HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) CME Test (opens in a new window) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Watanabe, Y. Articles by Dodo, Y. Search for Related Content PubMed PubMed Citation Articles by Watanabe, Y. Articles by Dodo, Y. Related Collections Gastrointestinal Radiology Magnetic Resonance Imaging

MR Imaging of Acute Biliary Disorders¹

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.

View larger version (121K): [in this window] [in a new window] [Download PPT slide]   Figure 1a.  Acute acalculous cholecystitis associated with adenomyomatosis in a 54-year-old man with right upper quadrant pain and a high fever. MR imaging was performed because the patient presented with severe symptoms and US and CT findings were inconclusive. (a, b) Image from single-section MR cholangiopancre-atography (a) and coronal heavily T2-weighted image (b) show a distended gallbladder with an enlarged Rokitansky-Aschoff sinus (arrow) at the gallbladder neck. (c) Axial heavily T2-weighted image shows diffuse hypointense thickening of the gallbladder wall (open arrows). There is some purulent bile (solid arrow), which like a sludge forms a lower layer and is hypointense relative to normal bile. Note the small amount of ascites around the liver (arrowhead). (d) Axial fat-suppressed T2-weighted image shows diffuse hyperintense thickening of the gallbladder wall (open arrows), a finding indicative of acute inflammation. It is difficult to identify the purulent bile on this image. Note the small amount of ascites around the liver (arrowhead).

 

View larger version (149K): [in this window] [in a new window] [Download PPT slide]   Figure 1b.  Acute acalculous cholecystitis associated with adenomyomatosis in a 54-year-old man with right upper quadrant pain and a high fever. MR imaging was performed because the patient presented with severe symptoms and US and CT findings were inconclusive. (a, b) Image from single-section MR cholangiopancre-atography (a) and coronal heavily T2-weighted image (b) show a distended gallbladder with an enlarged Rokitansky-Aschoff sinus (arrow) at the gallbladder neck. (c) Axial heavily T2-weighted image shows diffuse hypointense thickening of the gallbladder wall (open arrows). There is some purulent bile (solid arrow), which like a sludge forms a lower layer and is hypointense relative to normal bile. Note the small amount of ascites around the liver (arrowhead). (d) Axial fat-suppressed T2-weighted image shows diffuse hyperintense thickening of the gallbladder wall (open arrows), a finding indicative of acute inflammation. It is difficult to identify the purulent bile on this image. Note the small amount of ascites around the liver (arrowhead).

 

View larger version (163K): [in this window] [in a new window] [Download PPT slide]   Figure 1c.  Acute acalculous cholecystitis associated with adenomyomatosis in a 54-year-old man with right upper quadrant pain and a high fever. MR imaging was performed because the patient presented with severe symptoms and US and CT findings were inconclusive. (a, b) Image from single-section MR cholangiopancre-atography (a) and coronal heavily T2-weighted image (b) show a distended gallbladder with an enlarged Rokitansky-Aschoff sinus (arrow) at the gallbladder neck. (c) Axial heavily T2-weighted image shows diffuse hypointense thickening of the gallbladder wall (open arrows). There is some purulent bile (solid arrow), which like a sludge forms a lower layer and is hypointense relative to normal bile. Note the small amount of ascites around the liver (arrowhead). (d) Axial fat-suppressed T2-weighted image shows diffuse hyperintense thickening of the gallbladder wall (open arrows), a finding indicative of acute inflammation. It is difficult to identify the purulent bile on this image. Note the small amount of ascites around the liver (arrowhead).

 

View larger version (163K): [in this window] [in a new window] [Download PPT slide]   Figure 1d.  Acute acalculous cholecystitis associated with adenomyomatosis in a 54-year-old man with right upper quadrant pain and a high fever. MR imaging was performed because the patient presented with severe symptoms and US and CT findings were inconclusive. (a, b) Image from single-section MR cholangiopancre-atography (a) and coronal heavily T2-weighted image (b) show a distended gallbladder with an enlarged Rokitansky-Aschoff sinus (arrow) at the gallbladder neck. (c) Axial heavily T2-weighted image shows diffuse hypointense thickening of the gallbladder wall (open arrows). There is some purulent bile (solid arrow), which like a sludge forms a lower layer and is hypointense relative to normal bile. Note the small amount of ascites around the liver (arrowhead). (d) Axial fat-suppressed T2-weighted image shows diffuse hyperintense thickening of the gallbladder wall (open arrows), a finding indicative of acute inflammation. It is difficult to identify the purulent bile on this image. Note the small amount of ascites around the liver (arrowhead).

 

View larger version (145K): [in this window] [in a new window] [Download PPT slide]   Figure 2a.  Acute cholecystitis caused by cystic duct obstruction due to an impacted calculus in a 65-year-old man with right upper quadrant pain. MR imaging was performed because the cause of the suspected acute cholecystitis could not be determined with US. (a) Image from single-section MR cholangiopancreatography shows a distended gallbladder with an impacted calculus (arrow) in the gallbladder neck. There is another calculus (*) in the gallbladder body. Note the small amount of pericholecystic fluid (arrowheads), which is markedly hyperintense. (b) Axial fat-suppressed T2-weighted image shows the distended gallbladder caused by the impacted stone (solid arrow). There is diffuse wall thickening with patchy high signal intensity (open arrows). Note the small amount of pericholecystic fluid (arrowhead), which is markedly hyperintense. (c) Coronal steady-state coherent image shows the impacted calculus (arrow) in the gallbladder neck. The impacted stone demonstrates predominant signal loss with a small central region of high signal intensity.

