Contrast-enhanced ultrasound in diagnosis of gallbladder adenoma

BACKGROUND：Gallbladder adenoma is a pre-cancerous neoplasm and needs surgical resection.It is difficult to differentiate adenoma from other gallbladder polyps using imaging examinations.The study aimed to illustrate characteristics of contrast-enhanced ultrasound（CEUS）and its diagnostic value in gallbladder adenoma.METHODS： Thirty-seven patients with 39 gallbladder adenoma- toid lesions （maximal diameter _〉10 mm and without metastasis） were enrolled in this study. Lesion appearances in conventional ultrasound and CEUS were documented. The imaging features were compared individuaUy among gallbladder cholesterol polyp, gallbladder adenoma and malignant lesion. RESULTS： Adenoma lesions showed iso-echogenicity in ul- trasound, and an eccentric enhancement pattern, ＂fast-in and synchronous-out＂ contrast enhancement pattern and homo- geneous at peak-time enhancement in CEUS. The homogenic- ity at peak-time enhancement showed the highest diagnostic ability in differentiating gallbladder adenoma from cholesterol polyps. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and Youden index were 100%, 90.9%, 92.9%, 100%, 95.8% and 0.91, respectively. The characteristic of continuous gallbladder wall shown by CEUS had the highest diagnostic ability in differentiating adenoma from malignant lesion （100%, 86.7%, 86.7%, 100%, 92.9% and 0.87, respectively）. The characteristic of the eccentric enhance- ment pattern had the highest diagnostic ability in differenti- ating adenoma from cholesterol polyp and malignant lesion, with corresponding indices of 69.2%, 88.5%, 75.0%, 85.2%, 82.1% and 0.58, respectively.CONCLUSIONS： CEUS is valuable in differentiating gallbladder adenoma from other gallbladder polyps （〉_10 mm in diameter）. Homogeneous echogenicity on peak-time enhancement, a continuous gallbladder wall, and the eccentric enhancement pattern are important indicators of gallbladder adenoma on CEUS.

Liver injury in COVID-19: Known and unknown

Since the first report of the coronavirus disease 2019(COVID-19)in December 2019 in Wuhan,China,the outbreak of the disease is currently continuously evolving.Previous studies have shown varying degrees of liver damage in patients with COVID-19.However,the exact causes of liver injury and the relationship between COVID-19 and liver injury is unclear.This article describes liver injury induced by COVID-19,analyzes its causes,and discusses the treatment and prognosis of liver damage in patients with COVID-19.