Skip to main content

Advertisement

SpringerLink
Log in

Traveling gallstones: review of MR imaging and surgical pathology features of gallstone disease and its complications in the gallbladder and beyond

  • Review
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Gallstone-related disease comprises a spectrum of conditions resulting from biliary stone formation, leading to obstruction and inflammatory complications. These can significantly impact patient quality of life and carry high morbidity if not accurately detected. Appropriate imaging is essential for evaluating the extent of gallstone disease and assuring appropriate clinical management. Magnetic Resonance Imaging (MRI) techniques (including Magnetic Resonance Cholangiopancreatography (MRCP) are increasingly used for diagnosis of gallstone disease and its complications and provide high contrast resolution and facilitate tissue-level assessment of gallstone disease processes. In this review we seek to delve deep into the spectrum of MR imaging in diagnose of gallstone-related disease within the gallbladder and complications related to migration of the gallstones to the gall bladder neck or cystic duct, common hepatic duct or bile duct (choledocholithiasis) and beyond, including gallstone pancreatitis, gallstone ileus, Bouveret syndrome, and dropped gallstones, by offering key examples from our practice. Furthermore, we will specifically highlight the crucial role of MRI and MRCP for enhancing diagnostic accuracy and improving patient outcomes in gallstone-related disease and showcase relevant surgical pathology specimens of various gallstone related complications.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12

Similar content being viewed by others

References

  1. Schirmer BD, Winters KL, Edlich R (2005) Cholelithiasis and Cholecystitis. 15: 329-338

  2. Everhart JE, Ruhl CE (2009) Burden of Digestive Diseases in the United States Part III: Liver, Biliary Tract, and Pancreas. Gastroenterology 136: 1134-1144

    Article  PubMed  Google Scholar 

  3. Wermke W, Borges AC (1993) Pathophysiology of gallstone formation. Ther Umsch 50: 541-546

    PubMed  CAS  Google Scholar 

  4. Vítek L, Carey MC (2012) New pathophysiological concepts underlying pathogenesis of pigment gallstones. Clinics and Research in Hepatology and Gastroenterology 36: 122-129

    Article  PubMed  Google Scholar 

  5. Watanabe Y, Nagayama M, Okumura A, Amoh Y, Katsube T, Suga T, Koyama S, Nakatani K, Dodo Y (2007) MR Imaging of Acute Biliary Disorders. RadioGraphics 27: 477-495

    Article  PubMed  Google Scholar 

  6. Wertz JR, Lopez JM, Olson D, Thompson WM (2018) Comparing the Diagnostic Accuracy of Ultrasound and CT in Evaluating Acute Cholecystitis. American Journal of Roentgenology 211: W92-W97

    Article  PubMed  Google Scholar 

  7. Kim KW, Park M-S, Yu J-S, Chung JP, Ryu YH, Lee SI, Lee KS, Yoon S-W, Lee K-H (2003) Acute Cholecystitis at T2-weighted and Manganese–enhanced T1-weighted MR Cholangiography: Preliminary Study. Radiology 227: 580-584

    Article  PubMed  Google Scholar 

  8. Park MS, Yu JS, Kim YH, Kim MJ, Kim JH, Lee S, Cho N, Kim DG, Kim KW (1998) Acute cholecystitis: comparison of MR cholangiography and US. Radiology 209: 781-785

    Article  PubMed  CAS  Google Scholar 

  9. Loud PA, Semelka RC, Kettritz U, Brown JJ, Reinhold C (1996) MRI of acute cholecystitis: Comparison with the normal gallbladder and other entities. Magnetic Resonance Imaging 14: 349-355

    Article  PubMed  CAS  Google Scholar 

  10. Håkansson K, Leander P, Ekberg O, Håkansson HO (2000) MR imaging in clinically suspected acute cholecystitis Acta Radiologica 41: 322-328