 

View larger version (146K): [in this window] [in a new window] [Download PPT slide]   Figure 2b.  Acute cholecystitis caused by cystic duct obstruction due to an impacted calculus in a 65-year-old man with right upper quadrant pain. MR imaging was performed because the cause of the suspected acute cholecystitis could not be determined with US. (a) Image from single-section MR cholangiopancreatography shows a distended gallbladder with an impacted calculus (arrow) in the gallbladder neck. There is another calculus (*) in the gallbladder body. Note the small amount of pericholecystic fluid (arrowheads), which is markedly hyperintense. (b) Axial fat-suppressed T2-weighted image shows the distended gallbladder caused by the impacted stone (solid arrow). There is diffuse wall thickening with patchy high signal intensity (open arrows). Note the small amount of pericholecystic fluid (arrowhead), which is markedly hyperintense. (c) Coronal steady-state coherent image shows the impacted calculus (arrow) in the gallbladder neck. The impacted stone demonstrates predominant signal loss with a small central region of high signal intensity.

 

View larger version (145K): [in this window] [in a new window] [Download PPT slide]   Figure 2c.  Acute cholecystitis caused by cystic duct obstruction due to an impacted calculus in a 65-year-old man with right upper quadrant pain. MR imaging was performed because the cause of the suspected acute cholecystitis could not be determined with US. (a) Image from single-section MR cholangiopancreatography shows a distended gallbladder with an impacted calculus (arrow) in the gallbladder neck. There is another calculus (*) in the gallbladder body. Note the small amount of pericholecystic fluid (arrowheads), which is markedly hyperintense. (b) Axial fat-suppressed T2-weighted image shows the distended gallbladder caused by the impacted stone (solid arrow). There is diffuse wall thickening with patchy high signal intensity (open arrows). Note the small amount of pericholecystic fluid (arrowhead), which is markedly hyperintense. (c) Coronal steady-state coherent image shows the impacted calculus (arrow) in the gallbladder neck. The impacted stone demonstrates predominant signal loss with a small central region of high signal intensity.

 

View larger version (122K): [in this window] [in a new window] [Download PPT slide]   Figure 3a.  Acute cholecystitis caused by cystic duct obstruction due to gallbladder cancer with lymph node metastasis in a 64-year-old man with right upper quadrant pain. MR imaging was performed because the cause of the gallbladder distention could not be determined with US. (a) Image from single-section MR cholangiopancreatography shows a distended gallbladder with a hypointense tumor (arrow) adjacent to the gallbladder neck. The tumor mimics an impacted stone (cf Fig 2). There is a polypoid skip lesion (*) in the gallbladder body. (b) On an axial fat-suppressed T2-weighted image, the gallbladder neck tumor (solid arrow) has intermediate signal intensity. The thickened gallbladder wall has high signal intensity (open arrow). (c) On a coronal steady-state coherent image, the gallbladder neck tumor (arrow) has intermediate signal intensity, as does the liver. The skip lesion in the gallbladder body (*) has an irregular surface. The diagnosis of gallbladder cancer was confirmed at surgery and pathologic analysis.

 

View larger version (123K): [in this window] [in a new window] [Download PPT slide]   Figure 3b.  Acute cholecystitis caused by cystic duct obstruction due to gallbladder cancer with lymph node metastasis in a 64-year-old man with right upper quadrant pain. MR imaging was performed because the cause of the gallbladder distention could not be determined with US. (a) Image from single-section MR cholangiopancreatography shows a distended gallbladder with a hypointense tumor (arrow) adjacent to the gallbladder neck. The tumor mimics an impacted stone (cf Fig 2). There is a polypoid skip lesion (*) in the gallbladder body. (b) On an axial fat-suppressed T2-weighted image, the gallbladder neck tumor (solid arrow) has intermediate signal intensity. The thickened gallbladder wall has high signal intensity (open arrow). (c) On a coronal steady-state coherent image, the gallbladder neck tumor (arrow) has intermediate signal intensity, as does the liver. The skip lesion in the gallbladder body (*) has an irregular surface. The diagnosis of gallbladder cancer was confirmed at surgery and pathologic analysis.

 

View larger version (159K): [in this window] [in a new window] [Download PPT slide]   Figure 3c.  Acute cholecystitis caused by cystic duct obstruction due to gallbladder cancer with lymph node metastasis in a 64-year-old man with right upper quadrant pain. MR imaging was performed because the cause of the gallbladder distention could not be determined with US. (a) Image from single-section MR cholangiopancreatography shows a distended gallbladder with a hypointense tumor (arrow) adjacent to the gallbladder neck. The tumor mimics an impacted stone (cf Fig 2). There is a polypoid skip lesion (*) in the gallbladder body. (b) On an axial fat-suppressed T2-weighted image, the gallbladder neck tumor (solid arrow) has intermediate signal intensity. The thickened gallbladder wall has high signal intensity (open arrow). (c) On a coronal steady-state coherent image, the gallbladder neck tumor (arrow) has intermediate signal intensity, as does the liver. The skip lesion in the gallbladder body (*) has an irregular surface. The diagnosis of gallbladder cancer was confirmed at surgery and pathologic analysis.

