EURORAD ESR

Case 14481

Diffusion-weighted MRI: findings and role in acute cholecystitis

Author(s)
Tonolini Massimo, MD

"Luigi Sacco" University Hospital,
Radiology Department;
Via G.B. Grassi 74
20157 Milan, Italy;
Email:mtonolini@sirm.org
 
Patient
female, 60 year(s)
 
 
  • Figure 1
    Urgent unenhanced and post-contrast multidetector CT at admission
     

    Preliminary unenhanced acquisition showed distended gallbladder with small calcific stones and moderately thickened wall (arrow), normal-sized pancreas (*), absent peripancreatic effusion. Note hypoattenuating liver...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Acute;

    Axial (b,c) and coronal (d,e) portal-venous phase enhanced images showed preserved homogeneous pancreatic enhancement (*), distended gallbladder with moderately thickened wall (arrows) and mucosal enhancement (thin...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Acute;

    Axial (b,c) and coronal (d,e) portal-venous phase enhanced images showed preserved homogeneous pancreatic enhancement (*), distended gallbladder with moderately thickened wall (arrows) and mucosal enhancement (thin...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Acute;

    Coronal (d,e) portal-venous phase enhanced images showed preserved homogeneous pancreatic enhancement (*), distended gallbladder with moderately thickened wall (arrows) and mucosal enhancement (thin arrows).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Acute;

    Coronal (d,e) portal-venous phase enhanced images showed preserved homogeneous pancreatic enhancement (*), distended gallbladder with moderately thickened wall (arrows) and mucosal enhancement (thin arrows). Note...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Acute;
     
     
  • Figure 2
    Unenhanced MRI including diffusion-weighted and MR-cholangiopancreatography (MRCP)
     

    Ten days after CT, fat-saturated T1-weighted image showed decreasing gallbladder mural thickness (arrow) compared to Fig.1, and persistently normal pancreatic (*) thickness.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Acute;

    T2-weighted images (b.c) showed decreasing gallbladder mural thickness (arrow) compared to Fig.1, small calculi and sludge in the lumen, absent pericholecystic fluid, persistently normal pancreatic (*) thickness.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Acute;

    T2-weighted images (b.c) showed decreasing gallbladder mural thickness (arrow) compared to Fig.1, small calculi and sludge in the lumen, absent pericholecystic fluid, persistently normal pancreatic (*) thickness.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Acute;

    High (800) b-value diffusion-weighted images (d,e) showed visually hyperintense signal in the gallbladder wall (arrows) indicating acute inflammation, and pancreatic gland (*) gradually progressive hypersignal...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    High (800) b-value diffusion-weighted images (d,e) showed visually hyperintense signal in the gallbladder wall (arrows) indicating acute inflammation, and pancreatic gland (*) gradually progressive hypersignal...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Acute;

    Apparent diffusion coefficient map showed hypointensity indicating restricted diffusion in gallbladder wall (arrow, 1.45-1.6x10-3 mm2/s) and pancreas (*, progressively increasing from 0.8 at head to 1.1x10-3 mm2/s in...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Acute;

    MRCP showed upper normal caliber of main bile duct (arrowheads), without detectable intraluminal calculi. Note unremarkable appearance of Wirsung duct, absent pericholecystic and perihepatic fluid.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Acute;
     
     
Preliminary unenhanced acquisition showed distended gallbladder with small calcific stones and moderately thickened wall (arrow), normal-sized pancreas (*), absent peripancreatic effusion. Note hypoattenuating liver from steatosis.
 
Axial (b,c) and coronal (d,e) portal-venous phase enhanced images showed preserved homogeneous pancreatic enhancement (*), distended gallbladder with moderately thickened wall (arrows) and mucosal enhancement (thin arrows).
 
Axial (b,c) and coronal (d,e) portal-venous phase enhanced images showed preserved homogeneous pancreatic enhancement (*), distended gallbladder with moderately thickened wall (arrows) and mucosal enhancement (thin arrows).
 
Coronal (d,e) portal-venous phase enhanced images showed preserved homogeneous pancreatic enhancement (*), distended gallbladder with moderately thickened wall (arrows) and mucosal enhancement (thin arrows).
 
Coronal (d,e) portal-venous phase enhanced images showed preserved homogeneous pancreatic enhancement (*), distended gallbladder with moderately thickened wall (arrows) and mucosal enhancement (thin arrows). Note normal-calibre choledochus (arrowhead).
 
Ten days after CT, fat-saturated T1-weighted image showed decreasing gallbladder mural thickness (arrow) compared to Fig.1, and persistently normal pancreatic (*) thickness.
 
T2-weighted images (b.c) showed decreasing gallbladder mural thickness (arrow) compared to Fig.1, small calculi and sludge in the lumen, absent pericholecystic fluid, persistently normal pancreatic (*) thickness.
 
T2-weighted images (b.c) showed decreasing gallbladder mural thickness (arrow) compared to Fig.1, small calculi and sludge in the lumen, absent pericholecystic fluid, persistently normal pancreatic (*) thickness.
 
High (800) b-value diffusion-weighted images (d,e) showed visually hyperintense signal in the gallbladder wall (arrows) indicating acute inflammation, and pancreatic gland (*) gradually progressive hypersignal consistent with oedematous acute pancreatitis from tail to head.
 
High (800) b-value diffusion-weighted images (d,e) showed visually hyperintense signal in the gallbladder wall (arrows) indicating acute inflammation, and pancreatic gland (*) gradually progressive hypersignal consistent with oedematous acute pancreatitis from tail to head.
 
Apparent diffusion coefficient map showed hypointensity indicating restricted diffusion in gallbladder wall (arrow, 1.45-1.6x10-3 mm2/s) and pancreas (*, progressively increasing from 0.8 at head to 1.1x10-3 mm2/s in tail).
 
MRCP showed upper normal caliber of main bile duct (arrowheads), without detectable intraluminal calculi. Note unremarkable appearance of Wirsung duct, absent pericholecystic and perihepatic fluid.
 
 
 
Home Search Sections Teaching Cases History FAQ Case Archives Contact Login Disclaimer Imprint Switch to MOBILE version
View desktop version