Abstract: Objective The aim of this study was to investigate the application of gallbladder reporting and data system (GB-RADS), contrast-enhanced ultrasound (CEUS) and ultrasound micro-flow imaging in the diagnosis of gallbladder polypoid lesion (GPL) properties. Methods 114 patients with GPL were encountered in out hospital between January 2022 and December 2024, and all underwent ultrasound micro-flow imaging and CEUS scan for GB-RADS grading. The patients with GPL received radical or conventional surgical resection. Kappa consistency test was applied to evaluate the diagnostic performance. Results Histo-pathological examination found gallbladder cancer in 16 cases(14.0%) and benign lesions in 98 cases (86.0%), including gallbladder polyps in 72 cases, adenomas in 10 cases and gallbladder adenomyomatosis in 16 cases; the proportion of high enhancement in CEUS, multiple vessels in the lesions and fast in and fast out of enhancement model in the malignant lesions were 81.3%, 93.7% and 87.5%, all significantly higher than 46.9%, 17.3% and 39.8%(P<0.05) in benign lesions; the proportion of ultrasound micro-flow imaging grade 3-4 in malignant lesions was 100.0%, much higher than 60.2% in benign lesions (P<0.05); the proportion of GB-RADS grade 3-5 was 81.3%, much higher than 21.4% in benign lesions (P<0.05); Kappa consistency test showed the sensitivity, specificity and accuracy by CEUS in judging the GPL properties were 81.3%, 83.7% and 83.3%, and by GB-RADS were 81.3%, 78.6% and 78.9%, both much superior to 100.0%, 39.8% and 48.2%, respectively (P<0.05) by ultrasound micro-flow imaging. Conclusion The assessment of GPL property by multiple ultrasonography might be helpful in clinical practice, which warrants further investigation.

Key words: Gallbladder polypoid lesion, Contrast-enhanced ultrasound, Ultrasound micro-flow imaging, Gallbladder reporting and data system, Diagnosis