Abstract
The aim of this study was to correlate MR findings of gallbladder wall thickening with pathologic findings on the basis of the layered pattern and to evaluate the diagnostic value of MR imaging in gallbladder disease. We retrospectively evaluated the source images of HASTE sequences for MR cholangiography in 144 patients with gallbladder wall thickening. The layered pattern of thickened wall was classified into four patterns. Type 1 shows two layers with a thin hypointense inner layer and thick hyperintense outer layer. Type 2 has two layers of ill-defined margin. Type 3 shows multiple hyperintense cystic spaces in the wall. Type 4 shows diffuse nodular thickening without layering. MR findings of a layered pattern of thickened gallbladder were well correlated with histopathology. Chronic cholecystitis matched to type 1, acute cholecystitis corresponded to type 2, adenomyomatosis showed type 3, and the gallbladder carcinomas showed type 4. All four layered patterns were associated with PPV of 73% or greater, sensitivity of 92% or greater and specificity of 95% or greater. Our results indicate that MR findings of gallbladder wall thickening are characteristic in each entity and correlate well with pathologic findings. The classification of the layered pattern may be valuable for interpreting thickened gallbladder wall.
Similar content being viewed by others
References
Cooperberg PL, Gibney RG (1987) Imaging of the gallbladder. Radiology 163:605–613
McIntosh DM, Penney HF (1980) Gray-scale ultrasonography as a screening procedure in the detection of gallbladder disease. Radiology 136:725–727
Teefey SA, Baron RL, Bigler SA (1991) Sonography of the gallbladder: significance of striated (layered) thickening of the gallbladder wall. Am J Roentgenol 156:945–947
Shlaer WJ, Leopold GR, Scheible FW (1981) Sonography of the thickened gallbladder wall: a nonspecific finding. Am J Roentgenol 136:337–339
Yoshimitsu K, Honda H, Kaneko K et al (1997) Dynamic MRI of the gallbladder lesions: differentiation of benign from malignant. J Magn Reson Imaging 7:696–701
Demachi H, Matsui O, Hoshiba K et al (1997) Dynamic MRI using a surface coil in chronic cholecystitis and gallbladder carcinoma: radiologic and histopathologic correlation. J Comput Assist Tomogr 21:643–651
Irie H, Honda H, Tajima T et al (1998) Optimal MR cholangiopancreatographic sequence and its clinical application. Radiology 206:379–387
Reinhold C, Taourel P, Bret PM et al (1998) Choledocholithiasis: evaluation of MR cholangiography for diagnosis. Radiology 209:435–442
Mendler MH, Philippe B, Sautereau D et al (1998) Value of MR cholangiography in the diagnosis of obstructive diseases of the biliary tree: a study of 58 cases. Am J Gastroenterol 93:2482–2490
Becker CD, Grossholz M, Becker M, Mentha G, de Peyer R, Terrier F (1997) Choledocholithiasis and bile duct stenosis: diagnostic accuracy of MR cholangiopancreatography. Radiology 205:523–530
Lopera JE, Soto JA, Múnera F (2001) Malignant hilar and perihilar biliary obstruction: Use of MR cholangiography to define the extent of biliary ductal involvement and plan percutaneous interventions. Radiology 220:90–96
Fulcher AS, Turner MA, Capps GW, Zfass AM, Baker KM (1998) Half-Fourier RARE MR cholangiopancreatography: experience in 300 subjects. Radiology 207:21–32
Park MS, Yu JS, Kim YH et al (1998) Acute cholecystitis: comparison of MR cholangiography and US. Radiology 209:781–785
Hakansson K, Leander P, Ekberg O, Hakansson HO (2000) MR imaging in clinically suspected acute cholecystitis. A comparison with ultrasonography. Acta Radiol 41:322–328
Regan F, Schaefer DC, Smith DP, Petronis JD, Bohlman ME, Magnuson TH (1998) The diagnostic utility of HASTE MRI in the evaluation of acute cholecystitis. Half-Fourier acquisition single-shot turbo SE. J Comput Assist Tomogr 22:638–642
Kim MJ, Oh YT, Park YN et al (1999) Gallbladder adenomyomatosis: findings on MRI. Abdom Imaging 24:410–413
Yoshimitsu K, Honda H, Jimi M et al (1999) MR diagnosis of adenomyomatosis of the gallbladder and differentiation from gallbladder carcinoma: importance of showing Rokitansky-Aschoff sinuses. Am J Roentgenol 172:1535–1540
Engel JM, Deitch EA, Sikkema W (1979) Gallbladder wall thickness: sonographic accuracy and relation to disease. Am J Roentgenol 134:907–909
Dinkel H, Kraus S, Heimbucher J et al (2000) Sonography for selecting candidates for laparoscopic cholecystectomy: a prospective study. Am J Roentgenol 174:1433–1439
Imai Y, Kressel HY, Saul SH et al (1990) Colorectal tumors: an in vitro study of high-resolution MR imaging. Radiology 177:695–701
Lichtenstein JE (2000) Adenomyomatosis and cholesterolosis: the “hyperplastic cholecystoses”. In: Gore RM, Marc SL (eds) Textbook of gastrointestinal radiology, 2nd edn. Saunders, Philadelphia, pp 1353–1359
Cotran RS, Kumar V, Robbins SL (1989) Pathologic bases of disease, 4th edn. Saunders, Philadelphia, p 971
Ahmad MM, Macon WL (1983) Gangrene of the gallbladder. Am Surg 49:155–158
Singer JA, McKeen RV (1994) Laparoscopic cholecystectomy for acute or gangrenous cholecystitis. Am Surg 60:326–328
Chun KA, Ha HK, Yu ES et al (1997) Xanthogranulomatous cholecystitis: CT features with emphasis on differentiation from gallbladder carcinoma. Radiology 203:93–97
Parra JA, Acinas O, Bueno J, Guezmes A, Fernandez MA, Farinas MC (2000) Xanthogranulomatous cholecystitis: clinical, sonographic, and CT findings in 26 patients. Am J Roentgenol 174:979–983
Furuta A, Ishibashi T, Takahashi S, Sakamoto K (1996) MR imaging of xanthogranulomatous cholecystitis. Radiat Med 14:315–319
Shuto R, Kiyosue H, Komatsu E et al (2004) CT and MR imaging findings of xanthogranulomatous cholecystitis: correlation with pathologic findings. Eur Radiol 14:440–446
Hatakenaka M, Adachi T, Matsuyama A, Mori M, Yoshikawa Y (2003) Xanthogranulomatous cholecystitis:importance of chemical-shift gradient-echo MR imaging. Eur Radiol 315–319:2233–2235
Levy AD, Murakata LA, Rohrmann CA Jr (2001) Gallbladder carcinoma: radiologic–pathologic correlation. RadioGraphics 21:295–314
Acknowledgements
We thank Bonnie Hami, M.A. (Department of Radiology, University Hospitals of Cleveland, Cleveland, OH), for her editorial assistance in the preparation of the manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jung, S.E., Lee, J.M., Lee, K. et al. Gallbladder wall thickening: MR imaging and pathologic correlation with emphasis on layered pattern. Eur Radiol 15, 694–701 (2005). https://doi.org/10.1007/s00330-004-2539-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-004-2539-2