To evaluate the efficacy of dual phase MDCT findings to differentiate gallbladder cancer from chronic cholecystitis.

Dual phase MDCT findings in 45 patients(GB cancer, n=18, chronic cholecystitis, n=27) were retrospectively reviewed. The thickness, contour, involved extent, single or double layered pattern of wall thickening, enhancement degree of wall, degree of intrahepatic(IHD) and extrahepatic duct(EHD) dilatation, and other associated findings were evaluated.

Mean wall thickness was 14.7mm in cancer, and 5.5mm in cholecystitis(p=0.00). Irregular wall thickening(p=0.00), high enhancement of single layer of wall on arterial phase (p=0.00), associated mass(p=0.00), dilatation of IHD(p=0.00) and EHD(p=0.00), invasion to liver(p=0.01), larger diameter of GB(p=0.03), and pericholecystic fat infiltration(p=0.05) were significant to cancer. Associated stone(p=0.00), diffuse wall thickening(p=0.03), iso or low enhancement of outer layer of wall on venous phase(p=0.05) were significant to cholecystitis.

High enhancement of single layer of wall on arterial phase was significant to differentiate GB cancer from chronic cholecystitis with ancillary findings on dual phase MDCT.

Unexpected carcinoma of gallbaldder(GB) can be found in 1-2% of specimens after surgery of benign biliary disease. This study was designed to investigate the clinicopathological and radiological characteristics of unexpected GB cancer presumed benign biliary disease and compare with originally diagnosed GB cancer.

The modical records of nineteen patients(5 males and 14 females, mean age : 64±9 years) with unexpected GB cancer diagnosed postoperatively(Group 1 : cholecystitis, 12 cases ; GB empyema, 4 cases ; cholecystitis with bile duct stone, 3 cases) and thirty seven patients (12males and 25 females, mean age : 68±11 years) with originally diagnosed GB cancer(Group 2) were retrospectively reviewed at Ewha Womans university Mokdong hospital from October, 1993 to March, 1999.

Clinical findings including right upper quadrant pain, fever, and chilling were pre-dominant in group 1 and general weakness, anorexia, and weight loss were predominant in group 2. Ultrasonographic findings of the group 1 were not typical to detect GB cacer Diffuse thickened GB wall showed 47.3% and the gallstone showed 89.5% in group 1. The mass of thickened GB wall irregularly revealed in all and gallstone showed in 50% of group 2. The TMN stage of goup 1 revealed earlier stage than group 2. The curative resection was performed in 84.2% and 10% in group 1 and 2, respectively.

The stage of unexpected GB cancer revealed relatively early stage and the curative resection rate was higher than originally diagnosed GB cancer. Therefore, the careful and detail intraoperative histologic examination of considered in patient with clinical features of benign biliary disease to detect early and improve prognosis in the patients of GB cancer.