Role of dual energy CT in differentiation of benign and malignant gall bladder disease: A histopathological correlation.
DOI:
https://doi.org/10.51168/sjhrafrica.v5i11.2135Keywords:
Dual energy computed tomography, Gall bladder malignancy, pericholecystic invasion, regional lymphadenopathy, post-image processingAbstract
Objective:
To evaluate the role of dual-energy CT (DECT) and contrast enhancement in differentiating benign from malignant gallbladder (GB) diseases.
Methods:
Ninety patients (21–70 years) with GB wall thickening >3 mm or GB mass on ultrasonography undergoing cholecystectomy were enrolled. CT was performed using a 384-slice Siemens SOMATOM Force dual-source DECT scanner. Non-ionic contrast (iopromide, Ultravist 370) was administered, and attenuation images were acquired at 80 and 140 kVp. Parameters assessed included wall thickening and its pattern, presence and extent of polypoidal mass, iodine uptake in GB wall and pericholecystic liver parenchyma, attenuation pattern, pericholecystic invasion, and lymphadenopathy. DECT diagnoses were made by consensus of two radiologists. Histopathological examination (HPE) served as the reference standard. Data were analyzed using SPSS 21.0, with chi-square and independent t-tests applied. Diagnostic performance indices of DECT were calculated.
Results:
On HPE, 51 cases (56.7%) were benign and 39 (43.3%) malignant. Malignant cases had significantly higher mean age (51.13±11.80 years) than benign (41.18±10.01 years) (p<0.001). Most patients were female (71.1%) and from rural areas (63.3%). No significant association of clinicodemographic factors with HPE diagnosis was noted. On DECT, focal irregular wall thickening, mass replacing GB, increased iodine uptake in GB wall and pericholecystic liver, invasion, and lymphadenopathy were significantly linked to malignancy, whereas regular circumferential thickening suggested benignity. DECT diagnosed malignancy in 36 cases (40%) and benign disease in 54 (60%). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of DECT were 79.5%, 90.2%, 86.1%, 85.2%, and 85.6%, respectively.Conclusion:
Dual-energy CT is a reliable tool for distinguishing malignant from benign GB diseases, with good diagnostic accuracy. Its wider application may improve early detection, though further exploration is warranted.
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