Radiology, Bolzano Central Hospital, 5 Boehler Street, 39100, Bolzano, Italy.
| | - Norberto Vezzali
- Department of Radiology, Bolzano Central Hospital, 5 Boehler Street, 39100, Bolzano, Italy
| | - Fabio Lombardo
- Department of Radiology, Bolzano Central Hospital, 5 Boehler Street, 39100, Bolzano, Italy
| | - Federica Ferro
- Department of Radiology, Bolzano Central Hospital, 5 Boehler Street, 39100, Bolzano, Italy
| | - Giulia Zamboni
- Department of Radiology, University of Verona, 10 LA Scuro Place, 37134, Verona, Italy
| | - Martina Tauber
- Department of Pathology, Bolzano Central Hospital, 5 Boehler Street, 39100, Bolzano, Italy
| | - Giampietro Bonatti
- Department of Radiology, Bolzano Central Hospital, 5 Boehler Street, 39100, Bolzano, Italy
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Choi MJ, Cho CH, Kang G, Yang J. Color Doppler twinkling artifact: Possible mechanisms and clinical potential. Biomed Eng Lett 2014. [DOI: 10.1007/s13534-014-0124-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Jamzad A, Setarehdan SK. A novel approach for quantification and analysis of the color Doppler twinkling artifact with application in noninvasive surface roughness characterization: an in vitro phantom study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:597-610. [PMID: 24658939 DOI: 10.7863/ultra.33.4.597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The twinkling artifact is an undesired phenomenon within color Doppler sonograms that usually appears at the site of internal calcifications. Since the appearance of the twinkling artifact is correlated with the roughness of the calculi, noninvasive roughness estimation of the internal stones may be considered as a potential twinkling artifact application. This article proposes a novel quantitative approach for measurement and analysis of twinkling artifact data for roughness estimation. METHODS A phantom was developed with 7 quantified levels of roughness. The Doppler system was initially calibrated by the proposed procedure to facilitate the analysis. A total of 1050 twinkling artifact images were acquired from the phantom, and 32 novel numerical measures were introduced and computed for each image. The measures were then ranked on the basis of roughness quantification ability using different methods. The performance of the proposed twinkling artifact-based surface roughness quantification method was finally investigated for different combinations of features and classifiers. RESULTS Eleven features were shown to be the most efficient numerical twinkling artifact measures in roughness characterization. The linear classifier outperformed other methods for twinkling artifact classification. The pixel count measures produced better results among the other categories. The sequential selection method showed higher accuracy than other individual rankings. The best roughness recognition average accuracy of 98.33% was obtained by the first 5 principle components and the linear classifier. CONCLUSIONS The proposed twinkling artifact analysis method could recognize the phantom surface roughness with average accuracy of 98.33%. This method may also be applicable for noninvasive calculi characterization in treatment management.
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Affiliation(s)
- Amoon Jamzad
- Control and Intelligent Processing Center of Excellence, School of Electrical and Computer Engineering, College of Engineering, University of Tehran, North Kargar Street, Tehran 14395-515, Iran.
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