Based on the EPOS “Gallbladder adenomyomatosis: are we sure to know it?” DOI 10.1594/ecr2014/C-0198
Gallbladder adenomyomatosis (GA) is a benign alteration of the gallbladder wall that can be found in up to 9% of patients. GA is characterized by a gallbladder wall thickening containing small bile-filled cystic spaces (i.e., the Rokitansky–Aschoff sinuses, RAS). The bile contained in RAS may undergo a progressive concentration process leading to crystal precipitation and calcification development. A correct characterization of GA is fundamental in order to avoid unnecessary cholecystectomies. Ultrasound (US) is the imaging modality of choice for diagnosing GA; the use of high-frequency probes and a precise focal depth adjustment enable correct identification and characterization of GA in the majority of cases. Contrast-enhanced ultrasound (CEUS) can be performed if RAS cannot be clearly identified at baseline US: RAS appear avascular at CEUS, independently from their content. Magnetic resonance imaging (MRI) should be reserved for cases that are unclear on US and CEUS. At MRI, RAS can be identified with extremely high sensitivity, but their signal intensity varies widely according to their content. Positron emission tomography (PET) may be helpful for excluding malignancy in selected cases. Computed tomography (CT) and cholangiography are not routinely indicated in the suspicion of GA.
1. Gallbladder adenomyomatosis is a common benign lesion (1–9% of the patients).
2. Identification of Rokitansky–Aschoff sinuses is crucial for diagnosing gallbladder adenomyomatosis.
3. Sonography is the imaging modality of choice for diagnosing gallbladder adenomyomatosis.
4. Intravenous contrast material administration increases ultrasound accuracy in diagnosing gallbladder adenomyomatosis.
5. Magnetic resonance is a problem-solving technique for unclear cases.
Jutras JA (1960) Hyperplastic cholecystoses; hickey lecture, 1960. Am J Roentgenol Radium Therapy, Nucl Med 83:795–827
Aguirre JR, Bohler RO, Guraieb S (1969) Hyperplastic cholecystoses; a new contribution to the Unitarian theory. Am J Roentgenol Radium Therapy, Nucl Med 107:1–13 CrossRef
Bonatti M, Ferro F, Gentile L, Pozzi Mucelli R, Bonatti G (2014) Gallbladder Adenomyomatosis: Are We Sure to Know It? EPOS. doi: 10.1594/ecr2014/c-0198
Nabatame N, Shirai Y, Nishimura A, Yokoyama N, Wakai T, Hatakeyama K (2004) High risk of gallbladder carcinoma in elderly patients with segmental adenomyomatosis of the gallbladder. J Exp Clin Cancer Res 23:593–598 PubMed
Nishimura A, Shirai Y, Hatakeyama K (2004) Segmental adenomyomatosis of the gallbladder predisposes to cholecystolithiasis. J Hepato-Biliary-Pancreat Surg 11:342–347 CrossRef
Kim JH, Jeong IH, Han JH et al (2010) Clinical/pathological analysis of gallbladder adenomyomatosis; type and pathogenesis. Hepato-Gastroenterology 57:420–425 PubMed
March HC (1948) Visualization of the rokitansky-aschoff sinuses of the gallbladder during cholecystography. Am J Roentgenol Radium Ther 59:197–203 PubMed
Sparchez Z, Radu P (2012) Role of CEUS in the diagnosis of gallbladder disease. Med Ultrason 14:326–330 PubMed
- Gallbladder adenomyomatosis: imaging findings, tricks and pitfalls
- Springer Berlin Heidelberg
Neu im Fachgebiet Radiologie
Meistgelesene Bücher aus der Radiologie
Mail Icon II