Acute Cholecystitis: MR Findings and Differentiation from Chronic Cholecystitis

Abstract

Increased gallbladder wall enhancement and increased transient pericholecystic hepatic enhancement had the highest combination of sensitivity and specificity for the diagnosis and differentiation of acute and chronic cholecystitis.

The Gallbladder

“…The liver around the Although acute cholecystitis is routinely diagnosed with US, in equivocal situations MRI may be helpful owing to its superior ability to identify calculi within the gallbladder neck or cystic duct compared with US [ 22 ]. In young or pregnant patients with equivocal fi ndings of a cholecystitis, MRI is preferred to CT owing to its lack of ionizing radiation [ 23 ]. On MRI, acute cholecystitis is typically characterized by a distended gallbladder with a thickened, hyperenhancing wall, gallstones, pericholecystic fl uid, and pericholecystic fat signal intensity changes (Figs.…”

“…On MRI, acute cholecystitis is typically characterized by a distended gallbladder with a thickened, hyperenhancing wall, gallstones, pericholecystic fl uid, and pericholecystic fat signal intensity changes (Figs. 6.27 and 6.28 ) [ 23 ]. Less common but highly specifi c fi ndings for acute cholecystitis include intraluminal membranes and wall irregularity, indicating a gangrenous or necrotic gallbladder, and pericholecystic abscess.…”

“…Less common but highly specifi c fi ndings for acute cholecystitis include intraluminal membranes and wall irregularity, indicating a gangrenous or necrotic gallbladder, and pericholecystic abscess. The presence of gallbladder wall hyperenhancement and the presence of focal transient liver enhancement adjacent to the gallbladder are highly specifi c fi ndings (92 % for both) with moderate sensitivity for differentiating acute cholecystitis from chronic cholecystitis on MRI [ 23 ]. On cholescintigraphy, biliary excretion of radioisotope in the …”

“…Patients may be asymptomatic or may have a history of recurrent episodes of acute cholecystitis or biliary colic [ 29 ]. The fi ndings of acute and chronic cholecystitis may overlap on imaging, clinically and even histopathologically [ 23 ].…”

“…MRI is moderately specifi c (69 %) for differentiating acute cholecystitis from chronic cholecystitis. The most useful and discriminative fi ndings are increased gallbladder wall enhancement and increased transient pericholecystic hepatic enhancement, frequently present in acute cholecystitis but not seen in chronic cholecystitis [ 23 ]. The specifi c diagnosis may require cholescintigraphy and correlation with clinical fi ndings [ 21 , 28 ].…”