MR Imaging of the Gallbladder: A Pictorial Essay

Published Online:https://doi.org/10.1148/rg.281065183

The gallbladder serves as the repository for bile produced in the liver. However, bile within the gallbladder may become supersaturated with cholesterol, leading to crystal precipitation and subsequent gallstone formation. The most common disorders of the gallbladder are related to gallstones and include symptomatic cholelithiasis, acute and chronic cholecystitis, and carcinoma of the gallbladder. Other conditions that can affect the gallbladder include biliary dyskinesia (functional), adenomyomatosis (hyperplastic), and postoperative changes or complications (iatrogenic). Ultrasonography (US) has been the traditional modality for evaluating gallbladder disease, primarily owing to its high sensitivity and specificity for both stone disease and gallbladder inflammation. US performed before and after ingestion of a fatty meal may also be useful for functional evaluation of the gallbladder. However, US is limited by patient body habitus, with degradation of image quality and anatomic detail in obese individuals. With the advent of faster and more efficient imaging techniques, magnetic resonance (MR) imaging has assumed an increasing role as an adjunct modality for gallbladder imaging, primarily in patients who are incompletely assessed with US. MR imaging allows simultaneous anatomic and physiologic assessment of the gallbladder and biliary tract in both initial evaluation of disease and examination of the postoperative patient. This assessment is accomplished chiefly through the use of MR imaging contrast agents excreted preferentially via the biliary system.

