MR Imaging of Acute Biliary Disorders

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In patients with acute right-sided epigastric pain, jaundice, and a high fever, it is essential to accurately diagnose the cause of the symptoms, differentiate acute biliary disorders from nonbiliary disorders, and evaluate the severity of the disease. Gray-scale ultrasonography (US) and computed tomography (CT) are useful primary imaging modalities, but their results are not always conclusive. Magnetic resonance (MR) imaging, including MR cholangiopancreatography, can be a valuable complement to US and CT when additional information is needed. MR images have excellent tissue contrast and can provide more specific information, allowing diagnosis of complications that arise from acute cholecystitis, such as empyema, gangrenous cholecystitis, gallbladder perforation, enterocholecystic fistula, emphysematous cholecystitis, and hemorrhagic cholecystitis. In addition, causes of obstructive jaundice, acute suppurative cholangitis, and hemobilia can be clearly demonstrated with multisequence MR imaging. Single-section MR cholangiopancreatography and heavily T2-weighted imaging, in combination with fat-suppressed T1- and T2-weighted imaging, provide comprehensive and detailed information about the biliary system around the obstruction site, biliary calculi, inflammatory processes, purulent material, abscesses, gas, and hemorrhage. Contrast-enhanced MR imaging is useful for evaluation of the gallbladder wall; lack of enhancement and disruption of the wall may be findings specific for gangrenous cholecystitis and gallbladder perforation, respectively.

