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Fig. 4B —False-negative case of gallbladder cancer in 76-year-old man with gallbladder cancer. Axial (A) and oblique coronal (B) contrast-enhanced CT images show strong enhancement of inner layer (white arrow, A) and weakly enhancing or nonenhancing outer layer (black arrow, A), which is similar to type 2 pattern of enhancement. However, thickness of inner layer is 2.3 mm, whereas that of outer layer is 3.4 mm, and multiple stones (asterisk) exist in gallbladder lumen. Observer 1 interpreted this case as type 5 pattern and observer 2, as type 4 pattern. Patient underwent laparoscopic cholecystectomy and was diagnosed with early gallbladder cancer (pT1a), which shows flat type of growth and concomitant chronic active cholecystitis. When we reviewed this case, enhancement degree of inner layer was intense, but enhancement degree of hepatic parenchyma was also strong, which could be pitfall in differentiating type 2 from types 4 and 5 enhancement patterns even if thickness of inner and outer layers is equivocal.