 

View larger version (142K): [in this window] [in a new window] [Download PPT slide]   Figure 4a.  Acute gangrenous cholecystitis due to an impacted calculus in a 70-year-old man with right upper quadrant pain and a high fever. MR imaging was performed because US and CT findings were inconclusive in regard to the severe symptoms. (a, b) Axial fat-suppressed T2-weighted (a) and fat-suppressed T1-weighted (b) images show irregular thickening of the gallbladder wall with small areas of high signal intensity (arrowheads). The hyperintense bile on the fat-suppressed T1-weighted image (b) is suggestive of concentrated bile. (c) Axial contrast-enhanced fat-suppressed T1-weighted image shows inhomogeneous enhancement of the irregularly thickened gallbladder wall and lack of enhancement at the fundus (arrow). (d) Sagittal contrast-enhanced fat-suppressed T1-weighted image shows that the mucosal layer is disrupted at the gallbladder fundus and body (arrows). MR cholangiopancreatography showed an impacted calculus in the gallbladder neck.

 

View larger version (144K): [in this window] [in a new window] [Download PPT slide]   Figure 4b.  Acute gangrenous cholecystitis due to an impacted calculus in a 70-year-old man with right upper quadrant pain and a high fever. MR imaging was performed because US and CT findings were inconclusive in regard to the severe symptoms. (a, b) Axial fat-suppressed T2-weighted (a) and fat-suppressed T1-weighted (b) images show irregular thickening of the gallbladder wall with small areas of high signal intensity (arrowheads). The hyperintense bile on the fat-suppressed T1-weighted image (b) is suggestive of concentrated bile. (c) Axial contrast-enhanced fat-suppressed T1-weighted image shows inhomogeneous enhancement of the irregularly thickened gallbladder wall and lack of enhancement at the fundus (arrow). (d) Sagittal contrast-enhanced fat-suppressed T1-weighted image shows that the mucosal layer is disrupted at the gallbladder fundus and body (arrows). MR cholangiopancreatography showed an impacted calculus in the gallbladder neck.

 

View larger version (168K): [in this window] [in a new window] [Download PPT slide]   Figure 4c.  Acute gangrenous cholecystitis due to an impacted calculus in a 70-year-old man with right upper quadrant pain and a high fever. MR imaging was performed because US and CT findings were inconclusive in regard to the severe symptoms. (a, b) Axial fat-suppressed T2-weighted (a) and fat-suppressed T1-weighted (b) images show irregular thickening of the gallbladder wall with small areas of high signal intensity (arrowheads). The hyperintense bile on the fat-suppressed T1-weighted image (b) is suggestive of concentrated bile. (c) Axial contrast-enhanced fat-suppressed T1-weighted image shows inhomogeneous enhancement of the irregularly thickened gallbladder wall and lack of enhancement at the fundus (arrow). (d) Sagittal contrast-enhanced fat-suppressed T1-weighted image shows that the mucosal layer is disrupted at the gallbladder fundus and body (arrows). MR cholangiopancreatography showed an impacted calculus in the gallbladder neck.

 

View larger version (165K): [in this window] [in a new window] [Download PPT slide]   Figure 4d.  Acute gangrenous cholecystitis due to an impacted calculus in a 70-year-old man with right upper quadrant pain and a high fever. MR imaging was performed because US and CT findings were inconclusive in regard to the severe symptoms. (a, b) Axial fat-suppressed T2-weighted (a) and fat-suppressed T1-weighted (b) images show irregular thickening of the gallbladder wall with small areas of high signal intensity (arrowheads). The hyperintense bile on the fat-suppressed T1-weighted image (b) is suggestive of concentrated bile. (c) Axial contrast-enhanced fat-suppressed T1-weighted image shows inhomogeneous enhancement of the irregularly thickened gallbladder wall and lack of enhancement at the fundus (arrow). (d) Sagittal contrast-enhanced fat-suppressed T1-weighted image shows that the mucosal layer is disrupted at the gallbladder fundus and body (arrows). MR cholangiopancreatography showed an impacted calculus in the gallbladder neck.

 

View larger version (152K): [in this window] [in a new window] [Download PPT slide]   Figure 5a.  Gallbladder perforation associated with acute gangrenous cholecystitis in a 78-year-old woman with right upper quadrant pain and a high fever. MR imaging was performed because of US findings suggestive of a pericholecystic abscess. (a) Image from single-section MR cholangiopancreatography shows a distended gallbladder (arrowhead) with an irregular contour of the fundus and stenosis of the common hepatic duct (arrow) due to extrinsic compression by the gallbladder. (b, c) Axial heavily T2-weighted (b) and fat-suppressed T2-weighted (c) images show gallbladder wall thickening (arrowhead) and purulent bile (*), which like a sludge forms a lower layer of low signal intensity. A pericholecystic abscess (open arrow) is seen as an area of slightly higher signal intensity. The gallbladder wall is disrupted (solid arrow), and purulent bile is present outside the gallbladder; this bile is contained by the pericholecystic abscess. (d) Axial fat-suppressed T1-weighted image shows the purulent bile (*) as a lower layer of intermediate signal intensity. The purulent bile communicates with the pericholecystic abscess (open arrow) through the site of perforation (solid arrow).