© RSNA, 2008

References

  • 1 ClementeD. Excretory apparatus of the liver. In: Clemente D, ed. Gray’s anatomy. 30th ed. Philadelphia, Pa: Williams & Wilkins, 1985; 1500–1502. Google Scholar
  • 2 SchneiderG, Grazioli L, Saini S. Imaging of the biliary tree and gallbladder diseases. In: Schneider G, Grazioli L, Saini S, eds. MRI of the liver. 2nd ed. Heidelberg, Germany: Springer, 2005; 237–266. Google Scholar
  • 3 SahaniDV, Kalva SP. Magnetic resonance imaging of the gallbladder. In: Edelman RR, Hesselink JR, Zlatkin MB, Crues VC, eds. Clinical magnetic resonance imaging. 3rd ed. Philadelphia, Pa: Saunders, 2005; 2541–2553. Google Scholar
  • 4 BaderTR, Semelka RC. Gallbladder and biliary system. In: Semelka RC, ed. Abdominal-pelvic MRI. 2nd ed. Hoboken, NJ: Wiley, 2006; 447–507. Google Scholar
  • 5 BoydenEA. The accessory gallbladder: an embryological and comparative study of aberrant biliary vesicles occurring in man and in domestic mammals. Am J Anat1926; 38: 177–231. CrossrefGoogle Scholar
  • 6 MilotL, Partensky C, Scoazec JY, Valette PJ, Pilleul F. Double gallbladder diagnosed on contrast-enhanced MR cholangiopancreatography with mangafodipir trisodium. AJR Am J Roentgenol2005; 184(3 suppl): S88–S90. Crossref, MedlineGoogle Scholar
  • 7 SherlockS, Dooley J. Gallstones and inflammatory gallbladder diseases. In: Sherlock S, Dooley J, eds. Diseases of the liver and biliary system. 11th ed. Malden, Mass: Blackwell, 2002; 597–628. Google Scholar
  • 8 HortonJD, Bilhartz LE. Gallstone disease and its complications. In: Fedelman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fortran’s gastrointestinal and liver disease: pathophysiology/diagnosis/management. 7th ed. Philadelphia, Pa: Saunders, 2003; 1065–1090. Google Scholar
  • 9 GoreRM, Yaghmai V, Newmark GM, Berlin JW, Miller FH. Imaging benign and malignant disease of the gallbladder. Radiol Clin North Am2002; 40: 1307–1323. Crossref, MedlineGoogle Scholar
  • 10 MoriyasuF, Ban N, Nishida O, et al. Central signals of gallstones in magnetic resonance imaging. Am J Gastroenterol1987; 82: 139–142. MedlineGoogle Scholar
  • 11 BaronRL, Shuman WP, Lee SP, et al. MR appearance of gallstones in vitro at 1.5T: correlation with chemical composition. AJR Am J Roentgenol1989; 153: 497–502. Crossref, MedlineGoogle Scholar
  • 12 TsaiHM, Lin XZ, Chen CY, Lin PW, Lin JC. MRI of gallstones with different compositions. AJR Am J Roentgenol2004; 182: 1513–1519. Crossref, MedlineGoogle Scholar
  • 13 JeffreyRB, Ralls PW. The gallbladder and bile ducts. In: Jeffrey RB, Ralls PW, eds. CT and sonography of the acute abdomen. Philadelphia, Pa: Lippincott-Raven, 1996; 74–121. Google Scholar
  • 14 ParkMS, Yu JS, Kim YH, et al. Acute cholecystitis: comparison of MR cholangiography and US. Radiology1998; 209: 781–785. LinkGoogle Scholar
  • 15 OhKY, Gilfeather M, Kennedy A, et al. Limited abdominal MRI in the evaluation of acute right upper quadrant pain. Abdom Imaging2003; 28: 643–651. Crossref, MedlineGoogle Scholar
  • 16 PedrosaI, Guarise A, Goldsmith J, Procacci C, Rofsky NM. The interrupted sign in acute cholecystitis: a method to identify the gangrenous form with MRI. J Magn Reson Imaging2003; 18: 360–363. Crossref, MedlineGoogle Scholar
  • 17 LoudPA, Semelka RC, Kettritz U, Brown JJ, Reinhold C. MRI of acute cholecystitis: comparison with normal gallbladder and other entities. Magn Reson Imaging1996; 14: 349–355. Crossref, MedlineGoogle Scholar
  • 18 KimKW, Park MS, Yu JS, et al. Acute cholecystitis at T2-weighted and manganese-enhanced T1-weighted MR cholangiography: preliminary study. Radiology2003; 227: 580–584. LinkGoogle Scholar
  • 19 FayadLM, Holland GA, Bergin D, et al. Functional magnetic resonance cholangiography (fMRC) of the gallbladder and biliary tree with contrast-enhanced magnetic resonance cholangiography. J Magn Reson Imaging2003; 18: 449–460. Crossref, MedlineGoogle Scholar
  • 20 MirizziPL. Syndrome del conduct epatico. J Int Chir1948; 8: 731–737. Google Scholar
  • 21 FanST, Lan WY, Lee MJR, Wong KK. Chole-cysto-hepaticodochal fistula: the value of preoperative recognition. Br J Surg1985; 72: 743–744. Crossref, MedlineGoogle Scholar
