Differential diagnosis of gallbladder cholesterol polyps and adenomas using contrast-enhanced ultrasound-morphology and perfusion features.

PURPOSE: This study aimed to evaluate the value of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of gallbladder cholesterol polyps and adenomas.

METHODS

Sixty-seven patients with gallbladder polyps (GBPs) measuring ≥ 10 mm in diameter were consecutively enrolled. All patients underwent two-dimensional ultrasound, color Doppler flow imaging (CDFI), and CEUS before surgical treatment. The size of gallbladder, gallbladder contraction function, gallstones and cholecystitis were also included in the analysis.

RESULTS

Among the 59 patients in the final analysis, 43 cases (72.9%) were diagnosed as gallbladder cholesterol polyps and 16 cases (27.1%) as gallbladder adenomas, all confirmed by pathology. Compared with the cholesterol polyp group, the adenoma group exhibited significantly larger lesion size, a higher prevalence of solitary lesions, and more frequent regular morphology or nodular surface with homogeneous internal echotexture. A majority of cases showed positive CDFI findings. Additionally, the adenoma group demonstrated earlier enhancement onset, greater enhancement intensity, more frequent branch vessels in the arterial phase, and a lower incidence of cholecystitis. No significant differences were found between the two groups in terms of age, sex, lesion basal width, gallbladder volume, cholecystolithiasis, or gallbladder contraction function. Logistic regression analysis identified solitary lesions, higher enhancement degree, presence of branch vessels in the arterial phase, and smooth or nodular surface morphology post-enhancement as independent risk factors for gallbladder adenomas.

CONCLUSION

CEUS is effective in evaluating GBP perfusion and clearly delineating lesion morphology. Morphological and perfusion characteristics in CEUS could provide valuable differentiation between gallbladder cholesterol polyps and adenomas. These findings may enhance diagnostic accuracy and help reduce unnecessary surgical intervention for large (≥ 10 mm) gallbladder cholesterol polyps.