How to distinguish gallbladder stones from gallbladder polyps on ultrasound?

  The typical ultrasound images of gallbladder stones are as follows: 1. Strong echogenic clusters with stable morphology are seen in the gallbladder cavity. The ultrasound image often shows a crescent, hemimoon or spherical shape (the image resembles a lunar eclipse, because the ultrasound cannot penetrate all of the stones, but only on the surface of the stones and reflected back to form a sound image). 2. There is a sound shadow behind the stones. The ultrasound is reflected back at the stone surface, and a vacant area of ultrasound is formed behind the stone, so a long non-echoic dark area appears behind the stone intensity group, which is called the posterior acoustic shadow of the stone.   3. When the body is turned, the stone moves with the body position toward the low position of the gallbladder, that is, the strong light mass is seen to move with the body position toward gravity on the sonogram. Sediment-like stones can be deposited in layers with gravity.  Therefore, the classic description of a gallbladder stone on ultrasound is: one or more intense light clusters in the gallbladder with a posterior acoustic shadow that moves with body position.  If the gallbladder is filled with stones, if there is no bile in the gallbladder, or if there is significant atrophy of the gallbladder, this indicates that the gallbladder has lost its normal physiological function. In this case, the gallbladder stones may not move with the change of body position.  The typical ultrasound images of polyps in the gallbladder are as follows: small papillary bumps attached to the inner side of the gallbladder wall, most of them have a tip and do not move with the change of body position, and there is no sound shadow behind them, either one or more. In fact, gallbladder polyp is a general name which includes: cholesterol crystals, true polyps, adenomatous hyperplasia, adenoma, early small gallbladder cancer, etc.  Therefore, the classic description of gallbladder polyps on ultrasound is: one or more strong light spots or strong echogenic protrusions are seen on the inner wall of the gallbladder with no posterior acoustic shadow, which do not move with the change of body position.  If the bulging mass is more than 1.0 cm, it should be analyzed by a hepatobiliary surgeon and, if necessary, surgically treated to prevent the development of gallbladder malignancy.