    Article  PubMed  Google Scholar 

  11. Kalb B, Sharma P, Salman K, Ogan K, Pattaras JG, Martin DR (2010) Acute abdominal pain: Is there a potential role for MRI in the setting of the emergency department in a patient with renal calculi? Journal of Magnetic Resonance Imaging 32: 1012-1023

    Article  PubMed  Google Scholar 

  12. Itani M, Lalwani N, Anderson MA, Arif-Tiwari H, Paspulati RM, Shetty AS (2021) Magnetic resonance cholangiopancreatography: pitfalls in interpretation. Abdominal Radiology

  13. Kiewiet JJS, Leeuwenburgh MMN, Bipat S, Bossuyt PMM, Stoker J, Boermeester MA (2012) A Systematic Review and Meta-Analysis of Diagnostic Performance of Imaging in Acute Cholecystitis. Radiology 264: 708-720

    Article  PubMed  Google Scholar 

  14. Adusumilli S, Siegelman ES (2002) MR imaging of the gallbladder. Magnetic Resonance Imaging Clinics of North America 10: 165-184

    Article  PubMed  Google Scholar 

  15. Murphy MC, Gibney B, Gillespie C, Hynes J, Bolster F (2020) Gallstones top to toe: what the radiologist needs to know. Insights into Imaging 11: 13

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. O’Connor OJ, O’Neill S, Maher MM (2011) Imaging of Biliary Tract Disease. American Journal of Roentgenology 197: W551-W558

    Article  PubMed  Google Scholar 

  17. Tsai H-M, Lin X-Z, Chen C-Y, Lin P-W, Lin J-C (2004) MRI of Gallstones with Different Compositions. American Journal of Roentgenology 182: 1513-1519

    Article  PubMed  Google Scholar 

  18. Bilgin M, Shaikh F, Semelka RC, Bilgin SS, Balci NC, Erdogan A (2009) Magnetic Resonance Imaging of Gallbladder and Biliary System. Topics in Magnetic Resonance Imaging 20

  19. Ito K, Fujita N, Noda Y, Kobayashi G, Kimura K, Katakura Y, Matsunaga A, Yuki T, Nomura M, Sato T, Ishida K, Uchimi K, Senoo S, Okubo K, Suzuki T, Hirasawa D (2000) The significance of magnetic resonance cholangiopancreatography in acute cholecystitis. Nihon Shokakibyo Gakkai Zasshi 97: 1472-1479

    PubMed  CAS  Google Scholar 

  20. Watanabe Y, Dohke M, Ishimori T, Amoh Y, Oda K, Okumura A, Mitsudo K, Dodo Y (1998) High-Resolution MR Cholangiopancreatography. Critical Reviews in Diagnostic Imaging 39: 115-258

    Article  PubMed  CAS  Google Scholar 

  21. Tomizawa M, Shinozaki F, Tanaka S, Sunaoshi T, Kano D, Sugiyama E, Shite M, Haga R, Fukamizu Y, Fujita T, Kagayama S, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, Yamamoto S, Ishige N (2017) Diffusion-weighted whole-body magnetic resonance imaging with background body signal suppression/T2 image fusion for the diagnosis of acute cholecystitis. Exp Ther Med 14: 730-734

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Bagla P, Sarria JC, Riall TS (2016) Management of acute cholecystitis. Current Opinion in Infectious Diseases 29

  23. Wang A, Shanbhogue AK, Dunst D, Hajdu CH, Rosenkrantz AB (2016) Utility of diffusion-weighted MRI for differentiating acute from chronic cholecystitis. Journal of Magnetic Resonance Imaging 44: 89-97

    Article  PubMed  Google Scholar 

  24. Tonolini M, Ravelli A, Villa C, Bianco R (2012) Urgent MRI with MR cholangiopancreatography (MRCP) of acute cholecystitis and related complications: diagnostic role and spectrum of imaging findings. Emergency Radiology 19: 341-348

