Gallbladder Polyps with Internal Vascularity

Relationship Between Vascularity and Polyp Type

Detectable vascularity is more commonly observed in neoplastic polyps compared to non-neoplastic polyps, according to the Society of Radiologists in Ultrasound (SRU) consensus guidelines 1, 2
Larger cholesterol polyps (benign, non-neoplastic) may also demonstrate internal vascularity on color Doppler imaging, as stated by the SRU consensus guidelines 1
The SRU consensus conference committee explicitly states that detection of polyp vascularity should not influence risk stratification 3

Different vascular patterns may help differentiate polyp types when using contrast-enhanced ultrasound (CEUS), with stalk-like central enhancement pattern indicating a cholesterol polyp (benign) 4
Intralesional straight vessels are associated with adenomatous polyps, and intralesional branching vessels correlate with malignant neoplasms, as demonstrated by CEUS 4

Advances in sonographic technology have increased sensitivity for detecting subtle vascularity in polyps, according to the SRU consensus guidelines 1
Novel modified power Doppler-based techniques, such as Superb Microvascular Imaging (SMI), MicroFlow Imaging (MFI), and Microvascular flow imaging (MV-Flow), can separate slow or small-vessel flow signals from clutter artifacts 1

CEUS offers advantages in characterizing gallbladder polyps due to high spatial and temporal resolution, as recommended by the SRU consensus guidelines 1, 4
CEUS can help distinguish vascular lesions from sludge, and enhancement patterns on CEUS may help differentiate polyp types, including non-neoplastic, neoplastic, adenomatous, and malignant polyps 1, 4

The SRU consensus guidelines recommend risk stratification based primarily on polyp morphology and size, not vascularity, and short-interval follow-up US within 1-2 months with optimized technique is recommended for challenging cases 3, 4
CEUS may be used for further characterization if available, and MRI may be considered if CEUS is not available, as suggested by the SRU consensus guidelines 4, 6