Skip to main content

Advertisement

Log in

Imaging of the Gallbladder with Multi-energy CT

  • Computed Tomography (S Nicolaou and M Mohammed, Section Editors)
  • Published:
Current Radiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The goal of this review article is to provide an overview of applications of multi-energy CT as they pertain to gallbladder imaging. We discuss benefits and shortcomings of MECT of various gallbladder pathology, with an emphasis on the imaging of gallstones and cholecystitis. It also touches on promising areas that warrant further investigation.

Recent Findings

MECT has demonstrated improved sensitivity for cholelithiasis compared to conventional single-energy CT, with added value of MECT reconstructions, particularly virtual monoenergetic reconstructions, to detect isoattenuating gallstones. MECT iodine maps and virtual monoenergetic images potentially add value in evaluating other gallbladder pathologies, including detecting complications of acute cholecystitis, characterization of xanthogranulomatous cholecystitis and adenomyomatosis, and identifying and evaluating the extent of gallbladder carcinoma.

Summary

MECT is emerging as a useful exam to evaluate the gallbladder, particularly in the setting of acute abdominal pain, and has the potential to eliminate the need for other imaging exams such as ultrasound.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

Recently published papers of particular interest have been highlighted as: ∙ Of importance ∙∙ Of major importance

  1. Stoker J, van Randen A, Lameris W, Boermeester MA. Imaging patients with acute abdominal pain. Radiology. 2009;253(1):31–46. https://doi.org/10.1148/radiol.2531090302.

    Article  PubMed  Google Scholar 

  2. Trowbridge RL, Rutkowski NK, Shojania KG. Does this patient have acute cholecystitis? JAMA. 2003;289(1):80–6.

    Article  Google Scholar 

  3. ∙∙Fagenholz PJ, Fuentes E, Kaafarani H, Cropano C, King D, de Moya M, Butler K, Velmahos G, Chang Y, Yeh DD. Computed tomography is more sensitive than ultrasound for the diagnosis of acute cholecystitis. Surg Infect (Larchmt). 2015;16(5):509–12. https://doi.org/10.1089/sur.2015.102. Original research demonstrating that CT is more sensitive than ultrasound for acute cholecystitis (contrary to popular opinion).

    Article  Google Scholar 

  4. ∙∙McCollough CH, Leng S, Yu L, Fletcher JG. Dual- and multi-energy CT: principles, technical approaches, and clinical applications. Radiology. 2015;276(3):637–53. https://doi.org/10.1148/radiol.2015142631. Excellent review which provides a good foundation for understanding the principles of MECT.

    Article  Google Scholar 

  5. ∙∙Marin D, Boll DT, Mileto A, Nelson RC. State of the art: dual-energy CT of the abdomen. Radiology. 2014;271(2):327–42. https://doi.org/10.1148/radiol.14131480. Excellent review which provides a good foundation for understanding the principles of MECT.

    Article  Google Scholar 

  6. Ruhl CE, Everhart JE. Gallstone disease is associated with increased mortality in the United States. Gastroenterology. 2011;140(2):508–16. https://doi.org/10.1053/j.gastro.2010.10.060.

    Article  PubMed  Google Scholar 

  7. Baron RL, Rohrmann CA Jr, Lee SP, Shuman WP, Teefey SA. CT evaluation of gallstones in vitro: correlation with chemical analysis. Am J Roentgenol. 1988;151(6):1123–8. https://doi.org/10.2214/ajr.151.6.1123.

    Article  CAS  Google Scholar 

  8. Chan WC, Joe BN, Coakley FV, Prien EL Jr, Gould RG, Prevrhal S, Barber WC, Kirkwood KS, Qayyum A, Yeh BM. Gallstone detection at CT in vitro: effect of peak voltage setting. Radiology. 2006;241(2):546–53. https://doi.org/10.1148/radiol.2412050947.

    Article  PubMed  Google Scholar 

  9. Anderson SW, Lucey BC, Varghese JC, Soto JA. Accuracy of MDCT in the diagnosis of choledocholithiasis. Am J Roentgenol. 2006;187(1):174–80. https://doi.org/10.2214/AJR.05.0459.

