Learning objectives
To explain the pathological basis of gallbladder adenomyomatosis (GA).
To help the radiologist in familiarizing with the possible appearances of gallbladder adenomyomatosis at US,
CEUS,
CT,
MR and PET/CT in order to prevent interpretation mistakes.
To provide some tips and tricks that may increase the accuracy of US,
CT and MRI in diagnosing GA.
Background
GALLBLADDER ADENOMYOMATOSIS: WHAT IS IT?
Gallbladder adenomyomatosis (GA) is an alteration of gallbladder wall characterized by benign hyperplastic epithelial proliferation associated with hypertrophy of the muscularis propria.
The excessive epithelial proliferation leads to the formationup to 8 mm large epithelium-lined diverticular pouches,
the so-called Rokitansky-Aschoff sinuses (RAS),
which extend profoundly within the hypertrophic muscular layer.
The content of Rokitansky-Aschoff sinuses originally consists of clear bile,
but it undergoes a progressive concentration process that finally leads to cholesterine crystals precipitation.
Cholesterine crystals induce a chronic inflammatory...
Findings and procedure details
TRANSABDOMINAL ULTRASONOGRAPHY
Background
Transabdominal Ultrasonography (US) represents the first choice modality for evaluating gallbladder diseases.
The accuracy of US in diagnosing GA,
and in particular in differentiating GA from gallbladder cancer,
has progressively increased during the years (from 66.0% in year 2001 to 92.7% in year 2013),
mainly as a consequence of technical improvements of US scanners: i.e.
high frequency transducers,
harmonics,
compounding techniques and speckle reduction imaging.
US findings
Focal or diffuse gallbladder wall thickening (Fig 2, line)can be easily highlighted at US and...
Conclusion
US represents the imaging modality of choiche for diagnosing GA; contrast material administration is not indicated.
MR represents an excellentproblem solving technique in case of doubt at US.
PET may be used in patients in which the exclusion of a neoplasm is crucial and cannot be achieved with other methods.
CT is not indicated in the suspicion of GA.
And now,
test yourself! (Fig 16)
Personal information
Dr.
Matteo Bonatti
Department of Radiology
Bolzano Central Hospital
5 Boehler Street,
Bolzano
ITALY
[email protected]
References
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Differentiation of adenomyomatosis of the gallbladder from early-stage,
wall-thickening-type gallbladder cancer using high-resolution ultrasound. Joo I,
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Color Doppler twinkling artifacts in various conditions during abdominal and pelvic sonography. Kim HC,
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