imaging works n gall bladder pathologies

RDAIOLOGICAL FINDINGS IN COMMON GALL BLADDER PATHOLOGIES

1. Imaging in a diseased gall bladder - Shravani Shinde JR II Radiology

2. COMMON GALL BLADDER PATHOLOGIES Acute Cholecystitis Chronic Cholecystitis Emphysematous Cholecystitis Mirizzi Syndrome Xanthogranulomatous Cholecystitis ( Xgc ) Porcelain Gallbladder Strawberry Gallbladder Gallbladder Mucocele Cholelithiasis Cholesterolosis Adenomyomatosis Gall Bladder Polyps

3. MALIGNANCY- Gall Bladder Carcinoma

4. INVESTIGATIONS USG – First line; Good for stones, cholecystitis. Sometimes, evaluation of CBD and biliary tree is difficult CT - Specially for complications, other causes of abdominal pain MRCP- radiolucent stone detected, better soft tissue resolution, CBD and biliary dilatation, suspected cholangitis

5. IMAGING OF A NORMAL GALL BLADDER Anatomy, variants Well-distended 4-6 hours fasting T2 hyperintense, T1 hypo/ hyperintense bile Uniformly thin wall < 3mm Suboptimally distended/ Contracted 

6.  PROFORMA/ STRUCTURED FORMAT Anatomy, variants GB distension Intraluminal contents GB wall Pericholecystic region GB fossa

7. Agenesis of the Gallbladder . Anomalies of Gallbladder Shape Phrygian Cap Multiseptate Gallbladder Diverticula . Abnormalities of Gallbladder Position Wandering Gallbladder Gallbladder Torsion Ectopic Gallbladder Gb wall thickening : Important in both benign and malignant conditions Pericholecystic region/ gb fossa Wall thickening: Diffuse/focal Asymmetric/symmetric Site of thickening Neck/body/fundus Mural layering layered/ non layered Intact/ulcerated/ ruptured Enhanicng /non enhancing Air/cysts/ calcifications within

8. The normal gallbladder wall appears as a pencil-thin echogenic line at sonography. The thickness of the gallbladder wall depends on the degree of gallbladder distention and pseudothickening can occur in the postprandial state

9. Thickened gallbladder wall Thickening of the gallbladder wall is a relatively frequent finding at diagnostic imaging studies. A thickened gallbladder wall measures more than 3 mm, typically has a layered appearance at sonography [1], and at CT frequently contains a hypodense layer of subserosal oedema that mimics pericholecystic fluid.

10. Cholelithsiasis

11. ACUTE CHOLECYSTITIS On T2-weighted images, the gallbladder wall may show increased signal intensity and thickening (3 mm). Pericholecystic fluid collections and edema of the surrounding liver tissue may be found . Periportal hyperintensity, although a nonspecific finding, may be observed on T2-weighted images. Although an inflammation-related increase in bile protein content may result in variable signal intensity of the bile on T1-weighted images, the bile usually appears markedly hypointense with T1-weighted sequences due to the impairment of gallbladder concentrating capability, which is typical of the acute inflammatory state. Contrast-enhanced fat-suppressed images demonstrate increased enhancement of the gallbladder wall, adjacent fat, and surrounding liver parenchyma (Fig 9). The “interrupted rim sign,” which is characterized by patchy enhancement of the gallbladder mucosa, represents areas of necrosis and is useful in identifying the gangrenous form of acute cholecystitis at MR imaging.

12. The gallbladder appears small and contracted, with irregular and thickened walls. After the administration of gadolinium-based contrast material, the gallbladder wall enhances less intensely than in acute cholecystitis. The enhancement is usually smooth, slow, and prolonged unlike in gallbladder carcinoma, in which it is usually irregular, early, and prolonged. CHRONIC CHOLECYSTITIS

13. ACALCULOUS CHOLECYSTITIS

14. XANTHOGRANULOMATOUS CHOLECYSTITIS

15. MIRIZZI SYNDROME The gallbladder wall is usually thickened. It has a smooth contour and enhances after contrast material administration. Whereas US and CT can usually demonstrate only the presence and level of biliary obstruction, MR cholangiopancreatography can further characterize the nature of the obstruction, define the burden of gallstones in the biliary tree, and help evaluate the cystic duct obstruction. Moreover, Contrast-enhanced MR imaging can demonstrate the inflammation of the gallbladder associated with Mirizzi syndrom

16. Adenomyomatosis is characterized by excessive proliferation of surface epithelium with deep and branching invaginations (Rokitansky- Aschoff sinuses) into the thickened tunica muscularis or beyond. MR imaging demonstrates the mural thickening and multiple intramural cystic components (Rokitansky- Aschoff sinuses). Adenomyomatosis can appear almost identical to a mass and may be difficult to distinguish from gallbladder malignancy. On contrast-enhanced images, the diffuse type shows early mucosal and subsequent serosal enhancement. The “string of beads sign,” the hallmark of adenomyomatosis at MR imaging, refers to highsignal -intensity foci in the gallbladder wall on T2- weighted images, findings that correspond to bilefilled Rokitansky- Aschoff sinuses. This sign is highly specific in diagnosing gallbladder adenomyomatosis versus gallbladder cancer. The sign may be absent in cases of small (3-mm) sinuses or sinuses filled with inspissated proteinaceous bile or small calculi; therefore, its sensitivity is only 62%. In approximately 70% of patients, the contrast enhancement pattern of adenomyomatosis is indistinguishable from that of gallbladder cancer .

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