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

Abstract

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...

Helicobacter pyloriCagA Promotes the Formation of Gallstones by Increasing the Permeability of Gallbladder Epithelial Cells

“…Although all factors that can cause an imbalance in the ratio of cholesterol to bile acid phospholipids or bile stasis are considered to be inducers of gallstone formation, the mechanism of gallstone formation is not yet fully understood. It is noteworthy that the vast majority of gallstone formations are accompanied by gallbladder inflammation [15]. On the contrary, gallbladder stones and gallbladder inflammation diseases are common diseases associated with gallbladder motility disorders.…”

Diffusion-weighted whole-body magnetic resonance imaging with background body signal suppression was useful in a patient with isolated myocardial abscess confined to the right atrial wall: a case report

“…DWIBS is noninvasive, avoids radiation exposure, and allows imaging even in patients with poor renal function. In addition, the high signal detected by DWIBS decreases as inflammation improves, which is considered an indicator of inflammatory activity [ 10 , 19 ]. Given the lack of reported cases regarding the use of DWIBS for diagnosing isolated myocardial abscesses, it is imperative to explore the sensitivity and specificity of this diagnostic modality in future studies.…”

“…Given the lack of reported cases regarding the use of DWIBS for diagnosing isolated myocardial abscesses, it is imperative to explore the sensitivity and specificity of this diagnostic modality in future studies. Previous research has reported that the sensitivity of abdominal ultrasound and DWIBS in diagnosing acute cholecystitis to range from 37.5 to 91%, and 90.9% respectively [ 19 ]. In the present case, contrast-enhanced CT was used to monitor the abscess due to normal renal function and lower imaging frequency.…”

Comparison of emergency cholecystectomy and delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with acute cholecystitis: a systematic review and meta-analysis

“…Percutaneous transhepatic gallbladder drainage (PTGBD), which was first applied by Radder in 1980 [ 11 ], is a minimally invasive operation performed to relieve gallbladder tension through external drainage under ultrasound or CT guidance [ 3 ]. According to the 2018 Tokyo guidelines for drainage management of AC, PTGBD can alleviate inflammation caused by edema of the gallbladder wall and pericholecystic adhesions, and it has the advantage of a lower risk of adverse events compared with cholecystectomy, which is an alternative to surgical treatment in high-risk AC patients [ 6 , 12 , 13 ]. Previous studies have reported that LC performed after PTGBD has several advantages, such as early symptom remission, surgery facilitation and patient stabilization [ 14 – 16 ].…”