 

View larger version (172K): [in this window] [in a new window] [Download PPT slide]   Figure 5b.  Gallbladder perforation associated with acute gangrenous cholecystitis in a 78-year-old woman with right upper quadrant pain and a high fever. MR imaging was performed because of US findings suggestive of a pericholecystic abscess. (a) Image from single-section MR cholangiopancreatography shows a distended gallbladder (arrowhead) with an irregular contour of the fundus and stenosis of the common hepatic duct (arrow) due to extrinsic compression by the gallbladder. (b, c) Axial heavily T2-weighted (b) and fat-suppressed T2-weighted (c) images show gallbladder wall thickening (arrowhead) and purulent bile (*), which like a sludge forms a lower layer of low signal intensity. A pericholecystic abscess (open arrow) is seen as an area of slightly higher signal intensity. The gallbladder wall is disrupted (solid arrow), and purulent bile is present outside the gallbladder; this bile is contained by the pericholecystic abscess. (d) Axial fat-suppressed T1-weighted image shows the purulent bile (*) as a lower layer of intermediate signal intensity. The purulent bile communicates with the pericholecystic abscess (open arrow) through the site of perforation (solid arrow).

 

View larger version (154K): [in this window] [in a new window] [Download PPT slide]   Figure 5c.  Gallbladder perforation associated with acute gangrenous cholecystitis in a 78-year-old woman with right upper quadrant pain and a high fever. MR imaging was performed because of US findings suggestive of a pericholecystic abscess. (a) Image from single-section MR cholangiopancreatography shows a distended gallbladder (arrowhead) with an irregular contour of the fundus and stenosis of the common hepatic duct (arrow) due to extrinsic compression by the gallbladder. (b, c) Axial heavily T2-weighted (b) and fat-suppressed T2-weighted (c) images show gallbladder wall thickening (arrowhead) and purulent bile (*), which like a sludge forms a lower layer of low signal intensity. A pericholecystic abscess (open arrow) is seen as an area of slightly higher signal intensity. The gallbladder wall is disrupted (solid arrow), and purulent bile is present outside the gallbladder; this bile is contained by the pericholecystic abscess. (d) Axial fat-suppressed T1-weighted image shows the purulent bile (*) as a lower layer of intermediate signal intensity. The purulent bile communicates with the pericholecystic abscess (open arrow) through the site of perforation (solid arrow).

 

View larger version (172K): [in this window] [in a new window] [Download PPT slide]   Figure 5d.  Gallbladder perforation associated with acute gangrenous cholecystitis in a 78-year-old woman with right upper quadrant pain and a high fever. MR imaging was performed because of US findings suggestive of a pericholecystic abscess. (a) Image from single-section MR cholangiopancreatography shows a distended gallbladder (arrowhead) with an irregular contour of the fundus and stenosis of the common hepatic duct (arrow) due to extrinsic compression by the gallbladder. (b, c) Axial heavily T2-weighted (b) and fat-suppressed T2-weighted (c) images show gallbladder wall thickening (arrowhead) and purulent bile (*), which like a sludge forms a lower layer of low signal intensity. A pericholecystic abscess (open arrow) is seen as an area of slightly higher signal intensity. The gallbladder wall is disrupted (solid arrow), and purulent bile is present outside the gallbladder; this bile is contained by the pericholecystic abscess. (d) Axial fat-suppressed T1-weighted image shows the purulent bile (*) as a lower layer of intermediate signal intensity. The purulent bile communicates with the pericholecystic abscess (open arrow) through the site of perforation (solid arrow).

 

View larger version (143K): [in this window] [in a new window] [Download PPT slide]   Figure 6a.  Gallbladder perforation with an enterobiliary fistula in a 68-year-old man with right upper quadrant pain and a high fever. MR imaging was performed to search for the cause of gas in the gallbladder lumen seen at US and CT. (a) Axial heavily T2-weighted image shows a distorted gallbladder. Intraluminal gas (*) forms an upper layer and purulent bile (arrow) forms a lower layer of low signal intensity. Note the irregular thick gallbladder wall with a hyperintense focus (arrowhead), which represents a small ulcerative projection. (b) Axial fat-suppressed T2-weighted image shows the intraluminal gas (*) in the gallbladder, which has a diffuse thick hyperintense wall. There is a tiny gas bubble in the ulcerative projection (arrowhead). (c) Axial contrast-enhanced fat-suppressed T1-weighted image shows that the left gallbladder wall has an irregular contour with inhomogeneous intense enhancement (arrowhead), an appearance suggestive of gallbladder perforation. Note the decreased enhancement of the right gallbladder wall (arrows), a finding suggestive of ischemic change and gangrene. A subsequent gastroduodenal barium study and surgery demonstrated a cholecystoduodenal fistula.

 

View larger version (157K): [in this window] [in a new window] [Download PPT slide]   Figure 6b.  Gallbladder perforation with an enterobiliary fistula in a 68-year-old man with right upper quadrant pain and a high fever. MR imaging was performed to search for the cause of gas in the gallbladder lumen seen at US and CT. (a) Axial heavily T2-weighted image shows a distorted gallbladder. Intraluminal gas (*) forms an upper layer and purulent bile (arrow) forms a lower layer of low signal intensity. Note the irregular thick gallbladder wall with a hyperintense focus (arrowhead), which represents a small ulcerative projection. (b) Axial fat-suppressed T2-weighted image shows the intraluminal gas (*) in the gallbladder, which has a diffuse thick hyperintense wall. There is a tiny gas bubble in the ulcerative projection (arrowhead). (c) Axial contrast-enhanced fat-suppressed T1-weighted image shows that the left gallbladder wall has an irregular contour with inhomogeneous intense enhancement (arrowhead), an appearance suggestive of gallbladder perforation. Note the decreased enhancement of the right gallbladder wall (arrows), a finding suggestive of ischemic change and gangrene. A subsequent gastroduodenal barium study and surgery demonstrated a cholecystoduodenal fistula.

