Quantitative contrast-enhanced US helps differentiating neoplastic vs non-neoplastic gallbladder polyps

  • Jae Seok Bae
  • Se Hyung KimEmail author
  • Hyo-jin Kang
  • Haeryoung Kim
  • Ji Kon Ryu
  • Jin-Young Jang
  • Sang Hyub Lee
  • Woo Hyun Paik
  • Wooil Kwon
  • Jae Young Lee
  • Joon Koo Han



To differentiate between large (≥ 1 cm in diameter) gallbladder (GB) non-neoplastic and neoplastic polyps using quantitative analysis of contrast-enhanced ultrasound (CEUS) findings.


From September 2017 to May 2018, 29 patients (10 males; median age, 63 years) with GB polyps of ≥ 1 cm in diameter who were undergoing cholecystectomy were consecutively enrolled. All patients underwent preoperative conventional US and CEUS examinations. Quantitative analysis of CEUS findings using time-intensity curves between the two groups was independently performed by two radiologists. The interobserver agreement for the quantitative analysis of the CEUS results was measured using the intraclass correlation coefficient. Receiver operating characteristic analysis was performed to evaluate the diagnostic performance of CEUS examination.


After the cholecystectomy, the patients were classified into the non-neoplastic polyp group (n = 12) and the neoplastic polyp group (n = 17) according to the pathological results. The interobserver agreement for quantitative assessment between the two radiologists was near perfect to substantial. Quantitative assessment of the CEUS findings revealed that the rise time, mean transit time, time to peak, and fall time of non-neoplastic GB polyps were significantly shorter than those of neoplastic polyps (p < 0.001, p = 0.008, p = 0.013, and p = 0.002, respectively). The sensitivity and specificity of the quantitative CEUS parameters for the differentiation between the two groups were 76.5–100% and 75%, respectively, with an area under the curve of 0.765–0.887.


Quantitative analysis of CEUS findings could be valuable in differentiating GB neoplastic polyps from non-neoplastic polyps.

Key Points

• Quantitative analysis of CEUS findings could be valuable in differentiating gallbladder neoplastic polyps from non-neoplastic polyps.

• Quantitative analysis of CEUS findings in gallbladder polyps provides cut-off values for differentiation between neoplastic polyps and non-neoplastic polyps with near-perfect to substantial interobserver agreement.


Contrast media Ultrasonography Gallbladder Polyps 



Area under the curve


Contrast-enhanced ultrasound


Fall time




Mean transit time


Receiver operating characteristic


Region of interest


Rise time


Time-intensity curve


Time to peak enhancement



This research was supported by the Research Resettlement Fund for the new faculty of Seoul National University and from the Seoul National University Hospital Research Fund No. 05-2016-0060.

Compliance with ethical standards


The scientific guarantor of this publication is Joon Koo Han.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• diagnostic or prognostic study

• performed at one institution

Supplementary material

330_2019_6123_MOESM1_ESM.docx (16 kb)
ESM 1 (DOCX 15 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Jae Seok Bae
    • 1
    • 2
  • Se Hyung Kim
    • 1
    • 2
    • 3
    Email author
  • Hyo-jin Kang
    • 1
    • 2
  • Haeryoung Kim
    • 4
  • Ji Kon Ryu
    • 5
  • Jin-Young Jang
    • 6
  • Sang Hyub Lee
    • 5
  • Woo Hyun Paik
    • 5
  • Wooil Kwon
    • 6
  • Jae Young Lee
    • 1
    • 2
    • 3
  • Joon Koo Han
    • 1
    • 2
    • 3
  1. 1.Department of RadiologySeoul National University HospitalSeoulRepublic of Korea
  2. 2.Department of RadiologySeoul National University College of MedicineSeoulRepublic of Korea
  3. 3.Institute of Radiation MedicineSeoul National University Medical Research CenterSeoulRepublic of Korea
  4. 4.Department of PathologySeoul National University HospitalSeoulRepublic of Korea
  5. 5.Department of Internal MedicineSeoul National University HospitalSeoulRepublic of Korea
  6. 6.Department of SurgerySeoul National University HospitalSeoulRepublic of Korea

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