Ultrasonography and Computed Tomography Evaluation of Gall Bladder wall Thickening and it’s Histopathological correlation

Abstract

Background: Ultrasonography is usually the first preferred imaging modality for Gall bladder diseases. GB carcinoma is an important cause of thickening of the GB. USG is less sensitive in detecting GB malignancy, metastasis and staging than CT. Therefore, computed tomography (CT) is being increasingly used for early detection of GB carcinoma. Objective: Accuracy of Ultrasonography and contrast enhanced computed tomography (CECT) in correctly identifying the cause of GB wall thickening and comparing their findings with the histopathology. Methodology: After Ethical Approval this Prospective observational study was conducted in the Department of Radiology, Rajendra Institute of Medical Sciences, Ranchi over a duration of 18 months from April 2019 to October 2020. Data was entered in Excel sheet and analysed by SPSS. Results: 63 patients were enrolled, 43 were females (68.25%) and 20 were males (31.75%). Mean age of patients was 50.14 years with a standard deviation of 11.11. Mean GB wall thickness was 10.3 mm for malignant pathology with a standard deviation of 4.00. The association of focal/diffuse wall thickening with GB carcinoma was found to be significant (p− 0.001). Intra−hepatic biliary radical (IHBR) dilatation was observed in 11 patients (17.46%) and nine out of these eleven patients had GB carcinoma (p −0.002). The correlation of Loss of interface of thickened GB wall with liver parenchyma and malignancy was found to be significant (p−0.012). 7 (11.11%) patients with lymphadenopathy on Ultrasonography and CECT (p −0.0001) had a final diagnosis of malignancy on histopathology. The sensitivity of USG was found to be 70% while specificity was 66.60%. The sensitivity of CT was found to be 95.00% while specificity was 83.72%. Conclusion: Early detection of malignant cause is challenging because of identical presentations of benign and malignant conditions as wall thickening on imaging and vague clinical symptoms. Since carcinoma Gall bladder has very poor prognosis, early histopathological diagnosis following imaging diagnosis is crucial for reducing mortality and morbidity.