Cross-Sectional Imaging of Acute and Chronic Gallbladder Inflammatory Disease

Smith, Ethan A.; Dillman, Jonathan R.; Elsayes, Khaled M.; Menias, Christine O.; Bude, Ronald O.

doi:10.2214/ajr.07.3803

Cited by 127 publications

(95 citation statements)

References 45 publications

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“…Ancillary findings such as pneumobilia are more likely to be detected on CT. Specific findings that suggest gangrenous cholecystitis include foci of gas within the gallbladder wall, lack of gallbladder wall enhancement (focal or diffuse), mural striation, intraluminal membranes, pericholecystic abscess formation, and adjacent hepatic parenchyma hyperenhancement [8]. Bennet et al [6] in their comparative study of CT and ultrasonography on 13 patients with GBP detected the site of perforation in 50 % of patients on CT, but in no patient on ultrasonography.…”

Section: Discussionmentioning

confidence: 99%

“…Abnormally hyperintense areas of fat-suppressed T1-and T2-weighted signal within and adjacent to the gallbladder wall on MR cholangiopancreatography suggest possible perforation in the setting of acute cholecystitis. Causes for such areas of signal abnormality include gallbladder wall ulceration, intramural hemorrhage, mural necrosis, and abscess formation [8]. Contrast-enhanced MR imaging more clearly delineates the wall disruption.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis of Gallbladder Perforation—a Puzzle!

et al. 2013

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Gallstone disease is common and complications frequently encountered include acute cholecystitis, acute pancreatitis, and cholangitis, but gallbladder perforation (GBP) is rare. A definitive diagnosis is uncommon before surgery and morbidity and mortality associated with this condition are high. Reported incidence ranges between 2 and 10.6 % in patients with acute cholecystitis but is higher in patients managed conservatively. We report here five patients with GBP to show the difficulty in making an early diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnosis of Gallbladder Perforation—a Puzzle!

et al. 2013

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“…These data indicate that the detection of wall thickening by DWIBS/T2 make it an effective method in the evaluation and diagnosis of acute cholecystitis. The sensitivity of abdominal US in the diagnosis of acute cholecystitis is 37.5-91% (25,26), while the sensitivity of CT is 83% (25). In the current study, the sensitivity of DWIBS/ T2 in the diagnosis of acute cholecystitis was 90.9%.…”

Section: Discussionmentioning

confidence: 44%

Diffusion-weighted whole-body magnetic resonance imaging with background body signal suppression/T2 image fusion for the diagnosis of acute cholecystitis

Tomizawa

Shinozaki

Tanaka

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. Prompt and accurate diagnosis is critical in the treatment of acute cholecystitis. Diffusion-weighted whole-body magnetic resonance imaging with background body signal suppression/T2 image fusion (DWIBS/T2) identifies areas with high signal intensity, corresponding to inflammation. In the present study, the records and images of patients with acute cholecystitis who underwent DWIBS/T2 between January 2013 and March 2014 were retrospectively analyzed. A total of 11 patients with acute cholecystitis were enrolled. In one patient, DWIBS/T2 identified a thickened wall and high signal intensity, with high signal intensity in the pericholecystic space that suggested localized peritonitis. Positive DWIBS/T2 results indicating acute cholecystitis were obtained in 10/11 patients, with a sensitivity of 90.9%. In addition, wall thickening and high signal intensity were absent in DWIBS/T2 images when wall thickening was not detected by computed tomography. Wall thickening and high signal intensity was attenuated when patients with acute cholecystitis were clinically treated. These data suggest that a thickened gallbladder wall and high signal intensity are indicative of acute cholecystitis and that DWIBS/T2 may be a useful technique in evaluating the severity of acute cholecystitis. IntroductionAcute cholecystitis is characterized by inflammation of the gallbladder and typically occurs due to obstruction of the gallbladder neck or cystic duct by a gallstone (1). Gallbladder infection may also spread to the liver or pericholecystic cavity and lead to the development of liver abscesses or peritonitis, respectively (2-4). Therefore, prompt treatment with cholecystectomy, percutaneous transhepatic gallbladder drainage or aspiration is typically recommended following diagnosis of acute cholecystitis (5-7). Accurate diagnosis is also critical for the appropriate management of acute cholecystitis (8).Diffusion-weighted whole-body magnetic resonance imaging with background body signal suppression (DWIBS) is based on a diffusion-weighted imaging (DWI) technique, which enables visualization of the random movement of water molecules (Brownian motion) for diagnostic imaging (9). Images are acquired with DWIBS during free breathing of the patient through the use of multiple-signal averaging, fat suppression and heavy diffusion weighting (10). In particular, a high signal intensity of DWIBS is a positive indicator of cancer and inflammation. An advantage of DWIBS over DWI is that it exhibits positive signals with strong contrast against surrounding normal tissues. However, the evaluation of positive signals to obtain anatomical information becomes difficult when signals in the surrounding tissues are suppressed (11,12). Images obtained from DWIBS are fused with their corresponding T2-weighted images using a workstation (13-15). DWIBS and T2-weighted image fusion (DWIBS/T2) enables anatomical evaluation of the positive signals obtained from DWIBS (16). Therefore, the present study retrospectively analyzed images obtained by DWIB...

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“…Imaging modalities, especially ultrasonography and cholescintigraphy, have been considered the most reliable method for the diagnosis of AAC. Among sonographic findings, increased thickness of the gallbladder wall (≥ 3-5 mm), recognizable striation, pericholecystic fluid, presence of sludge and a positive sonographic Murphy's sign have been considered diagnostic (Smith et al, 2009). …”

Section: Discussionmentioning

confidence: 99%

Acalculous Cholecystitis or Biliary Dyskinesia for Epstein-Barr Virus Gallbladder Involvement?

et al. 2014

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Abstract:We present two patients with Epstein-Barr virus (EBV) infection related to gallbladder involvement. Such an association is already known as EBV induced acalculous cholecystitis, diagnosed on the basis of ultrasonographic findings. In our patients, radioisotopic cholescintigraphy was also performed and it showed that gallbladder was visualized in both patients in contrast to that what can be observed in cases of cholecystitis. However, the value of ejection fraction was compatible with biliary dyskinesia. We, therefore, consider that impaired gallbladder contractility in EBV infection cases may actually represent biliary dyskinesia and not acalculous cholecystitis taking into account the radioisotopic findings and the self limited course of the disorder.Mailing Address:

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Cross-Sectional Imaging of Acute and Chronic Gallbladder Inflammatory Disease

Cited by 127 publications

References 45 publications

Diagnosis of Gallbladder Perforation—a Puzzle!

Diagnosis of Gallbladder Perforation—a Puzzle!

Diffusion-weighted whole-body magnetic resonance imaging with background body signal suppression/T2 image fusion for the diagnosis of acute cholecystitis

Acalculous Cholecystitis or Biliary Dyskinesia for Epstein-Barr Virus Gallbladder Involvement?

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