 

View larger version (171K): [in this window] [in a new window] [Download PPT slide]   Figure 6c.  Gallbladder perforation with an enterobiliary fistula in a 68-year-old man with right upper quadrant pain and a high fever. MR imaging was performed to search for the cause of gas in the gallbladder lumen seen at US and CT. (a) Axial heavily T2-weighted image shows a distorted gallbladder. Intraluminal gas (*) forms an upper layer and purulent bile (arrow) forms a lower layer of low signal intensity. Note the irregular thick gallbladder wall with a hyperintense focus (arrowhead), which represents a small ulcerative projection. (b) Axial fat-suppressed T2-weighted image shows the intraluminal gas (*) in the gallbladder, which has a diffuse thick hyperintense wall. There is a tiny gas bubble in the ulcerative projection (arrowhead). (c) Axial contrast-enhanced fat-suppressed T1-weighted image shows that the left gallbladder wall has an irregular contour with inhomogeneous intense enhancement (arrowhead), an appearance suggestive of gallbladder perforation. Note the decreased enhancement of the right gallbladder wall (arrows), a finding suggestive of ischemic change and gangrene. A subsequent gastroduodenal barium study and surgery demonstrated a cholecystoduodenal fistula.

 

View larger version (165K): [in this window] [in a new window] [Download PPT slide]   Figure 7a.  Emphysematous cholecystitis in a 62-year-old man with right upper quadrant pain and a high fever followed by symptoms of shock. MR imaging was performed to search for the cause of gas in the gallbladder lumen seen at US and CT. (a) Coronal heavily T2-weighted image shows numerous signal void bubbles (arrowheads) in the lumina of the distended gallbladder and the common bile duct. (b) Axial fat-suppressed T2-weighted image shows that the gas bubbles (arrowheads) form an upper layer in the dependent portions of the gallbladder and cystic duct; purulent bile (*) like a sludge forms a lower layer of relatively low signal intensity. Note the thick gallbladder wall with a hyperintense focus (open arrows), an appearance suggestive of an intramural abscess. Pericholecystic fluid is also seen (solid arrows). (c) Axial fat-suppressed T1-weighted image shows similar findings of gas (arrowhead) and an inflamed thick gallbladder wall. The medial gallbladder wall has very high signal intensity (arrows), a finding suggestive of intramural hemorrhage or hemorrhagic necrosis.

 

View larger version (156K): [in this window] [in a new window] [Download PPT slide]   Figure 7b.  Emphysematous cholecystitis in a 62-year-old man with right upper quadrant pain and a high fever followed by symptoms of shock. MR imaging was performed to search for the cause of gas in the gallbladder lumen seen at US and CT. (a) Coronal heavily T2-weighted image shows numerous signal void bubbles (arrowheads) in the lumina of the distended gallbladder and the common bile duct. (b) Axial fat-suppressed T2-weighted image shows that the gas bubbles (arrowheads) form an upper layer in the dependent portions of the gallbladder and cystic duct; purulent bile (*) like a sludge forms a lower layer of relatively low signal intensity. Note the thick gallbladder wall with a hyperintense focus (open arrows), an appearance suggestive of an intramural abscess. Pericholecystic fluid is also seen (solid arrows). (c) Axial fat-suppressed T1-weighted image shows similar findings of gas (arrowhead) and an inflamed thick gallbladder wall. The medial gallbladder wall has very high signal intensity (arrows), a finding suggestive of intramural hemorrhage or hemorrhagic necrosis.

 

View larger version (156K): [in this window] [in a new window] [Download PPT slide]   Figure 7c.  Emphysematous cholecystitis in a 62-year-old man with right upper quadrant pain and a high fever followed by symptoms of shock. MR imaging was performed to search for the cause of gas in the gallbladder lumen seen at US and CT. (a) Coronal heavily T2-weighted image shows numerous signal void bubbles (arrowheads) in the lumina of the distended gallbladder and the common bile duct. (b) Axial fat-suppressed T2-weighted image shows that the gas bubbles (arrowheads) form an upper layer in the dependent portions of the gallbladder and cystic duct; purulent bile (*) like a sludge forms a lower layer of relatively low signal intensity. Note the thick gallbladder wall with a hyperintense focus (open arrows), an appearance suggestive of an intramural abscess. Pericholecystic fluid is also seen (solid arrows). (c) Axial fat-suppressed T1-weighted image shows similar findings of gas (arrowhead) and an inflamed thick gallbladder wall. The medial gallbladder wall has very high signal intensity (arrows), a finding suggestive of intramural hemorrhage or hemorrhagic necrosis.

