Gallbladder carcinoma (GBC) is the most prevalent malignancy of the biliary tract and is characterized by its highly aggressive nature, contributing to significant morbidity and mortality worldwide. It represents a major challenge in gastrointestinal oncology due to its insidious onset and late-stage diagnosis, leading to poor overall survival outcomes [1]. The global incidence of GBC exhibits significant geographical variation, with a higher prevalence observed in specific regions such as northern India, Chile, Bolivia, and Eastern Europe, implicating potential genetic predisposition and environmental influences in its pathogenesis [2].

The etiology of GBC is multifactorial, involving a combination of genetic, inflammatory, and environmental risk factors. Established risk factors include chronic cholelithiasis, which leads to persistent inflammation and mucosal dysplasia, ultimately increasing the likelihood of malignant transformation. Other risk factors include the presence of a porcelain gallbladder (calcification of the gallbladder wall), gallbladder polyps larger than 1 cm, an anomalous pancreaticobiliary duct junction (APBDJ), and chronic bacterial infections such as Helicobacter pylori colonization, which may contribute to carcinogenesis via chronic inflammatory mechanisms and molecular alterations in the gallbladder epithelium [3,4].

Given the aggressive nature of GBC and its tendency for early metastasis to adjacent liver segments, regional lymph nodes, and distant sites via hematogenous and lymphatic dissemination, accurate staging at the time of diagnosis is critical for determining appropriate therapeutic strategies. Imaging modalities play a pivotal role in this context, providing essential information regarding tumor extent, vascular invasion, and metastatic spread [5].

This study aims to assess the role of MDCT in accurately staging gallbladder malignancy and its correlation with histopathological findings, facilitating improved diagnostic precision and guiding clinical decision-making.

This cross-sectional analytical study was conducted in the Department of Radiodiagnosis, Gujarat Cancer Research Institute, Ahmedabad, from March 2022 to June 2024. A total of 50 biopsy-proven cases of gallbladder malignancy were included, with patients recruited from Gujarat and neighboring states. The study included biopsy-proven cases of gallbladder malignancies in patients who had not undergone prior treatment or surgery for gallbladder disease. Only patients willing to participate and provide informed consent were enrolled. Exclusion criteria comprised patients unwilling to participate, those with a history of partial or complete cholecystectomy, individuals who had received chemotherapy or radiotherapy for gallbladder malignancy, and patients with known allergies to contrast agents or contraindications for contrast-enhanced CT imaging.

Relevant clinical history and previous investigations were reviewed, and uncooperative patients received sedation under anesthetic supervision. Informed consent was obtained from all participants, and ethical clearance was secured from the Institutional Ethics Committee. 

Patients underwent a triple-phase multidetector computed tomography (MDCT) scan of the thorax, abdomen, and pelvis using SIEMENS SOMATOM EMOTION 16-slice and GE 128-slice CT scanners. Imaging parameters included a 5 mm slice thickness, 130 kV, and patient-specific mAs. A standardized contrast-enhanced protocol was followed, with nonionic iodinated contrast (Omnipaque, 350 mg/mL) administered intravenously at 3–3.5 mL/sec. Image acquisition was performed in plain, arterial (20 sec), portal (40 sec), and venous (60 sec) phases, with additional delayed-phase imaging (3 min, 15 min if required). Negative oral contrast (diluted Mannitol) was used for bowel opacification. 

CT findings were analyzed for tumor size, morphology, local infiltration, vascular involvement, lymphadenopathy, and distant metastasis. Histopathological diagnosis and clinical follow-up data were recorded to correlate imaging findings. Data were statistically analyzed and compared with existing literature to assess MDCT accuracy in staging gallbladder malignancy and its role in surgical decision-making.

This study included 50 biopsy-proven cases of gallbladder malignancy, with a male-to-female ratio of 1.27:1. The mean age of presentation was 55 years, with the majority of cases (52%) occurring in the 41–60 years age group (Table 1)

Table 1: Age Distribution of Gallbladder Malignancy Cases

Demographic and Clinical Characteristics: The most common presenting symptoms were abdominal pain (86%), weight loss (64%), and jaundice (52%). Clinical examination revealed hepatomegaly in 40% of cases, while a palpable abdominal lump was noted in 38% (Table 2).

