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DOI: 10.1148/rg.272055148
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RadioGraphics 2007;27:477-495
© RSNA, 2007

EDUCATION EXHIBIT

MR Imaging of Acute Biliary Disorders1

Yuji Watanabe, MD, Masako Nagayama, MD, Akira Okumura, MD, Yoshiki Amoh, MD, Takashi Katsube, MD, Tsuyoshi Suga, MD, Shingo Koyama, MD, Kohya Nakatani, MD and Yoshihiro Dodo, MD

1 From the Department of Radiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan. Presented as an education exhibit at the 2003 RSNA Annual Meeting. Received July 22, 2005; revision requested September 27; final revision received June 23, 2006; accepted June 28. All authors have no financial relationships to disclose. Address correspondence to Y.W. (e-mail: yw5904{at}kchnet.or.jp).

In patients with acute right-sided epigastric pain, jaundice, and a high fever, it is essential to accurately diagnose the cause of the symptoms, differentiate acute biliary disorders from nonbiliary disorders, and evaluate the severity of the disease. Gray-scale ultrasonography (US) and computed tomography (CT) are useful primary imaging modalities, but their results are not always conclusive. Magnetic resonance (MR) imaging, including MR cholangiopancreatography, can be a valuable complement to US and CT when additional information is needed. MR images have excellent tissue contrast and can provide more specific information, allowing diagnosis of complications that arise from acute cholecystitis, such as empyema, gangrenous cholecystitis, gallbladder perforation, enterocholecystic fistula, emphysematous cholecystitis, and hemorrhagic cholecystitis. In addition, causes of obstructive jaundice, acute suppurative cholangitis, and hemobilia can be clearly demonstrated with multisequence MR imaging. Single-section MR cholangiopancreatography and heavily T2-weighted imaging, in combination with fat-suppressed T1- and T2-weighted imaging, provide comprehensive and detailed information about the biliary system around the obstruction site, biliary calculi, inflammatory processes, purulent material, abscesses, gas, and hemorrhage. Contrast-enhanced MR imaging is useful for evaluation of the gallbladder wall; lack of enhancement and disruption of the wall may be findings specific for gangrenous cholecystitis and gallbladder perforation, respectively.

© RSNA, 2007






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