    Article  PubMed  Google Scholar 

  25. Greenberger NJ, Paumgartner G, Pratt DS (2022) Diseases of the Gallbladder and Bile Ducts. In: Loscalzo J, Fauci A, Kasper D, Hauser S, Longo D, Jameson JL (eds) Harrison's Principles of Internal Medicine, 21e. McGraw-Hill Education, New York, NY

  26. Hanbidge AE, Buckler PM, O’Malley ME, Wilson SR (2004) From the RSNA Refresher Courses. RadioGraphics 24: 1117-1135

    Article  PubMed  Google Scholar 

  27. Bennett GL, Balthazar EJ (2003) Ultrasound and CT evaluation of emergent gallbladder pathology. Radiol Clin North Am 41: 1203-1216

    Article  PubMed  Google Scholar 

  28. Gore RM, Yaghmai V, Newmark GM, Berlin JW, Miller FH (2002) Imaging benign and malignant disease of the gallbladder. Radiol Clin North Am 40: 1307-1323, vi

    PubMed  Google Scholar 

  29. Ahmad MM, Macon WL (1983) Gangrene of the gallbladder. The American Surgeon 49 3: 155-158

    PubMed  CAS  Google Scholar 

  30. Jeffrey RB, Laing FC, Wong W, Callen PW (1983) Gangrenous cholecystitis: diagnosis by ultrasound. Radiology 148: 219-221

    Article  PubMed  CAS  Google Scholar 

  31. Varma DGK, Faust J (1988) Computed tomography of gangrenous acute postoperative acalculous cholecystitis. The Journal of Computed Tomography 12 1: 29-31

    Article  PubMed  CAS  Google Scholar 

  32. Gomes CA, Soares C, di Saverio S, Sartelli M, de Souza Silva PG, Orlandi AS, Heringer TL, Gomes FC, Catena F (2019) Gangrenous cholecystitis in male patients: A study of prevalence and predictive risk factors. Annals of Hepato-Biliary-Pancreatic Surgery 23: 34 - 40

    Article  PubMed  PubMed Central  Google Scholar 

  33. Grayson DE, Abbott RM, Levy AD, Sherman PM (2002) Emphysematous Infections of the Abdomen and Pelvis: A Pictorial Review. RadioGraphics 22: 543-561

    Article  PubMed  Google Scholar 

  34. Katagiri H, Yoshinaga Y, Kanda Y, Mizokami K (2014) Emphysematous cholecystitis successfully treated by laparoscopic surgery. Journal of Surgical Case Reports 2014

  35. Hicks N (2014) Haemorrhagic cholecystitis: an unusual cause of upper gastrointestinal bleeding. BMJ Case Rep, p bcr2013202437

  36. Parekh J, Corvera CU (2010) Hemorrhagic Cholecystitis. Archives of Surgery 145: 202-204

    Article  PubMed  Google Scholar 

  37. Pandya R, O’Malley C (2008) Hemorrhagic cholecystitis as a complication of anticoagulant therapy: role of CT in its diagnosis. Abdominal Imaging 33: 652-653

    Article  PubMed  Google Scholar 

  38. Elsayes KM, Oliveira EP, Narra VR, El-Merhi FM, Brown JJ (2007) Magnetic resonance imaging of the gallbladder: spectrum of abnormalities. Acta Radiol 48: 476-482

    Article  PubMed  CAS  Google Scholar 

  39. Stempel L, Vogelzang RL (1993) Hemorrhagic cholecystitis with hemobilia: treatment with percutaneous cholecystostomy and transcatheter urokinase. Journal of Vascular and Interventional Radiology 4 377-380

    Article  PubMed  CAS  Google Scholar 

  40. David V, Reinhold C, Hochman MG, Chuttani R, Mckee JD, Waxman I, Wang L, Li W, Kaplan R, Edelman RR (1998) Pitfalls in the interpretation of MR cholangiopancreatography. American Journal of Roentgenology 170 1055-1059

