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Features Suggestive of Gallbladder Malignancy: Analysis of T1, T2, and T3 Tumors on Cross-Sectional Imaging

Mitchell, Charles H. MD; Johnson, Pamela T. MD; Fishman, Elliot K. MD; Hruban, Ralph H. MD; Raman, Siva P. MD

Journal of Computer Assisted Tomography: March/April 2014 - Volume 38 - Issue 2 - p 235–241
doi: 10.1097/RCT.0b013e3182aafb6b
Abdominal Imaging

Objectives Gallbladder cancer carries an extremely high mortality rate, with a 5-year survival rate as low as 12%. Survival is dependent on the diagnosis of these tumors in their earliest stages. This study sought to describe the clinical and imaging features of stages T1, T2, and T3 gallbladder tumors and to illustrate features that may allow radiologists to make an early diagnosis.

Materials and Methods After approval from the institutional review board, a search of the pathology department database yielded 18 patients with surgically proven T1, T2, and T3 gallbladder cancers with available preoperative computed tomography (CT) or magnetic resonance imaging. The imaging was reviewed for lesional morphology (focal polyploid mass, focal wall thickening, circumferential wall thickening), enhancement characteristics, liver invasion, locoregional lymphadenopathy, and distant metastatic disease. The electronic medical record was also searched for demographic information and clinical presentation.

Results There were 10 women and 8 men with a mean age of 69 years. Virtually all patients were symptomatic, with most patients demonstrating symptoms suggestive of underlying malignancy (including jaundice, weight loss, and chronic abdominal pain). Tumors on CT and MRI included 6 polyploid masses, 9 tumors with focal wall thickening, and 3 with circumferential wall thickening. The mean attenuation of those tumors imaged with CT was 59.4 Hounsfield units (HUs) on the arterial phase and 86.5 HUs on the venous phase, with a mean increase in Hounsfield attenuation between the arterial and venous phases of 28.2 HUs. Twelve of the 18 patients were correctly diagnosed prospectively on CT.

Conclusions The imaging findings of gallbladder cancer can be subtle, regardless of whether the tumor presents as a discrete mass, focal wall thickening, or circumferential diffuse wall thickening, and radiologists should be aware of the wide range of different possible appearances. Moreover, the vast majority of these patients had clinical symptoms suggestive of an underlying malignancy, and this should precipitate a careful evaluation of the gallbladder in all such cases.

From the *Department of Radiology, Johns Hopkins University, and †Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD.

Received for publication August 10, 2013; accepted October 3, 2013.

Reprints: Siva P. Raman, MD, Department of Radiology, Johns Hopkins University, Johns Hopkins Outpatient Center 3251, 601 N Caroline St, Baltimore, MD 21287 (e-mail:

The authors declare no conflict of interest.

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