RSNA Education Exhibits

Abstract

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.

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. Crossref, Google 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, Medline, Google 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, Medline, Google Scholar
10 MoriyasuF, Ban N, Nishida O, et al. Central signals of gallstones in magnetic resonance imaging. Am J Gastroenterol1987; 82: 139–142. Medline, Google 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, Medline, Google 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, Medline, Google 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. Link, Google 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, Medline, Google 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, Medline, Google 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, Medline, Google 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. Link, Google 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, Medline, Google 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, Medline, Google 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, Medline, Google 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, Medline, Google Scholar
24 KimPN, Outwater EK, Mitchell DG. Mirizzi syndrome: evaluation by MRI imaging. Am J Gastroenterol1999; 94: 2546–2550. Crossref, Medline, Google Scholar
25 RosPR, Goodman ZD. Xanthogranulomatous cholecystitis versus gallbladder carcinoma. Radiology1997; 203: 10–12. Link, Google 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. Link, Google Scholar
27 ChunKA, Ha HK, Yu ES, et al. Xanthogranulomatous cholecystitis: features with emphasis on differentiation from gallbladder carcinoma. Radiology1997; 203: 93–97. Link, Google 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, Medline, Google 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, Medline, Google 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, Medline, Google 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. Link, Google Scholar
34 KimMJ, Oh YT, Park YN, et al. Gallbladder adenomyomatosis: findings on MRI. Abdom Imaging1999; 24: 410–413. Crossref, Medline, Google Scholar
35 BartlettDL. Gallbladder cancer. Semin Surg Oncol2000; 19: 145–155. Crossref, Medline, Google 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. Link, Google 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, Medline, Google Scholar
40 KalraN, Suri S, Gupta R, et al. MDCT in the staging of gallbladder carcinoma. AJR Am J Roentgenol2006; 186: 758–762. Crossref, Medline, Google Scholar
41 RooholaminiSA, Tehrani NS, Razavi MK, et al. Imaging of gallbladder carcinoma. RadioGraphics1994; 14: 291–306. Link, Google Scholar
42 StroszczynskiC, Hunerbein M. Malignant biliary obstruction: value of imaging findings. Abdom Imaging2005; 30: 314–323. Crossref, Medline, Google 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, Medline, Google Scholar
44 WilburAC, Sagireddy PB, Aizenstein RI. Carcinoma of the gallbladder: color Doppler ultrasound and CT findings. Abdom Imaging1997; 22: 187–189. Crossref, Medline, Google 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, Medline, Google Scholar
46 KimMJ, Kim KW, Kim HC, et al. Unusual malignant tumors of the gallbladder. AJR Am J Roentgenol2006; 187: 473–480. Crossref, Medline, Google 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, Medline, Google 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, Medline, Google 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. Medline, Google 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, Medline, Google 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, Medline, Google 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. Medline, Google 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, Medline, Google 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, Medline, Google 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, Medline, Google 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, Medline, Google 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, Medline, Google Scholar
59 WardJ, Sheridan MB, Guthrie JA, et al. Bile duct strictures after hepatobiliary surgery: assessment with MR cholangiography. Radiology2004; 231: 101–108. Link, Google 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, Medline, Google 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, Medline, Google Scholar

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Published in print: Jan 2008

Vol. 28, No. 1

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