    Article  Google Scholar 

  10. Hessler PC, Hill DS, Deforie FM, Rocco AF. High accuracy sonographic recognition of gallstones. Am J Roentgenol. 1981;136(3):517–20. https://doi.org/10.2214/ajr.136.3.517.

    Article  CAS  Google Scholar 

  11. ∙∙Uyeda JW, Richardson IJ, Sodickson AD. Making the invisible visible: improving conspicuity of noncalcified gallstones using dual-energy CT. Abdom Radiol (NY). 2017. https://doi.org/10.1007/s00261-017-1229-x. Original research article assessing use of commercially available MECT reconstructions to improve identification of isoattenuating gallstones.

    Article  Google Scholar 

  12. ∙∙Yang CB, Zhang S, Jia YJ, Duan HF, Ma GM, Zhang XR, Yu Y, He TP. Clinical application of dual-energy spectral computed tomography in detecting cholesterol gallstones from surrounding bile. Acad Radiol. 2017;24(4):478–82. https://doi.org/10.1016/j.acra.2016.10.006. Original research article assessing use of MECT to detect cholesterol gallstones.

    Article  Google Scholar 

  13. ∙∙Chen AL, Liu AL, Wang S, Liu JH, Ju Y, Sun MY, Liu YJ. Detection of gallbladder stones by dual-energy spectral computed tomography imaging. World J Gastroenterol. 2015;21(34):9993–8. https://doi.org/10.3748/wjg.v21.i34.9993. Original research article assessing use of MECT to detect cholesterol gallstones.

    Article  Google Scholar 

  14. ∙Lee HA, Lee YH, Yoon KH, Bang DH, Park DE. Comparison of virtual unenhanced images derived from dual-energy CT with true unenhanced images in evaluation of gallstone disease. Am J Roentgenol. 2016;206(1):74–80. https://doi.org/10.2214/ajr.15.14570. Original research article assessing use of virtual unenhanced images to detect gallstones.

    Article  Google Scholar 

  15. Kim JE, Lee JM, Baek JH, Han JK, Choi BI. Initial assessment of dual-energy CT in patients with gallstones or bile duct stones: can virtual nonenhanced images replace true nonenhanced images? Am J Roentgenol. 2012;198(4):817–24. https://doi.org/10.2214/ajr.11.6972.

    Article  Google Scholar 

  16. Soesbe TC, Lewis MA, Leyendecker JR, Ananthakrishnan L, Lenkinski JR. Differentiating and segmenting isoattenuating cholesterol gallstones from bile using spectral CT material attenuation decomposition (MAD) plots. In: Society of computed body tomography and magnetic resonance, Nashville, TN, 11 September 2017.

  17. Lewis MA, Soesbe TC, Do QN, Nasr K, Moore WA, Duan X, Gotman S, Lenkinski RE. Spectral CT “Fingerprinting” on a pre-clinical detection based spectral CT scanner: tools for exploration and examples. In: Radiological Society of North America, Chicago, IL, 28 November 2016.

  18. Lewis MA, Soesbe TC, Ananthakrishnan L, Abbara S, Peshock R, Lenkinski RE. Spectral CT analysis using custom plugins for a clinical DICOM viewer. In: Radiological Society of North America, Chicago, IL, 27 November 2017.

  19. Gore RM, Thakrar KH, Newmark GM, Mehta UK, Berlin JW. Gallbladder imaging. Gastroenterol Clin N Am. 2010;39(2):265–87. https://doi.org/10.1016/j.gtc.2010.02.009.

    Article  Google Scholar 

  20. Harvey RT, Miller WT Jr. Acute biliary disease: initial CT and follow-up US versus initial US and follow-up CT. Radiology. 1999;213(3):831–6. https://doi.org/10.1148/radiology.213.3.r99dc17831.