  • 22 KoehlerRE, Melson GL, Lee JK, Long J. Common hepatic duct obstruction by cystic duct stone: Mirizzi syndrome. AJR Am J Roentgenol1979; 132: 1007–1009. Crossref, MedlineGoogle Scholar
  • 23 BeckerCD, Hassler H, Terrier F. Preoperative diagnosis of the Mirizzi syndrome: limitations of sonography and computed tomography. AJR Am J Roentgenol1984; 143: 591–596. Crossref, MedlineGoogle Scholar
  • 24 KimPN, Outwater EK, Mitchell DG. Mirizzi syndrome: evaluation by MRI imaging. Am J Gastroenterol1999; 94: 2546–2550. Crossref, MedlineGoogle Scholar
  • 25 RosPR, Goodman ZD. Xanthogranulomatous cholecystitis versus gallbladder carcinoma. Radiology1997; 203: 10–12. LinkGoogle Scholar
  • 26 LevyAD, Murakata LA, Abbott RM, Rohrmann CA Jr. From the archives of the AFIP. Benign tumors and tumorlike lesions of the gallbladder and extrahepatic bile ducts: radiologic-pathologic correlation. RadioGraphics2002; 22: 387–413. LinkGoogle Scholar
  • 27 ChunKA, Ha HK, Yu ES, et al. Xanthogranulomatous cholecystitis: features with emphasis on differentiation from gallbladder carcinoma. Radiology1997; 203: 93–97. LinkGoogle Scholar
  • 28 KimPN, Lee SH, Gong GY, et al. Xanthogranulomatous cholecystitis: radiologic findings with histologic correlation that focuses on intramural nodules. AJR Am J Roentgenol1999; 172: 949–953. Crossref, MedlineGoogle Scholar
  • 29 ShutoR, Kiyosue H, Komatsu E, et al. CT and MR imaging findings of xanthogranulomatous cholecystitis: correlation with pathologic findings. Eur Radiol2004; 14: 440–446. Crossref, MedlineGoogle Scholar
  • 30 BilhartzLE. Acalculous cholecystitis, cholesterolosis, adenomyomatosis, and polyps of the gallbladder. In: Fedelman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fortran’s gastrointestinal and liver disease: pathophysiology/diagnosis/management. 7th ed. Philadelphia, Pa: Saunders, 2003; 1116–1128. Google Scholar
  • 31 YoshimitsuK, Honda H, Aibe H, et al. Radiologic diagnosis of adenomyomatosis of the gallbladder: comparative study among MRI, helical CT, and transabdominal US. J Comput Assist Tomogr2001; 25: 843–850. Crossref, MedlineGoogle Scholar
  • 32 YamaoK, Ohashi K. Adenomyomatosis and cholesterolosis. In: Okuda K, Mitchell DG, Itai Y, Ariyama J. Hepatobiliary diseases, pathophysiology and imaging. Malden, Mass: Blackwell, 2001; 711–720. Google Scholar
  • 33 HaradomeH, Ichikawa T, Sou H, et al. The pearl necklace sign: an imaging sign of adenomyomatosis of the gallbladder at MR cholangiopancreatography. Radiology2003; 227: 80–88. LinkGoogle Scholar
  • 34 KimMJ, Oh YT, Park YN, et al. Gallbladder adenomyomatosis: findings on MRI. Abdom Imaging1999; 24: 410–413. Crossref, MedlineGoogle Scholar
  • 35 BartlettDL. Gallbladder cancer. Semin Surg Oncol2000; 19: 145–155. Crossref, MedlineGoogle Scholar
  • 36 SohnTA, Lillemoe KD. Tumors of the gallbladder, bile ducts, and ampulla. In: Fedelman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fortran’s gastrointestinal and liver disease: pathophysiology/diagnosis/management. 7th ed. Philadelphia, Pa: Saunders, 2003; 1153–1164. Google Scholar
  • 37 LevyAD, Murakata LA, Rohrmann CA Jr. Gallbladder carcinoma: radiologic-pathologic correlation. RadioGraphics2001; 21: 295–314. LinkGoogle Scholar
  • 38 SherlockS, Dooley J. Tumours of the gallbladder and bile ducts. In: Sherlock S, Dooley J, eds. Diseases of the liver and biliary system. 11th ed. Malden, Mass: Blackwell, 2002; 647–656. Google Scholar
  • 39 SchwartzLH, Black J, Fong Y, et al. Gallbladder carcinoma: findings at MR imaging with MR cholangiopancreatography. J Comput Assist Tomogr2002; 26: 405–410. Crossref, MedlineGoogle Scholar
  • 40 KalraN, Suri S, Gupta R, et al. MDCT in the staging of gallbladder carcinoma. AJR Am J Roentgenol2006; 186: 758–762. Crossref, MedlineGoogle Scholar
  • 41 RooholaminiSA, Tehrani NS, Razavi MK, et al. Imaging of gallbladder carcinoma. RadioGraphics1994; 14: 291–306. LinkGoogle Scholar
  • 42 StroszczynskiC, Hunerbein M. Malignant biliary obstruction: value of imaging findings. Abdom Imaging2005; 30: 314–323. Crossref, MedlineGoogle Scholar