    Article  PubMed  CAS  Google Scholar 

  41. Alobaidi M, Gupta R, Jafri SZ, Fink-Bennet DM (2004) Current trends in imaging evaluation of acute cholecystitis. Emergency Radiology 10: 256-258

    Article  PubMed  Google Scholar 

  42. Derici H, Kara C, Bozdag A-D, Nazli O, Tansug T, Akca E (2006) Diagnosis and treatment of gallbladder perforation. World Journal of Gastroenterology 12: 7832-7836

    Article  PubMed  PubMed Central  Google Scholar 

  43. Clemente G, Tringali A, De Rose AM, Panettieri E, Murazio M, Nuzzo G, Giuliante F (2018) Mirizzi Syndrome: Diagnosis and Management of a Challenging Biliary Disease. Canadian Journal of Gastroenterology and Hepatology 2018: 6962090

    Article  PubMed  PubMed Central  Google Scholar 

  44. Akute OO, Alegbeleye BJ, Afolabi AO (2013) Mirizzi syndrome: report of a case and the challenge of management in our environment. Afr J Med Med Sci 42: 107-110

    PubMed  CAS  Google Scholar 

  45. Klekowski J, Piekarska A, Góral M, Kozula M, Chabowski M (2021) The Current Approach to the Diagnosis and Classification of Mirizzi Syndrome. Diagnostics

  46. Kim PN, Outwater EK, Mitchell DG (1999) Mirizzi Syndrome: Evaluation by MR Imaging. Journal of the American College of Gastroenterology 94

  47. Choi BW, Kim MJ, Chung JJ, Chung JB, Yoo HS, Lee JT (2000) Radiologic findings of Mirizzi syndrome with emphasis on MRI. Yonsei Med J 41: 144-146

    Article  PubMed  CAS  Google Scholar 

  48. Chen H, Siwo EA, Khu M, Tian Y (2018) Current trends in the management of Mirizzi Syndrome: A review of literature. Medicine 97

  49. Jeon TJ, Cho JH, Kim YS, Song SY, Park JY (2017) Diagnostic Value of Endoscopic Ultrasonography in Symptomatic Patients with High and Intermediate Probabilities of Common Bile Duct Stones and a Negative Computed Tomography Scan. Gut Liver 11: 290-297

    Article  PubMed  CAS  Google Scholar 

  50. McNicoll CF, Pastorino A, Farooq U, Froehlich MJ, St Hill CR (2022) Choledocholithiasis. StatPearls. StatPearls Publishing LLC, Treasure Island (FL)

    Google Scholar 

  51. LaRocca CJ, Hoskuldsson T, Beilman GJ (2015) The Use of Imaging in Gallbladder Disease. In: Eachempati SR, Reed IIRL (eds) Acute Cholecystitis. Springer International Publishing, Cham, pp 41-53

    Chapter  Google Scholar 

  52. Petrescu I, Bratu AM, Petrescu S, Popa BV, Cristian D, Burcos T (2015) CT vs. MRCP in choledocholithiasis jaundice. J Med Life 8: 226-231

    PubMed  PubMed Central  CAS  Google Scholar 

  53. Chen W, Mo JJ, Lin L, Li CQ, Zhang JF (2015) Diagnostic value of magnetic resonance cholangiopancreatography in choledocholithiasis. World J Gastroenterol 21: 3351-3360

    Article  PubMed  PubMed Central  Google Scholar 

  54. Maher M, Dixon AK (2015) Grainger & Allison's Diagnostic Radiology: Abdominal Imaging. Elsevier Health Sciences

  55. Yeh BM, Liu PS, Soto JA, Corvera CA, Hussain HK (2009) MR Imaging and CT of the Biliary Tract. RadioGraphics 29: 1669-1688

