Cholelithiasis full description radiology

Radiological representation of cholelithiasis

1. KAZAKH NATIONAL MEDICAL UNIVERSITY NAMED AFTER S.D. ASFENDYAROVA Almaty - 2023 Radiological semiotics of cholelithiasis

2. Plan 2 KazNMU named after . S.D.ASFENDIYAROVA Definition Pathogenesis Classification Anatomy of the gallbladder Diagnostic methods Radiological semiotics Differential diagnosis Recommendations

3. Cholelithiasis (cholelithiasis, or, as they are incorrectly called, gallstones) 3 KazNMU named after . S.D.ASFENDIYAROVA This is a disease associated with a disorder in the metabolism of cholesterol and bilirubin , resulting in the formation of stones in the gall bladder ( cholecystolithiasis ) and/or in the bile ducts ( choledocholithiasis ).

4. 4 KazNMU named after . S.D.ASFENDIYAROVA mixed Types of gallstones pigmented cholesterol

5. 5 KazNMU named after . S.D.ASFENDIYAROVA Anatomy of the gallbladder and bile ducts neck of the gallbladder cystic duct gallbladder body common bile duct common hepatic duct sphincter muscles bottom of the gallbladder hepatopancreatic ampulla pancreatic duct

6. FREQUENT LOCALIZATION OF STONES 6 KazNMU named after . S.D.ASFENDIYAROVA gallstone location options this moving stone periodically wedges into the mouth of the gallbladder causes biliary colic stones in the intrahepatic bile ducts are rare cystic duct stone stones in the common bile duct - the cause of jaundice stones in gallbladder this stone simultaneously blocks both the common bile duct and the pancreatic duct

7. Research methods 7 KazNMU named after . S.D.ASFENDIYAROVA Ultrasound (gold standard) Radiography CT MRI Endoscopic retrograde cholangiopancreatography

8. Ultrasound semiotics of cholelithiasis 8 KazNMU named after . S.D.ASFENDIYAROVA A highly reflective echogenic focus in the lumen of the gallbladder , usually with pronounced posterior acoustic shadowing, regardless of the type of pathology (acoustic shadowing is independent of the composition and calcium content) Gravity- dependent movement is often observed when the patient changes position ( RollingStone sign )

9. 9 KazNMU named after . S.D.ASFENDIYAROVA Color Doppler can demonstrate Shimmering artifact and especially useful for identifying small stones

10. 10 KazNMU named after . S.D.ASFENDIYAROVA An accumulation of stones is detected in the neck of the gallbladder , casting an acoustic shadow Multiple floating Gallbladder stones .

11. 11 KazNMU named after . S.D.ASFENDIYAROVA Radiography X-ray data of stones in Gallbladder ( cholelithiasis ): • X-ray contrast pigment stones: 50% • Radiopaque cholesterol stones: 5%

12. CT scan for gallstones 12 KazNMU named after . S.D.ASFENDIYAROVA CT without contrast enhancement : -Calcareous stones of the gallbladder have a greater density compared to bile -Pure cholesterol stones have a lower density; There is an inverse relationship between cholesterol levels and X-ray attenuation: -May have the same density as bile and not be detected on CT -The central part of the stone may contain nitrogen gas: a symptom of the Mercedes-Benz

13. 13 KazNMU named after . S.D.ASFENDIYAROVA On an axial computed tomogram without contrast, a cluster of layered and faceted stones is determined in the gallbladder .

14. 14 KazNMU named after . S.D.ASFENDIYAROVA In a patient with acute calculous cholecystitis on the axial A computed tomogram with contrast shows thickening of the gallbladder wall and calcified stones.

15. 15 KazNMU named after . S.D.ASFENDIYAROVA ABDOMEB CT WITH CONTRAST The patient's sagittal computed tomogram and 3D reconstruction reveal a large calcified calculus.

16. 16 KazNMU named after . S.D.ASFENDIYAROVA MRI FOR GALLBLADDER STONES T1 – pigmented stones ( hyperintense ) - cholesterol stones ( hypointense ) • T2-VI: A small focus of absent or weak signal limited to highly echogenic bile within the gallbladder • MRcholangiopancreatography : Round lesions of absence of intragallbladder

17. 17 KazNMU named after . S.D.ASFENDIYAROVA Axial T2 HASTE in a slightly thickened gallbladder, multiple stones giving a weak signal are determined.

18. 18 KazNMU named after . S.D.ASFENDIYAROVA Small area of absent or weak signal limited to highly echogenic bile, inside the gallbladder

19. 19 KazNMU named after . S.D.ASFENDIYAROVA MR tomograms in the axial and frontal planes. Cholelithiasis. Gallstones in the gallbladder cavity are characterized by a lack of signal within the gallbladder on T2-VI and STIR

20. 20 KazNMU named after . S.D.ASFENDIYAROVA Endoscopic retrograde cholangiopancreatography Mobile filling defects inside Contrast-filled gallbladder blisters and stones in the extrahepatic bile ducts ERCP sensitivity 68 - 93% tubular stenosis of the common bile duct with reflux of contrast into the main hepatic duct against the background of cholelithiasis expansion of the pancreatic duct and branches of the 2nd and 3rd order, uneven contours of the duct and branches

21. 21 KazNMU named after . S.D.ASFENDIYAROVA Forforan gallbladder General characteristics: • Best diagnostic criterion: o Calcification in the form of a curved “rim” in the right hypochondrium, resembling the shape of a gallbladder • Morphology: Two options: - Limited mucosal calcification: high risk of malignancy - Diffuse wall calcification: low risk of malignancy

22. 22 KazNMU named after . S.D.ASFENDIYAROVA DIFFERENTIAL DIAGNOSTICS Gallbladder polyp Bladder bile sludge Gallbladder carcinoma Focal adenomyomatosis Parasitic infestation of the gallbladder Intestinal gases Emphysematous cholecystitis

23. 23 KazNMU named after . S.D.ASFENDIYAROVA VISUALIZATION GUIDELINES: Ultrasound is the best imaging modality for evaluating patients with upper abdominal pain/discomfort. ➢When evaluating patients with pain/discomfort in the upper right quadrant of the abdomen after a fatty meal, especially middle-aged obese women , remember the likely presence of cholelithiasis ➢Tips for interpreting images: the acoustic shadow they cast is of great importance - Stones that do not cast a shadow can be mistaken for other formations of the gallbladder, for example, polyp, sludge , carcinoma - Shrinking, stone-filled gallbladder: assess for wall-echo-shadow sign or examine interlobar fissure

24. Thank you for attention! ​Mr. Almaty, st. Tole bi, 94 [phone] www.kaznmu.kz [email protected] KAZAKH NATIONAL MEDICAL UNIVERSITY NAMED AFTER S.D. ASFENDYAROVA ​@ kaznmu https:// www.facebook.com/KazNMU https://www.youtube.com/kaznmu _