  • 43 DemachiH, Matsui O, Hoshiba K, et al. Dynamic MRI using a surface coil in chronic cholecystitis and gallbladder carcinoma: radiologic and histopathologic correlation. J Comput Assist Tomogr1997; 21: 643–651. Crossref, MedlineGoogle Scholar
  • 44 WilburAC, Sagireddy PB, Aizenstein RI. Carcinoma of the gallbladder: color Doppler ultrasound and CT findings. Abdom Imaging1997; 22: 187–189. Crossref, MedlineGoogle Scholar
  • 45 YoshimitsuK, Honda H, Jimi M, et al. MR diagnosis of adenomyomatosis of the gallbladder and differentiation from gallbladder carcinoma: importance of showing Rokitansky-Aschoff sinuses. AJR Am J Roentgenol1999; 172: 1535–1540. Crossref, MedlineGoogle Scholar
  • 46 KimMJ, Kim KW, Kim HC, et al. Unusual malignant tumors of the gallbladder. AJR Am J Roentgenol2006; 187: 473–480. Crossref, MedlineGoogle Scholar
  • 47 TsengJH, Wan YL, Hung CF, et al. Diagnosis and staging of gallbladder carcinoma: evaluation with dynamic MR imaging. Clin Imaging2002; 26: 177–182. Crossref, MedlineGoogle Scholar
  • 48 KimJH, Kim TK, Eun HW, et al. Preoperative evaluation of gallbladder carcinoma: efficacy of combined use of MR imaging, MR cholangiography, and contrast-enhanced dual-phase three-dimensional MR angiography. J Magn Reson Imaging2002; 16: 676–684. Crossref, MedlineGoogle Scholar
  • 49 BickelA, Eitan A, Tsilman B, Cohen HI. Low-grade B cell lymphoma of mucosa-associated lymphoid tissue (MALT) arising in the gallbladder. Hepatogastroenterology1999; 46: 1643–1646. MedlineGoogle Scholar
  • 50 ChimCS, Liang R, Loong F, Chung LP. Primary mucosa-associated lymphoid tissue lymphoma of the gallbladder. Am J Med2002; 112: 505–507. Google Scholar
  • 51 YamamotoT, Kawanishi M, Yoshiba H, Kanehira E, Itoh H. Primary non-Hodgkin’s lymphoma of the gallbladder. AJR Am J Roentgenol2005; 184: S86–S87. Crossref, MedlineGoogle Scholar
  • 52 InoueY, Komatsu Y, Yoshikawa K, et al. Biliary motor function in gallstone patients evaluated by fatty-meal MR cholangiography. J Magn Reson Imaging2003; 18: 196–203. Crossref, MedlineGoogle Scholar
  • 53 KoikeS, Ito K, Honjo K, Takano K, Yasui M, Matsunaga N. Oddi sphincter and common channel: evaluation with pharmacodynamic MR cholangiopancreatography using fatty meal and secretin stimulation. Radiat Med2000; 18: 115–122. MedlineGoogle Scholar
  • 54 KhalidTR, Casillas VJ, Montalvo BM, Centeno R, Levi JU. Using MR cholangiopancreatography to evaluate iatrogenic bile duct injury. AJR Am J Roentgenol2001; 177: 1347–1352. Crossref, MedlineGoogle Scholar
  • 55 ChaudharyA, Negi SS, Puri SK, Narang P. Comparison of magnetic resonance cholangiography and percutaneous transhepatic cholangiography in the evaluation of bile duct strictures after cholecystectomy. Br J Surg2002; 89: 433–436. Crossref, MedlineGoogle Scholar
  • 56 PavoneP, Laghi A, Catalano C, et al. MR cholangiography in the examination of patients with biliary-enteric anastomoses. AJR Am J Roentgenol1997; 169: 807–811. Crossref, MedlineGoogle Scholar
  • 57 VitellasKM, El-Dieb A, Vaswani KK, et al. Using contrast-enhanced MR cholangiography with IV mangafodipir trisodium (Teslascan) to evaluate bile duct leaks after cholecystectomy: a prospective study of 11 patients. AJR Am J Roentgenol2002; 179: 409–416. Crossref, MedlineGoogle Scholar
  • 58 HottatN, Winant C, Metens T, Bourgeois N, Deviere J, Matos C. MR cholangiography with manganese dipyridoxyl diphosphate in the evaluation of biliary-enteric anastomoses: preliminary experience. AJR Am J Roentgenol2005; 184: 1556–1562. Crossref, MedlineGoogle Scholar
  • 59 WardJ, Sheridan MB, Guthrie JA, et al. Bile duct strictures after hepatobiliary surgery: assessment with MR cholangiography. Radiology2004; 231: 101–108. LinkGoogle Scholar
  • 60 MorganB, Utting JF, Higginson A, Thomas AL, Steward WP, Horsfield MA. A simple, reproducible method for monitoring the treatment of tumours using dynamic contrast-enhanced MR imaging. Br J Cancer2006; 94: 1420–1427. Crossref, MedlineGoogle Scholar
  • 61 MuruganandhamM, Lupu M, Dyke JP, et al. Preclinical evaluation of tumor microvascular response to a novel antiangiogenic/antitumor agent RO0281501 by dynamic contrast-enhanced MRI at 1.5 T. Mol Cancer Ther2006; 5: 1950–1957. Crossref, MedlineGoogle Scholar

Article History

Published in print: Jan 2008