© RSNA, 2007


  • 1 WilsonJD, Braunwald E, Isselbacher KJ, et al. Acute and chronic cholecystitis. In: Harrison TR, Wilson JD, eds. Harrison’s principles of internal medicine. 12th ed. New York, NY: McGraw-Hill, 1991; 1362–1365. Google Scholar
  • 2 HanbidgeAE, Buckler PM, O’Malley ME, Wilson SR. Imaging evaluation for acute pain in the right upper quadrant. RadioGraphics2004; 24: 1117–1135. LinkGoogle Scholar
  • 3 BennettGL, Balthazar EJ. Ultrasound and CT evaluation of emergent gallbladder pathology. Radiol Clin North Am2003; 41: 1203–1216. Crossref, MedlineGoogle Scholar
  • 4 GoreRM, Yaghmai V, Newmark GM, et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin North Am2002; 40: 1307–1323. Crossref, MedlineGoogle Scholar
  • 5 ChoKS, Beak SY, Kang BC, et al. Evaluation of preoperative sonography in acute cholecystitis to predict technical difficulties during laparoscopic cholecystectomy. J Clin Ultrasound2004; 32: 115–122. Crossref, MedlineGoogle Scholar
  • 6 AlobaidiM, Gupta R, Jafri SZ, et al. Current trends in imaging evaluation of acute cholecystitis. Emerg Radiol2004; 10: 256–258. Crossref, MedlineGoogle Scholar
  • 7 AdusumilliS, Siegelman ES. MR imaging of the gallbladder. Magn Reson Imaging Clin N Am2002; 10: 165–184. Crossref, MedlineGoogle Scholar
  • 8 Cohen-SolalC, Parquet M, Tiffon B, et al. Magnetic resonance imaging for the visualization of cholesterol gallstones in hamster fed a new high sucrose lithogenic diet. J Hepatol1995; 22: 486–494. Crossref, MedlineGoogle Scholar
  • 9 DavidV, Reinhold C, Hochman M, et al. Pitfalls in the interpretation of MR cholangiopancreatography. AJR Am J Roentgenol1998; 170: 1055–1059. Crossref, MedlineGoogle Scholar
  • 10 FulcherAS, Turner MA, Capps GW. MR cholangiography: technical advances and clinical applications. RadioGraphics1999; 19: 25–44. LinkGoogle Scholar
  • 11 WatanabeY, Dohke M, Ishimori T, et al. High-resolution MR cholangiopancreatography. Crit Rev Diagn Imaging1998; 39(2–3): 115–258. Crossref, MedlineGoogle Scholar
  • 12 BarishMA, Soto JA. MR cholangiopancreatography: techniques and clinical applications. AJR Am J Roentgenol1997; 169: 1295–1303. Crossref, MedlineGoogle Scholar
  • 13 WatanabeY, Dohke M, Ishimori T, et al. Diagnostic pitfalls of MR cholangiopancreatography in the evaluation of the biliary tract and gallbladder. RadioGraphics1999; 19: 415–429. LinkGoogle Scholar
  • 14 VitellasKM, Keogan MT, Spritzer CE, Nelson RC. MR cholangiopancreatography of bile and pancreatic duct abnormalities with emphasis on the single-shot fast spin-echo technique. RadioGraphics2000; 20: 939–957. LinkGoogle Scholar
  • 15 ReganF, Schaefer DC, Smith DP, et al. The diagnostic utility of HASTE MRI in the evaluation of acute cholecystitis: half-Fourier acquisition single-shot turbo SE. J Comput Assist Tomogr1998; 22: 638–642. Crossref, MedlineGoogle Scholar
  • 16 van den BrinkJS, Watanabe Y, Kuhl CK, et al. Implications of SENSE MR in routine clinical practice. Eur J Radiol2003; 46: 3–27. Crossref, MedlineGoogle Scholar
  • 17 WatanabeY, Nagayama M, Okumura A, et al. Black-blood T2-weighted SE-EPI imaging of the liver and the biliary tree. Recent Res Devel Radiol2004; 2: 1–16. Google Scholar
  • 18 PerelesFS, McCarthy RM, Baskaran V, et al. Thoracic aortic dissection and aneurysm: evaluation with nonenhanced true-FISP MR angiography in less than 4 minutes. Radiology2002; 223: 270–274. LinkGoogle Scholar
  • 19 VasanawalaSS, Pauly MJ, Nishimura GD. Linear combination steady-state free precession MRI. Magn Reson Med2000; 43: 82–90. Crossref, MedlineGoogle Scholar
  • 20 ItoK, Fujita N, Noda Y, et al. The significance of magnetic resonance cholangiopancreatography in acute cholecystitis [in Japanese]. Nippon Shokakibyo Gakkai Zasshi2000; 97: 1472–1479. MedlineGoogle Scholar
  • 21 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
  • 22 ParkMS, Yu JS, Kim YH, et al. Acute cholecystitis: comparison of MR cholangiography and US. Radiology1998; 209: 781–785. LinkGoogle Scholar
  • 23 LoudPA, Semelka RC, Kettritz U, et al. MRI of acute cholecystitis: comparison with the normal gallbladder and other entities. Magn Reson Imaging1996; 14: 349–355. Crossref, MedlineGoogle Scholar
  • 24 WeisslederR, Stark DD, Compton CC, et al. Cholecystitis: diagnosis by MR imaging. Magn Reson Imaging1988; 6: 345–348. Crossref, MedlineGoogle Scholar
  • 25 HakanssonK, Leander P, Ekberg O, Hakansson HO. MR imaging in clinically suspected acute cholecystitis: a comparison with ultrasonography. Acta Radiol2000; 41: 322–328. Crossref, MedlineGoogle Scholar
  • 26 AhmadMM, Macon WL. Gangrene of the gall-bladder. Am Surg1983; 49: 155–158. MedlineGoogle Scholar
  • 27 CotranRS, Kumar V, Robbins SL. Pathologic basis of disease. 4th ed. Philadelphia, Pa: Saunders, 1989. Google Scholar
  • 28 JeffreyRB, Laing FC, Wong W, Callen PW. Gangrenous cholecystitis: diagnosis by ultrasound. Radiology1983; 148: 219–221. LinkGoogle Scholar