    Article  PubMed  Google Scholar 

  56. Kang SK, Heacock L, Doshi AM, Ream JR, Sun J, Babb JS (2017) Comparative performance of non-contrast MRI with HASTE vs. contrast-enhanced MRI/3D-MRCP for possible choledocholithiasis in hospitalized patients. Abdominal Radiology 42: 1650-1658

    Article  PubMed  Google Scholar 

  57. Gulaya K, Desai SS, Sato K (2016) Percutaneous Cholecystostomy: Evidence-Based Current Clinical Practice. Semin Intervent Radiol 33: 291-296

    Article  PubMed  PubMed Central  Google Scholar 

  58. Shah A, Mourad M, Bramhall S (2018) Acute pancreatitis: Current perspectives on diagnosis and management. Journal of Inflammation Research 11: 77-85

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  59. Balthazar EJ (2002) Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation. Radiology 223: 603-613

    Article  PubMed  Google Scholar 

  60. Merkle EM, Görich J (2002) Imaging of acute pancreatitis. European Radiology 12: 1979-1992

    Article  PubMed  Google Scholar 

  61. Osvaldt AB, Viero P, Borges da Costa MS, Wendt LR, Bersch VP, Rohde L (2001) Evaluation of Ranson, Glasgow, APACHE-II, and APACHE-O criteria to predict severity in acute biliary pancreatitis. Int Surg 86: 158-161

    PubMed  CAS  Google Scholar 

  62. Hazem ZM (2009) Acute biliary pancreatitis: diagnosis and treatment. Saudi Journal Gastroenterology 15: 147-155

    Article  ADS  Google Scholar 

  63. Chawla A, Bosco JIE, Lim TC, Srinivasan S, Teh HS, Shenoy JN (2015) Imaging of acute cholecystitis and cholecystitis-associated complications in the emergency setting. Singapore Medical Journal 56 438-443; quiz 444

  64. Masannat YA, Masannat Y, Shatnawei A (2006) Gallstone ileus: a review. The Mount Sinai Journal of Medicine 73 1132-1134

    PubMed  Google Scholar 

  65. Lassandro F, Romano S, Ragozzino A, Rossi G, Valente T, Ferrara I, Romano L, Grassi R (2005) Role of Helical CT in Diagnosis of Gallstone Ileus and Related Conditions. American Journal of Roentgenology 185: 1159-1165

    Article  PubMed  Google Scholar 

  66. Nuño-Guzmán CM, Marín-Contreras ME, Figueroa-Sánchez M, Corona JL (2016) Gallstone ileus, clinical presentation, diagnostic and treatment approach. World Journal of Gastrointestinal Surgery 8: 65-76

    Article  PubMed  PubMed Central  Google Scholar 

  67. Ayantunde A, Agrawal A (2007) Gallstone Ileus: Diagnosis and Management. World Journal of Surgery 31: 1292-1297

    Article  PubMed  CAS  Google Scholar 

  68. L H, Liasis L, Demosthenous M (2015) Gallstone Coleus: A Rare Relation of Gallstone Ileus. International Journal of Surgery and Research: 28-31

  69. Athwal TS, Howard N, Belfield J, Gur U (2012) Large bowel obstruction due to impaction of a gallstone. BMJ Case Rep, p bcr1120115100

  70. Carr SP, MacNamara FT, Muhammed KM, Boyle E, McHugh SM, Naughton P, Leahy A (2015) Perforated closed-loop obstruction secondary to gallstone ileus of the transverse colon: a rare entity. Case Rep Surg 2015: 691713

    PubMed  PubMed Central  CAS  Google Scholar 

  71. Balzarini M, Broglia L, Comi G, Calcara C (2015) Large Bowel Obstruction Due to a Big Gallstone Successfully Treated with Endoscopic Mechanical Lithotripsy. Case Reports in Gastrointestinal Medicine 2015: 798746