 

View larger version (178K): [in this window] [in a new window] [Download PPT slide]   Figure 8a.  Hemorrhagic cholecystitis and gallbladder perforation causing biliary peritonitis in a 72-year-old man with upper abdominal pain and melena. MR imaging was performed because the patient presented with severe symptoms and US and CT findings were inconclusive. (a) Coronal heavily T2-weighted image shows multiple defects (arrows) in the common bile duct, which represent clots. The gallbladder is not visualized. (b, c) Axial heavily T2-weighted (b) and fat-suppressed T2-weighted (c) images show hemorrhagic bile (thin solid arrows) like a sludge in the common bile duct and gallbladder, forming a lower layer of low signal intensity. The distended and distorted gall-bladder has a focal protrusion (open arrows) and an irregular wall that is disrupted at the fundus (arrowheads). Biliary peritonitis has caused an encapsulated fluid collection (thick solid arrow) beside the spleen. A small amount of ascites is also seen. (d) Axial fat-suppressed T1-weighted image shows high signal intensity of the lower layer of hemorrhagic bile (thin solid arrow). The long disruption of the gallbladder wall (arrowheads) with focal protrusion (open arrows) at the fundus is also seen. Thick solid arrow = encapsulated fluid collection beside the spleen. Subsequent endoscopic retrograde cholangiopancreatography revealed hemobilia. Ten days later, the patient died of multiple organ failure.

 

View larger version (163K): [in this window] [in a new window] [Download PPT slide]   Figure 8b.  Hemorrhagic cholecystitis and gallbladder perforation causing biliary peritonitis in a 72-year-old man with upper abdominal pain and melena. MR imaging was performed because the patient presented with severe symptoms and US and CT findings were inconclusive. (a) Coronal heavily T2-weighted image shows multiple defects (arrows) in the common bile duct, which represent clots. The gallbladder is not visualized. (b, c) Axial heavily T2-weighted (b) and fat-suppressed T2-weighted (c) images show hemorrhagic bile (thin solid arrows) like a sludge in the common bile duct and gallbladder, forming a lower layer of low signal intensity. The distended and distorted gall-bladder has a focal protrusion (open arrows) and an irregular wall that is disrupted at the fundus (arrowheads). Biliary peritonitis has caused an encapsulated fluid collection (thick solid arrow) beside the spleen. A small amount of ascites is also seen. (d) Axial fat-suppressed T1-weighted image shows high signal intensity of the lower layer of hemorrhagic bile (thin solid arrow). The long disruption of the gallbladder wall (arrowheads) with focal protrusion (open arrows) at the fundus is also seen. Thick solid arrow = encapsulated fluid collection beside the spleen. Subsequent endoscopic retrograde cholangiopancreatography revealed hemobilia. Ten days later, the patient died of multiple organ failure.

 

View larger version (140K): [in this window] [in a new window] [Download PPT slide]   Figure 8c.  Hemorrhagic cholecystitis and gallbladder perforation causing biliary peritonitis in a 72-year-old man with upper abdominal pain and melena. MR imaging was performed because the patient presented with severe symptoms and US and CT findings were inconclusive. (a) Coronal heavily T2-weighted image shows multiple defects (arrows) in the common bile duct, which represent clots. The gallbladder is not visualized. (b, c) Axial heavily T2-weighted (b) and fat-suppressed T2-weighted (c) images show hemorrhagic bile (thin solid arrows) like a sludge in the common bile duct and gallbladder, forming a lower layer of low signal intensity. The distended and distorted gall-bladder has a focal protrusion (open arrows) and an irregular wall that is disrupted at the fundus (arrowheads). Biliary peritonitis has caused an encapsulated fluid collection (thick solid arrow) beside the spleen. A small amount of ascites is also seen. (d) Axial fat-suppressed T1-weighted image shows high signal intensity of the lower layer of hemorrhagic bile (thin solid arrow). The long disruption of the gallbladder wall (arrowheads) with focal protrusion (open arrows) at the fundus is also seen. Thick solid arrow = encapsulated fluid collection beside the spleen. Subsequent endoscopic retrograde cholangiopancreatography revealed hemobilia. Ten days later, the patient died of multiple organ failure.

 

View larger version (154K): [in this window] [in a new window] [Download PPT slide]   Figure 8d.  Hemorrhagic cholecystitis and gallbladder perforation causing biliary peritonitis in a 72-year-old man with upper abdominal pain and melena. MR imaging was performed because the patient presented with severe symptoms and US and CT findings were inconclusive. (a) Coronal heavily T2-weighted image shows multiple defects (arrows) in the common bile duct, which represent clots. The gallbladder is not visualized. (b, c) Axial heavily T2-weighted (b) and fat-suppressed T2-weighted (c) images show hemorrhagic bile (thin solid arrows) like a sludge in the common bile duct and gallbladder, forming a lower layer of low signal intensity. The distended and distorted gall-bladder has a focal protrusion (open arrows) and an irregular wall that is disrupted at the fundus (arrowheads). Biliary peritonitis has caused an encapsulated fluid collection (thick solid arrow) beside the spleen. A small amount of ascites is also seen. (d) Axial fat-suppressed T1-weighted image shows high signal intensity of the lower layer of hemorrhagic bile (thin solid arrow). The long disruption of the gallbladder wall (arrowheads) with focal protrusion (open arrows) at the fundus is also seen. Thick solid arrow = encapsulated fluid collection beside the spleen. Subsequent endoscopic retrograde cholangiopancreatography revealed hemobilia. Ten days later, the patient died of multiple organ failure.

