ArticleEuropean radiology2018
CT diagnosis of gallbladder adenomyomatosis: importance of enhancing mucosal epithelium, the "cotton ball sign".
Article in European radiology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 22 citations in OpenAlex.
- Interpretation, Reporting, Imaging-Based Workups, and Surveillance of Incidentally Detected Gallbladder Polyps and Gallbladder Wall Thickening: 2025 Recommendations From the Korean Society of Abdominal Radiology.Korean journal of radiology · 2025Guideline
- Article
- The rosary sign.Abdominal radiology (New York) · 2025Article
- The "cotton ball sign" of the galbladder.Abdominal radiology (New York) · 2023Article
- Article
- Gallbladder polyps and adenomyomatosis.The British journal of radiology · 2023Review
- Routine Histopathological Examination of the Specimen After Laparoscopic Cholecystectomy: Can We Be Brave Enough to Give Up?The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology · 2021Article
- A narrative review of gallbladder adenomyomatosis: what we need to know.Annals of translational medicine · 2020Review
- Imaging-based algorithmic approach to gallbladder wall thickening.World journal of gastroenterology · 2020Review
- Benign gallbladder diseases: Imaging techniques and tips for differentiating with malignant gallbladder diseases.World journal of gastroenterology · 2020Review
- Development and Validation of a Nomogram for Early Detection of Malignant Gallbladder Lesions.Clinical and translational gastroenterology · 2019Article
- [Differential diagnosis of gallbladder abnormalities : Ultrasound, computed tomography, and magnetic resonance imaging].Der Radiologe · 2019Review
Corrections and comments
- Erratum issued
Authors and funding
9 authors at 8 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo determine the diagnostic value of the cotton ball sign and other CT features in patients with gallbladder (GB) wall thickenings (WTs).
methodsThree blinded readers reviewed the preoperative CT and MR images of 101 patients with pathologically confirmed GB adenomyomatosis (GA) (n = 34) and other benign (n = 29), malignant (n = 41), and premalignant (n = 2) GBWTs. Three readers analysed the morphological features of GBWT and presence of the "cotton ball sign", defined as fuzzy grey dots in GBWT or a dotted outer border of the inner enhancing layer on contrast-enhanced (CE) CT. In addition, the "pearl necklace sign" on MR was analysed.
resultsIn the GA group (n = 34), prevalence of the cotton ball sign and pearl necklace sign was 74% (25/34) and 44% (15/34), respectively. Presence of the cotton ball sign, smooth contour of the mucosa, double-layering enhancement, and enhancement degree weaker than the renal cortex on CT images were significant predictors of benign GBWT (p < 0.01). When differentiating GA from GB malignancy or premalignancy, accuracy of the cotton ball sign and pearl necklace sign was 81% (62/77) and 74% (57/77), respectively.
conclusionThe cotton ball sign on CE-CT showed higher sensitivity and comparable specificity to those of the pearl necklace sign in differentiating GA from malignancy. KEY POINTS: • Prevalence of the cotton ball sign on CT was 74% in gallbladder adenomyomatosis. • The cotton ball sign was useful in differentiating gallbladder adenomyomatosis from gallbladder cancer. • The cotton ball sign was more sensitive than the pearl necklace sign for adenomyomatosis diagnosis.
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