  • 29 VarmaDG, Faust JM. Computed tomography of gangrenous acute postoperative acalculous cholecystitis. J Comput Tomogr1988; 12: 29–31. Crossref, MedlineGoogle Scholar
  • 30 BennettGL, Rusinek H, Lisi V, et al. CT findings in acute gangrenous cholecystitis. AJR Am J Roentgenol2002; 178: 275–281. Crossref, MedlineGoogle Scholar
  • 31 StrohlEL, Diffenbaugh WG, Baker JH, Chemma MH. Collective reviews: gangrene, and perforation of the gallbladder. Int Abstr Surg1962; 114: 1–7. Google Scholar
  • 32 NeimeierOW. Acute free perforation of the gall-bladder. Ann Surg1934; 99: 922–924. Crossref, MedlineGoogle Scholar
  • 33 FletcherAG, Ravdin IS. Perforation of the gall-bladder. Am J Surg1951; 81: 178–185. Crossref, MedlineGoogle Scholar
  • 34 MadrazoBL, Francis I, Hricak H, Sandler MA, Hudak S, Gitschlag K. Sonographic findings in perforation of the gallbladder. AJR Am J Roentgenol1982; 139: 491–496. Crossref, MedlineGoogle Scholar
  • 35 SoodBP, Kalra N, Gupta S, et al. Role of sonography in the diagnosis of gallbladder perforation. J Clin Ultrasound2002; 30: 270–274. Crossref, MedlineGoogle Scholar
  • 36 KimPN, Lee KS, Kim IY, Bae WK, Lee BH. Gallbladder perforation: comparison of US findings with CT. Abdom Imaging1994; 19: 239–242. Crossref, MedlineGoogle Scholar
  • 37 SoodB, Jain M, Khandelwal N, et al. MRI of perforated gallbladder. Australas Radiol2002; 46: 438–440. Crossref, MedlineGoogle Scholar
  • 38 PedrosaI, Guarise A, Goldsmith J, Procacci C, Rofsky NM. The interrupted rim sign in acute cholecystitis: a method to identify the gangrenous form with MRI. J Magn Reson Imaging2003; 18: 360–363. Crossref, MedlineGoogle Scholar
  • 39 HegnerCF. Gaseous pericholecystitis with chole-cystitis and cholelithiasis. Arch Surg1931; 22: 993–1000. CrossrefGoogle Scholar
  • 40 JacobH, Appelman R, Stein HD. Emphysematous cholecystitis. Am J Gastroenterol1979; 71: 325–330. MedlineGoogle Scholar
  • 41 MayRE, Strong R. Acute emphysematous cholecystitis. Br J Surg1971; 58: 453–458. Crossref, MedlineGoogle Scholar
  • 42 MentzerRM Jr, Golden GT, Chandler JG, Horsley JS. A comparative appraisal of emphysematous cholecystitis. Am J Surg1975; 129: 10–15. Crossref, MedlineGoogle Scholar
  • 43 GraysonDE, Abbott RM, Levy AD, Sherman PM. Emphysematous infections of the abdomen and pelvis: a pictorial review. RadioGraphics2002; 22: 543–561. LinkGoogle Scholar
  • 44 GillKS, Chapman AH, Weston MJ. The changing face of emphysematous cholecystitis. Br J Radiol1997; 70: 986–991. Crossref, MedlineGoogle Scholar
  • 45 KonnoK, Ishida H, Naganuma H, et al. Emphysematous cholecystitis: sonographic findings. Abdom Imaging2002; 27: 191–195. Crossref, MedlineGoogle Scholar
  • 46 BloomRA, Libson E, Lebensart PD, et al. The ultrasound spectrum of emphysematous cholecystitis. J Clin Ultrasound1989; 17: 251–256. Crossref, MedlineGoogle Scholar
  • 47 JenkinsM, Golding RH, Cooperberg PL. Sonography and computed tomography of hemorrhagic cholecystitis. AJR Am J Roentgenol1983; 140: 1197–1198. Crossref, MedlineGoogle Scholar
  • 48 MoskosMM, Eschelman DJ. Abdominal case of the day: hemorrhagic cholecystitis. AJR Am J Roentgenol1991; 156: 1304–1305. Crossref, MedlineGoogle Scholar
  • 49 AibeH, Honda H, Kuroiwa T, et al. Gallbladder torsion: case report. Abdom Imaging2002; 27: 51–53. Crossref, MedlineGoogle Scholar
  • 50 UsuiM, Matsuda H, Suzuki H, Ogura Y. Preoperative diagnosis of gallbladder torsion by magnetic resonance cholangiopancreatography. Scand J Gastroenterol2000; 35: 218–222. Crossref, MedlineGoogle Scholar
  • 51 BeckerCD, Grossholz M, Becker M, Mentha G, de Peyer R, Terrier F. Choledocholithiasis and bile duct stenosis: diagnostic accuracy of MR cholangiopancreatography. Radiology1997; 205: 523–530. LinkGoogle Scholar
  • 52 KimPN, Outwater EK, Mitchell DG. Mirizzi syndrome: evaluation by MR imaging. Am J Gastroenterol1999; 94: 2546–2550. Crossref, MedlineGoogle Scholar
  • 53 MatthewsBD, Sing RF, Heniford BT. Magnetic resonance cholangiopancreatographic diagnosis of Mirizzi’s syndrome. J Am Coll Surg2000; 190: 630. Crossref, MedlineGoogle Scholar
  • 54 DoaiK, Uchiyama K, Kuniyasu Y, Saisyo H. MR cholangiopancreatography of Mirizzi syndrome and Lemmel syndrome [in Japanese]. Nippon Rinsho1998; 56: 2933–2938. MedlineGoogle Scholar
  • 55 SiegelJH. Endoscopic sphincterectomy in the management of cholangitis. In: Endoscopic retrograde cholangiopancreatography. New York, NY: Raven, 1992; 211–215. Google Scholar
  • 56 HanauLH, Steigbigel NH. Acute (ascending) cholangitis. Infect Dis Clin North Am2000; 14: 521–546. Crossref, MedlineGoogle Scholar
  • 57 HakanssonK, Ekberg O, Hakansson HO, Leander P. MR characteristics of acute cholangitis. Acta Radiol2002; 43(2): 175–179. Crossref, MedlineGoogle Scholar

Article History

Published in print: Mar 2007