 

View larger version (167K): [in this window] [in a new window] [Download PPT slide]   Figure 9a.  Acute suppurative cholangitis caused by ampullary cancer in a 63-year-old woman with abdominal pain, a high fever, and jaundice. MR imaging was performed to search for the cause of the obstructive jaundice because the patient presented with severe symptoms and US and CT findings were inconclusive. (a) Image from single-section MR cholangiopancreatography shows a dilated pancreaticobiliary duct and a distended gallbladder caused by an ampullary cancer (arrow), which protruded into the lower common bile duct as a small polypoid nodule. Minimal pericholecystic fluid is evident (arrowhead). (b) Coronal steady-state coherent image shows the polypoid tumor (arrow) as an area of intermediate signal intensity, allowing differentiation from a low-signal-intensity stone (cf Fig 2). (c) Axial heavily T2-weighted image shows that the gallbladder has a thick wall (arrows). Purulent bile (arrowheads) in the gallbladder and common bile duct forms lower layers of low signal intensity. (d) Axial black blood T2-weighted spin-echo echo-planar image shows periportal inflammation of high signal intensity (arrows) extending along the intrahepatic portal vein, which appears as a signal void.

 

View larger version (169K): [in this window] [in a new window] [Download PPT slide]   Figure 9b.  Acute suppurative cholangitis caused by ampullary cancer in a 63-year-old woman with abdominal pain, a high fever, and jaundice. MR imaging was performed to search for the cause of the obstructive jaundice because the patient presented with severe symptoms and US and CT findings were inconclusive. (a) Image from single-section MR cholangiopancreatography shows a dilated pancreaticobiliary duct and a distended gallbladder caused by an ampullary cancer (arrow), which protruded into the lower common bile duct as a small polypoid nodule. Minimal pericholecystic fluid is evident (arrowhead). (b) Coronal steady-state coherent image shows the polypoid tumor (arrow) as an area of intermediate signal intensity, allowing differentiation from a low-signal-intensity stone (cf Fig 2). (c) Axial heavily T2-weighted image shows that the gallbladder has a thick wall (arrows). Purulent bile (arrowheads) in the gallbladder and common bile duct forms lower layers of low signal intensity. (d) Axial black blood T2-weighted spin-echo echo-planar image shows periportal inflammation of high signal intensity (arrows) extending along the intrahepatic portal vein, which appears as a signal void.

 

View larger version (139K): [in this window] [in a new window] [Download PPT slide]   Figure 9c.  Acute suppurative cholangitis caused by ampullary cancer in a 63-year-old woman with abdominal pain, a high fever, and jaundice. MR imaging was performed to search for the cause of the obstructive jaundice because the patient presented with severe symptoms and US and CT findings were inconclusive. (a) Image from single-section MR cholangiopancreatography shows a dilated pancreaticobiliary duct and a distended gallbladder caused by an ampullary cancer (arrow), which protruded into the lower common bile duct as a small polypoid nodule. Minimal pericholecystic fluid is evident (arrowhead). (b) Coronal steady-state coherent image shows the polypoid tumor (arrow) as an area of intermediate signal intensity, allowing differentiation from a low-signal-intensity stone (cf Fig 2). (c) Axial heavily T2-weighted image shows that the gallbladder has a thick wall (arrows). Purulent bile (arrowheads) in the gallbladder and common bile duct forms lower layers of low signal intensity. (d) Axial black blood T2-weighted spin-echo echo-planar image shows periportal inflammation of high signal intensity (arrows) extending along the intrahepatic portal vein, which appears as a signal void.

 

View larger version (103K): [in this window] [in a new window] [Download PPT slide]   Figure 9d.  Acute suppurative cholangitis caused by ampullary cancer in a 63-year-old woman with abdominal pain, a high fever, and jaundice. MR imaging was performed to search for the cause of the obstructive jaundice because the patient presented with severe symptoms and US and CT findings were inconclusive. (a) Image from single-section MR cholangiopancreatography shows a dilated pancreaticobiliary duct and a distended gallbladder caused by an ampullary cancer (arrow), which protruded into the lower common bile duct as a small polypoid nodule. Minimal pericholecystic fluid is evident (arrowhead). (b) Coronal steady-state coherent image shows the polypoid tumor (arrow) as an area of intermediate signal intensity, allowing differentiation from a low-signal-intensity stone (cf Fig 2). (c) Axial heavily T2-weighted image shows that the gallbladder has a thick wall (arrows). Purulent bile (arrowheads) in the gallbladder and common bile duct forms lower layers of low signal intensity. (d) Axial black blood T2-weighted spin-echo echo-planar image shows periportal inflammation of high signal intensity (arrows) extending along the intrahepatic portal vein, which appears as a signal void.

 

View larger version (138K): [in this window] [in a new window] [Download PPT slide]   Figure 10a.  Cholangiocarcinoma of the hepatic hilum in a 62-year-old man with jaundice. MR imaging was performed to determine the extent of a bile duct tumor detected with US and CT. (a) Coronal heavily T2-weighted image shows marked dilatation of the intrahepatic bile ducts and severe stenosis of the hepatic duct (arrow). (b, c) Axial T1-weighted (b) and fat-suppressed T2-weighted (c) images show a cholangiocarcinoma (arrows) at the hepatic hilum. The tumor is hypointense on the T1-weighted image (b) and slightly hyperintense on the fat-suppressed T2-weighted image (c). Subsequently, endoscopic biliary drainage was successfully performed.

 

View larger version (158K): [in this window] [in a new window] [Download PPT slide]   Figure 10b.  Cholangiocarcinoma of the hepatic hilum in a 62-year-old man with jaundice. MR imaging was performed to determine the extent of a bile duct tumor detected with US and CT. (a) Coronal heavily T2-weighted image shows marked dilatation of the intrahepatic bile ducts and severe stenosis of the hepatic duct (arrow). (b, c) Axial T1-weighted (b) and fat-suppressed T2-weighted (c) images show a cholangiocarcinoma (arrows) at the hepatic hilum. The tumor is hypointense on the T1-weighted image (b) and slightly hyperintense on the fat-suppressed T2-weighted image (c). Subsequently, endoscopic biliary drainage was successfully performed.