Table 2: Clinical Presentation of Gallbladder Malignancy

Imaging Patterns and Tumor Characteristics: MDCT imaging revealed three predominant tumor growth patterns: mass replacing the gallbladder (52%), diffuse wall thickening (38%), and an intraluminal polypoidal mass (10%) (Table 3). The most frequent tumor location was the entire gallbladder (42%), followed by the fundus and body (20%). On non-contrast CT, 74% of lesions were hypodense compared to liver parenchyma, while 26% were isodense. Post-contrast imaging demonstrated heterogeneous enhancement in 76% of cases, mild enhancement in 20%, and hypodensity in 4% (Table 4).

Table 3: Imaging Patterns of Gallbladder Malignancy

Table 4: CT Density and Enhancement Patterns of Tumor

Tumor Staging and Metastasis: MDCT staging showed that the majority of cases were in T3 (58%) or T4 (20%) stages, with only 4% in T1 (Table 5). Lymph node involvement was observed in 46% of cases, with 28% in the N2 stage, indicating a non-resectable state. Distant metastasis was noted in 48% of cases, with the liver being the most common site (38%), followed by the lungs (12%) and omentum (10%) (Figure 1).

Table 5: Tumor Staging on MDCT

  Surgical Resectability: Only 24% of cases were surgically resectable at presentation, while 76% were deemed non-resectable due to locoregional spread, vascular encasement, or distant metastasis (Figure 2).

The CT images of a 62-year-old female depict a large, heterogeneously enhancing mass completely replacing the gallbladder (GB), indicative of advanced malignancy. The axial CT image (Image 1A) shows an irregular, hypodense mass with central necrosis, along with multiple metastatic liver deposits, confirming hepatic spread. The coronal reformatted image (Image 1B) further highlights direct liver infiltration and the tumor’s extensive involvement. These findings suggest Stage IV gallbladder carcinoma, with non-resectability due to hepatic metastasis. MDCT plays a crucial role in staging by identifying tumor morphology, invasion, and distant spread, guiding treatment decisions.

Gallbladder carcinoma (GBC) is a highly aggressive malignancy with poor prognosis, often diagnosed at an advanced stage due to its asymptomatic early course. In this study, the majority of cases (66%) were Stage IV at presentation, with liver metastasis being the most common site of distant spread (38%), consistent with findings by Itai et al. [6]. Surgical resectability was low (24%), aligning with previous reports indicating a high rate of unresectability due to locoregional spread and distant metastases [7].

MDCT remains a critical imaging modality for staging GBC, offering superior assessment of tumor morphology, vascular involvement, and nodal metastasis. The most common radiological pattern observed was a mass replacing the gallbladder (52%), followed by diffuse wall thickening (38%) and polypoidal growths (10%), findings that parallel those of Kalra et al. [8]. MDCT showed high accuracy in staging, with 71.42% concordance for T staging and 100% for N staging compared to histopathology, as supported by Mukhopadhyay et al. [9].

Locoregional invasion was frequently observed, with liver infiltration in 74% of cases and vascular encasement in 18%, similar to findings by Jindal et

1. [10]. The ability of MDCT to differentiate between resectable and non-resectable tumors is crucial, as seen in its detection of adjacent organ involvement such as duodenal (20%) and colonic infiltration (12%), aiding preoperative evaluation, as also reported by Onoyama et al. [11].

Distant metastasis was observed in 48% of cases, with the lung (12%) and omentum (10%) being other common metastatic sites, supporting findings by Ohtani et al. [12]. Early hematogenous spread was noted in some cases before lymphatic involvement, emphasizing the aggressive nature of the disease, as previously documented by Afifi et al. [13-15].

Despite its advantages, MDCT has limitations in differentiating malignancy from inflammatory conditions such as xanthogranulomatous cholecystitis, which may mimic carcinoma, as noted by Kanthan et al. [7]. Additionally, PET-CT may offer superior sensitivity in detecting occult metastases, as highlighted by Shukla et al. [4].

Overall, this study confirms MDCT’s role in accurately staging GBC and determining resectability, thereby guiding treatment strategies. Improved imaging techniques and early detection methods remain crucial for enhancing patient outcomes.

MDCT plays a crucial role in the staging of gallbladder malignancy, providing accurate assessment of tumor extent, nodal involvement, and metastasis. The majority of cases present at advanced stages, with liver being the most common site of spread. MDCT effectively determines surgical resectability, guiding treatment planning. Given its high diagnostic accuracy, MDCT remains the preferred imaging modality for evaluating gallbladder cancer and predicting patient outcomes.

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