胆嚢ポリープのCEUS指標に基づく悪性リスク層別化モデル最適化に関する予備的検討

To investigate whether incorporating contrast-enhanced ultrasound (CEUS) features improves the diagnostic performance of conventional ultrasound (US)-based malignant risk stratification model for gallbladder polyps (GBPs).

A total of 300 consecutive patients with GBPs who underwent surgery at two centers between June 2021 and January 2025 were prospectively enrolled. All underwent pre-operative US and CEUS. Two derivative models were developed based on the conventional US model: a simplified CEUS model (by revising scores of US-derived parameters via CEUS) and a multiparametric CEUS model (by incorporating CEUS perfusion characteristics). Surgical pathology served as the gold standard for comparing the three models' diagnostic efficacy.

Eight CEUS indicators demonstrated excellent inter-observer consistency (kappa > 0.75). The simplified CEUS model revised scores for polyp shape, size and gallbladder wall integrity, whereas the multiparametric CEUS model incorporated six additional CEUS indicators: pedicle, base width, vascular morphology, gallbladder wall thickening at the polyp attachment site, arterial-phase hyperenhancement of the gallbladder wall at the attachment site and peak enhancement pattern. In the validation set, the multiparametric CEUS model outperformed the simplified CEUS and conventional US models. For non-neoplastic versus neoplastic polyps, their area under the receiver operating characteristic curve values were 0.820 (US), 0.900 (simplified CEUS) and 0.962 (multiparametric CEUS); for benign versus malignant polyps, the values were 0.893 (US), 0.974 (simplified CEUS) and 0.983 (multiparametric CEUS), respectively.

Incorporation of CEUS features significantly improves the diagnostic efficacy of the malignant risk stratification model for GBPs, a tool with high clinical value that merits widespread clinical application.