 

View larger version (144K): [in this window] [in a new window] [Download PPT slide]   Figure 10c.  Cholangiocarcinoma of the hepatic hilum in a 62-year-old man with jaundice. MR imaging was performed to determine the extent of a bile duct tumor detected with US and CT. (a) Coronal heavily T2-weighted image shows marked dilatation of the intrahepatic bile ducts and severe stenosis of the hepatic duct (arrow). (b, c) Axial T1-weighted (b) and fat-suppressed T2-weighted (c) images show a cholangiocarcinoma (arrows) at the hepatic hilum. The tumor is hypointense on the T1-weighted image (b) and slightly hyperintense on the fat-suppressed T2-weighted image (c). Subsequently, endoscopic biliary drainage was successfully performed.

 

View larger version (138K): [in this window] [in a new window] [Download PPT slide]   Figure 11a.  Mirizzi syndrome in a 63-year-old man with abdominal pain and jaundice. MR imaging was performed to search for the cause of the obstructive jaundice because US and CT findings were inconclusive. (a) Image from single-section MR cholangiopancreatography shows severe stenosis of the common hepatic duct (arrowhead) due to extrinsic compression. Note the calculus (arrow) in the lower common bile duct. (b, c) Axial fat-suppressed T2-weighted (b) and fat-suppressed T1-weighted (c) images show an impacted calculus with low signal intensity (arrow) in the gallbladder neck and associated atrophy of the gallbladder (arrowheads). Cholecystectomy was unsuccessful because of severe fibrous adhesions. Subsequent endoscopic dilation of the common hepatic duct was performed.

 

View larger version (164K): [in this window] [in a new window] [Download PPT slide]   Figure 11b.  Mirizzi syndrome in a 63-year-old man with abdominal pain and jaundice. MR imaging was performed to search for the cause of the obstructive jaundice because US and CT findings were inconclusive. (a) Image from single-section MR cholangiopancreatography shows severe stenosis of the common hepatic duct (arrowhead) due to extrinsic compression. Note the calculus (arrow) in the lower common bile duct. (b, c) Axial fat-suppressed T2-weighted (b) and fat-suppressed T1-weighted (c) images show an impacted calculus with low signal intensity (arrow) in the gallbladder neck and associated atrophy of the gallbladder (arrowheads). Cholecystectomy was unsuccessful because of severe fibrous adhesions. Subsequent endoscopic dilation of the common hepatic duct was performed.

 

View larger version (152K): [in this window] [in a new window] [Download PPT slide]   Figure 11c.  Mirizzi syndrome in a 63-year-old man with abdominal pain and jaundice. MR imaging was performed to search for the cause of the obstructive jaundice because US and CT findings were inconclusive. (a) Image from single-section MR cholangiopancreatography shows severe stenosis of the common hepatic duct (arrowhead) due to extrinsic compression. Note the calculus (arrow) in the lower common bile duct. (b, c) Axial fat-suppressed T2-weighted (b) and fat-suppressed T1-weighted (c) images show an impacted calculus with low signal intensity (arrow) in the gallbladder neck and associated atrophy of the gallbladder (arrowheads). Cholecystectomy was unsuccessful because of severe fibrous adhesions. Subsequent endoscopic dilation of the common hepatic duct was performed.

 

View larger version (188K): [in this window] [in a new window] [Download PPT slide]   Figure 12a.  Hemobilia due to biliary invasion by hepatocellular carcinoma in a 72-year-old man with abdominal pain, melena, and jaundice. MR imaging was performed to search for the cause of the melena, since US and CT demonstrated the hepatocellular carcinoma but did not show the cause of the melena. (a) Axial fat-suppressed T1-weighted image shows high signal intensity of dilated intrahepatic ducts (arrows) in the left lobe, an appearance suggestive of intraductal hemorrhage. (b) Image from a dynamic contrast-enhanced study shows an ill-defined hypervascular hepatocellular carcinoma (arrowheads) in the quadrate lobe of the liver. Endoscopic retrograde cholangiopancreatography demonstrated hemorrhage in the common bile duct flowing out into the duodenum.

 

View larger version (119K): [in this window] [in a new window] [Download PPT slide]   Figure 12b.  Hemobilia due to biliary invasion by hepatocellular carcinoma in a 72-year-old man with abdominal pain, melena, and jaundice. MR imaging was performed to search for the cause of the melena, since US and CT demonstrated the hepatocellular carcinoma but did not show the cause of the melena. (a) Axial fat-suppressed T1-weighted image shows high signal intensity of dilated intrahepatic ducts (arrows) in the left lobe, an appearance suggestive of intraductal hemorrhage. (b) Image from a dynamic contrast-enhanced study shows an ill-defined hypervascular hepatocellular carcinoma (arrowheads) in the quadrate lobe of the liver. Endoscopic retrograde cholangiopancreatography demonstrated hemorrhage in the common bile duct flowing out into the duodenum.

 

---

HOME

HELP

FEEDBACK

SUBSCRIPTIONS

ARCHIVE

SEARCH

TABLE OF CONTENTS

RADIOGRAPHICS

RADIOLOGY

RSNA JOURNALS ONLINE

Copyright © 2007 by the Radiological Society of North America.