    Article  CAS  PubMed  Google Scholar 

  21. ∙∙Wertz JR, Lopez JM, Olson D, Thompson WM. Comparing the diagnostic accuracy of ultrasound and CT in evaluating acute cholecystitis. Am J Roentgenol. 2018;211(2):W92–7. https://doi.org/10.2214/ajr.17.18884. This original research article compares the diagnostic accuracy of the two most common imaging modalities (ultrasound and CT) in assessment of acute cholecystitis.

    Article  Google Scholar 

  22. Young N, Kinsella S, Raio CC, Nelson M, Chiricolo G, Johnson A, Malcolm G, Drumheller BC, Ward MF, Sama A. Economic impact of additional radiographic studies after registered diagnostic medical sonographer (RDMS)-certified emergency physician-performed identification of cholecystitis by ultrasound. J Emerg Med. 2010;38(5):645–51. https://doi.org/10.1016/j.jemermed.2008.10.016.

    Article  PubMed  Google Scholar 

  23. ∙∙Ratanaprasatporn L, Uyeda JW, Wortman JR, Richardson I, Sodickson AD. Multimodality imaging, including dual-energy CT, in the evaluation of gallbladder disease. Radiographics. 2018;38(1):75–89. https://doi.org/10.1148/rg.2018170076. This excellent review article provides an overview of gallbladder evaluation using MECT and other modalities.

    Article  Google Scholar 

  24. Zhao F, Lu PX, Yan SX, Wang GF, Yuan J, Zhang SZ, Wang YX. CT and MR features of xanthogranulomatous cholecystitis: an analysis of consecutive 49 cases. Eur J Radiol. 2013;82(9):1391–7. https://doi.org/10.1016/j.ejrad.2013.04.026.

    Article  PubMed  Google Scholar 

  25. Catalano OA, Sahani DV, Kalva SP, Cushing MS, Hahn PF, Brown JJ, Edelman RR. MR imaging of the gallbladder: a pictorial essay. Radiographics. 2008;28(1):135–155; quiz 324. https://doi.org/10.1148/rg.281065183.

    Article  Google Scholar 

  26. Chun KA, Ha HK, Yu ES, Shinn KS, Kim KW, Lee DH, Kang SW, Auh YH. Xanthogranulomatous cholecystitis: CT features with emphasis on differentiation from gallbladder carcinoma. Radiology. 1997;203(1):93–7. https://doi.org/10.1148/radiology.203.1.9122422.

    Article  CAS  PubMed  Google Scholar 

  27. Haradome H, Ichikawa T, Sou H, Yoshikawa T, Nakamura A, Araki T, Hachiya J. The pearl necklace sign: an imaging sign of adenomyomatosis of the gallbladder at MR cholangiopancreatography. Radiology. 2003;227(1):80–8. https://doi.org/10.1148/radiol.2271011378.

    Article  PubMed  Google Scholar 

  28. ∙Bonatti M, Vezzali N, Lombardo F, Ferro F, Zamboni G, Tauber M, Bonatti G. Gallbladder adenomyomatosis: imaging findings, tricks and pitfalls. Insights Imaging. 2017;8(2):243–253. https://doi.org/10.1007/s13244-017-0544-7. This excellent review article provides overview of imaging findings of gallbladder adenomyomatosis.

    Article  Google Scholar 

  29. ∙Yang HK, Lee JM, Yu MH, Lee SM, Park J, Han NY, Lee K, Jang JY, Han JK. CT diagnosis of gallbladder adenomyomatosis: importance of enhancing mucosal epithelium, the “cotton ball sign”. Eur Radiol. 2018. https://doi.org/10.1007/s00330-018-5412-4. Original research evaluating the “cotton ball sign” as a feature associated with adenomyomatosis.

    Article  Google Scholar 

  30. Kanthan R, Senger JL, Ahmed S, Kanthan SC. Gallbladder Cancer in the 21st Century. J Oncol. 2015;2015:967472. https://doi.org/10.1155/2015/967472.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lai CH, Lau WY. Gallbladder cancer—a comprehensive review. Surgeon. 2008;6(2):101–10.

