The Value of MDCT Scans in Differentiation between Benign and Malignant Gallbladder Wall Thickening
Ranista Tongdee MD*, Panitpong Maroongroge MD*, Wanwarang Suthikeree MD*
Affiliation : * Department of Diagnostic Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To evaluate the value of MDCT in differentiation of gallbladder carcinoma from other benign conditions in patients
with thickened gallbladder wall.
Material and Method: MDCT of 125 patients, 18 gallbladder carcinomas and 107 other benign conditions were retrospectively
reviewed. Various direct and indirect CT findings of benign and malignant gallbladder diseases were evaluated. Differences
in CT findings between benign and malignancy were calculated using Chi-square test and odds ratio. Additionally, the wall
enhancement pattern was evaluated and categorized into five types, according to the presence of striation, thickness of the
outer and inner layers, and degree of enhancement of each layer compared with that of normal liver parenchyma. The
diagnostic performance of enhancement pattern analysis on MDCT was analyzed.
Results : Five direct and five indirect CT findings including wall irregularity, focal wall thickening, discontinuous mucosa,
submucosal edema, polypoid mass, direct invasion to adjacent organ, biliary obstruction, regional and paraaortic
lymphadenopathy and distant metastasis show significant differences between benign and malignancy. The thickened gallbladder
wall with one-layer heterogeneous enhancement (type 1) was significantly associated with malignancy. By using type 1
enhancement pattern as the predictor for malignancy, the sensitivity, specificity, and accuracy of MDCT for detection of
malignancy was 78%, 94% and 92%, respectively.
Conclusion : MDCT is a reliable diagnostic method for differentiating between benign and malignant thickened gallbladder
wall. Focal and irregular wall thickening are two direct signs that most associated with malignancy. Moreover, the one-layer
heterogeneous enhancement of gallbladder wall is suggestive of malignancy.
Keywords : Gallbladder carcinoma, Gallbladder wall thickening