    Article  PubMed  PubMed Central  Google Scholar 

  72. Sigmon L, Rejeski J, Marion B, Fina M (2017) Colonic gallstone ileus. BMJ Case Rep, pp bcr-2017-220898

  73. Heaney RM (2014) Colonic gallstone ileus: the rolling stones. BMJ Case Rep 2014: bcr2014204402

  74. Ranga N (2011) Large bowel and small bowel obstruction due to gallstones in the same patient. BMJ Case Rep 2011: bcr0920103372

  75. Cargill A, Farkas N, Black J, West N (2015) A novel surgical approach for treatment of sigmoid gallstone ileus. BMJ Case Rep 2015: bcr2014209229

  76. Ball WR, Elshaieb M, Hershman MJ (2013) Rectosigmoid gallstone coleus: a rare emergency presentation. BMJ Case Rep 2013: bcr2013201136

  77. Ishikura H, Sakata A, Kimura S, Okitsu H, Ishikawa M, Ichimori T, Takechi H, Uyama K (2005) Gallstone ileus of the colon. Surgery 138: 540-542

    PubMed  Google Scholar 

  78. Gan S, Roy-Choudhury SH, Agrawal SN, Kumar H, Pallan A, Super PA, Richardson M (2008) More than meets the eye: subtle but important CT findings in Bouveret's syndrome. American Journal of Roentgenology 191 182-185

    Article  PubMed  Google Scholar 

  79. Gavrila D, Galusca C, Berbecel M, Boroș M, Dumitrașcu T (2016) Bouveret Syndrome - An Exceptional Complication of a Very Frequent Disease. Chirurgia 111 283-285

    PubMed  Google Scholar 

  80. Ploneda-Valencia CF, Gallo-Morales M, Rinchon C, Navarro-Muñiz E, Bautista-López CA, de la Cerda-Trujillo LF, Rea-Azpeitia LA, López-Lizarraga CR (2017) Gallstone ileus: An overview of the literature. Revista de Gastroenterología de México 82: 248-254

    Article  PubMed  CAS  Google Scholar 

  81. Lobo DN, Jobling JC, Balfour TW (2000) Gallstone ileus: diagnostic pitfalls and therapeutic successes. J Clin Gastroenterol 30: 72-76

    Article  PubMed  CAS  Google Scholar 

  82. Nayak L, Menias CO, Gayer G (2013) Dropped gallstones: spectrum of imaging findings, complications and diagnostic pitfalls. The British Journal of Radiology 86: 20120588

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  83. Adel F, Ramia-Angel J, de la Plaza Llamas R, Quilñones J, Arteaga V, Garcia-Parreño J (2012) Retroperitoneal Abscess Due to Dropped Gallstones After Laparoscopic Cholecystectomy. Clinics and Practice 2: e20

    Article  PubMed  PubMed Central  Google Scholar 

  84. Woodfield JC, Rodgers M, Windsor JA (2004) Peritoneal gallstones following laparoscopic cholecystectomy. Surgical Endoscopy And Other Interventional Techniques 18: 1200-1207

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA

    Gabriel Duhancioglu, Hina Arif-Tiwari, Stefano Natali & Conner Reynolds

  2. Virginia Commonwealth University/Medical College of Medicine (VCU), Richmond, VA, USA

    Neeraj Lalwani & Ann Fulcher

Authors
  1. Gabriel Duhancioglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hina Arif-Tiwari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefano Natali
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Conner Reynolds
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Neeraj Lalwani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ann Fulcher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hina Arif-Tiwari.

Ethics declarations

Conflict of interest

No conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Duhancioglu, G., Arif-Tiwari, H., Natali, S. et al. Traveling gallstones: review of MR imaging and surgical pathology features of gallstone disease and its complications in the gallbladder and beyond. Abdom Radiol 49, 722–737 (2024). https://doi.org/10.1007/s00261-023-04107-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-023-04107-5

Keywords

Search

Navigation