Imaging of adenomyomatosis of the gall bladder

Abstract

Adenomyomatosis is a relatively common abnormality of the gall bladder, with a reported incidence of between 2.8 and 5%. Although mainly confined to the adult study group, a number of cases have been reported in the paediatric study group. It is characterized pathologically by excessive proliferation of the surface epithelium and hypertrophy of the muscularis propria of the gall bladder wall, with invagination of the mucosa into the thickened muscularis forming the so-called 'Rokitansky-Aschoff' sinuses. The condition is usually asymptomatic and is often diagnosed as an incidental finding on abdominal imaging. The radiological diagnosis is largely dependent on the visualization of the characteristic Rokitansky-Aschoff sinuses. As the condition is usually asymptomatic, the importance of making a correct diagnosis is to prevent misinterpretation of other gall bladder conditions such as gall bladder cancer, leading to incorrect treatment. In the past, oral cholecystography was the main imaging method used to make this diagnosis. In most institutions, oral cholecystography is no longer carried out, and the diagnosis is now more commonly seen on cross-sectional imaging. In this review article, we describe the manifestations of adenomyomatosis on the various imaging methods, with an emphasis on more modern techniques such as magnetic resonance cholangiopancreatography. A brief section on oral cholecystography to aid readers familiar with this technique in understanding the comparable imaging features on more modern imaging techniques is included.

A Comparative Study of Clinicopathological Features between Chronic Cholecystitis Patients with and without Helicobacter pylori Infection in Gallbladder Mucosa

“…[27] GAM can be diagnosed preoperatively through ultrasound, CT scan or MRI. [28], [29] Incidence rate of GAM is reported to be 25.8%–32% in chronic cholecystitis patients based on the cholecystectomy specimens. [30], [31] Some investigators strongly recommended cholecystectomy in case of GAM with gallstones or symptomatic GAM because stones and chronic inflammation secondary to GAM may lead to dysplasia, metaplasia and cancer.…”

Differentiating between Adenomyomatosis and Gallbladder Cancer: Revisiting a Comparative Study of High-Resolution Ultrasound, Multidetector CT, and MR Imaging

“…Diagnostic criteria for ADM on CT were as follows: the presence of the Rosary sign (enhancing mucosal epithelium with intramural diverticula surrounded by the relatively unenhanced, hypertrophied GB muscle coat), multiple intramural cysts or discrete hypoattenuating lesions (16, 18-20). The only diagnostic criterion for ADM on MRI was the presence of multiple intramural cysts in the thickened wall (pearl necklace sign) (21-23).…”

Adenomyomatosis of the Gallbladder: The “Good Omen” Comet

“…The teaching that GBA does not lead to carcinoma has been recently challenged, particularly for elderly patients (5,12,13). There is co-existent carcinoma in 2-6% of …”

“…However, the most urgent concern for the emergency physician is making the distinction between GBA and emphysematous cholecystitis (5,12). A less ill patient without significant tenderness and normal liver function tests is more likely to have GBA (13). Lack of inhomogeneous hypoechoic sonographic shadowing (also known as "dirty shadowing") also favors this diagnosis (12,17,18).…”