Altenmüller Johannes, Wiegard Christiane, Sebode Marcial, Lohse Ansgar W, Villard Christina, Kechagias Stergios, Nilsson Emma, Rorsman Fredrik, Marschall Hanns-Ulrich, Jokelainen Kalle, Bergquist Annika, Färkkilä Martti, Schramm Christoph
Ist Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Ist Derparmtent of Medicine, Westküstenklinikum Heide, Heide, Germany.
Liver Int. 2025 Sep;45(9):e70312. doi: 10.1111/liv.70312.
In primary sclerosing cholangitis (PSC), the risk for gallbladder malignancy is increased. Surveillance imaging is used for early diagnosis. The study aims to assess the reliability of ultrasound and magnetic resonance imaging (MRI) for the detection of gallbladder polyps in people with PSC and to define a polyp size as a cut-off at which cholecystectomy is indicated due to the high probability of a malignant finding.
In this retrospective European multicentre study, we included 51 people with PSC who had cholecystectomy for gallbladder polyps detected on imaging using ultrasound and/or MRI within 6 months prior to cholecystectomy and a histology report available. As a control group, we included 102 people with PSC with other indications for cholecystectomy. Malignancy was defined as high-grade dysplasia or carcinoma on histology.
Including all 153 patients, ultrasound was significantly more sensitive than MRI in detecting gallbladder polyps (p < 0.001). MRI missed 3 of the 8 malignant polyps. Malignant polyps (n = 8, median size = 12.5 mm) were significantly larger than non-malignant polyps (n = 26, median size = 6 mm) on ultrasound (p < 0.001). Ultrasound detected malignant polyps reliably (AUC = 0.91, p < 0.001) with an optimal cut-off of 8 mm. This cut-off was defined in the Hamburg cohort and validated in a multicentre validation cohort with an AUC of 0.92 (p = 0.02).
Ultrasound is more sensitive for the detection of gallbladder polyps than MRI in people with PSC. The best cut-off to differentiate between benign and malignant polyps was 8 mm. Ultrasound (gallbladder) and MRI (bile ducts) may thus be complementary methods for hepatobiliary malignancy surveillance in people with PSC.
在原发性硬化性胆管炎（PSC）中，胆囊恶性肿瘤的风险增加。监测成像用于早期诊断。本研究旨在评估超声和磁共振成像（MRI）在检测PSC患者胆囊息肉方面的可靠性，并确定一个息肉大小作为因恶性发现可能性高而需行胆囊切除术的临界值。
在这项回顾性欧洲多中心研究中，我们纳入了51例因在胆囊切除术前6个月内通过超声和/或MRI成像检测到胆囊息肉而接受胆囊切除术且有组织学报告的PSC患者。作为对照组，我们纳入了102例因其他指征接受胆囊切除术的PSC患者。恶性肿瘤定义为组织学上的高级别发育异常或癌。
纳入所有153例患者后，超声在检测胆囊息肉方面比MRI显著更敏感（p < 0.001）。MRI漏诊了8个恶性息肉中的3个。超声显示恶性息肉（n = 8，中位大小 = 12.5 mm）明显大于非恶性息肉（n = 26，中位大小 = 6 mm）（p < 0.001）。超声能可靠地检测出恶性息肉（AUC = 0.91，p < 0.001），最佳临界值为8 mm。该临界值在汉堡队列中确定，并在多中心验证队列中得到验证，AUC为0.92（p = 0.02）。
在PSC患者中，超声在检测胆囊息肉方面比MRI更敏感。区分良性和恶性息肉的最佳临界值为8 mm。因此，超声（胆囊）和MRI（胆管）可能是PSC患者肝胆恶性肿瘤监测的互补方法。