    Article  Google Scholar 

  32. ∙Kim SW, Kim HC, Yang DM, Ryu JK, Won KY. Gallbladder carcinoma: causes of misdiagnosis at CT. Clin Radiol. 2016;71(1):e96–109. https://doi.org/10.1016/j.crad.2015.10.016. This excellent review provides an overview of the imaging features of gallbladder carcinoma and common imaging pitfalls.

    Article  CAS  Google Scholar 

  33. Kim SJ, Lee JM, Lee JY, Kim SH, Han JK, Choi BI, Choi JY. Analysis of enhancement pattern of flat gallbladder wall thickening on MDCT to differentiate gallbladder cancer from cholecystitis. Am J Roentgenol. 2008;191(3):765–71. https://doi.org/10.2214/AJR.07.3331.

    Article  Google Scholar 

  34. Pfeiffer D, Parakh A, Patino M, Kambadakone A, Rummeny EJ, Sahani DV. Iodine material density images in dual-energy CT: quantification of contrast uptake and washout in HCC. Abdom Radiol (NY). 2018. https://doi.org/10.1007/s00261-018-1636-7.

    Article  Google Scholar 

  35. Sun K, Han R, Han Y, Shi X, Hu J, Lu B. Accuracy of combined computed tomography colonography and dual energy iodine map imaging for detecting colorectal masses using high-pitch dual-source CT. Sci Rep. 2018;8(1):3790. https://doi.org/10.1038/s41598-018-22188-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Wei J, Zhao J, Zhang X, Wang D, Zhang W, Wang Z, Zhou J. Analysis of dual energy spectral CT and pathological grading of clear cell renal cell carcinoma (ccRCC). PLoS ONE. 2018;13(5):e0195699. https://doi.org/10.1371/journal.pone.0195699.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Gerstenmaier JF, Hoang KN, Gibson RN. Contrast-enhanced ultrasound in gallbladder disease: a pictorial review. Abdom Radiol (NY). 2016;41(8):1640–52. https://doi.org/10.1007/s00261-016-0729-4.

    Article  CAS  Google Scholar 

  38. ∙Liu XS, Gu LH, Du J, Li FH, Wang J, Chen T, Zhang YH. Differential diagnosis of polypoid lesions of the gallbladder using contrast-enhanced sonography. J Ultrasound Med. 2015;34(6):1061–9. https://doi.org/10.7863/ultra.34.6.1061. Original research evaluating various useful MDCT findings in addition to size to differentiate benign and malignant polyps.

    Article  Google Scholar 

  39. Song ER, Chung WS, Jang HY, Yoon M, Cha EJ. CT differentiation of 1-2-cm gallbladder polyps: benign vs malignant. Abdom Imaging. 2014;39(2):334–41. https://doi.org/10.1007/s00261-013-0071-z.

    Article  PubMed  Google Scholar 

  40. Chen S, Zhong X, Hu S, Dorn S, Kachelriess M, Lell M, Maier A. Automatic multi-organ segmentation in dual energy CT using 3D fully convolutional network. 2018. Paper presented at the 1st Conference on Medical Imaging with Deep Learning, Amsterdam, The Netherlands, 11 April 2018.

  41. Uhrig M, Sedlmair M, Schlemmer HP, Hassel JC, Ganten M. Monitoring targeted therapy using dual-energy CT: semi-automatic RECIST plus supplementary functional information by quantifying iodine uptake of melanoma metastases. Cancer Imaging. 2013;13(3):306–13. https://doi.org/10.1102/1470-7330.2013.0031.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lakshmi Ananthakrishnan.

Ethics declarations

Conflict of interest

Both Yee Seng Ng and Lakshmi Ananthakrishnan declare that there is an institutional research agreement between UT Southwestern Medical Center and both Philips Healthcare and Siemens Healthcare, but neither of the authors has any personal conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical collection on Computed Tomography.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ng, Y.S., Ananthakrishnan, L. Imaging of the Gallbladder with Multi-energy CT. Curr Radiol Rep 6, 46 (2018). https://doi.org/10.1007/s40134-018-0305-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s40134-018-0305-5

Keywords

Navigation