Urgent MRI with MR cholangiopancreatography (MRCP) of acute cholecystitis and related complications: diagnostic role and spectrum of imaging findings

Abstract

Acute cholecystitis, which is usually associated with gallstones, is one of the commonest surgical causes of emergency hospital admission and may be further complicated by mural necrosis, perforation, and abscess formation. Magnetic resonance imaging (MRI) is increasingly available in the emergency setting. Technically improved equipment and faster acquisition protocols allow excellent tissue contrast and MRI is now an attractive modality for imaging acute abdominal disorders. The use of MRI with MR cholangiopancreatography in the emergency setting provides rapid, noninvasive, and confident diagnosis or exclusion of acute cholecystitis and of coexistent choledocholithiasis. To familiarize the reader with these cross-sectional imaging appearances, this paper reviews MRI findings consistent with uncomplicated cholecystitis. These include gallbladder distension, intraluminal sludge and gallstones, impacted stones obstructing the gallbladder neck or cystic duct, thickening of the gallbladder wall, abnormal signal intensity and edematous stratification, and pericholecystic and perihepatic fluid, plus increased enhancement of the gallbladder wall and adjacent liver parenchyma when intravenous paramagnetic contrast is used. Furthermore, MRI allows prompt detection and comprehensive visualization and characterization of cholecystitis-related complications such as gangrene, perforation, pericholecystic abscess, and intrahepatic fistulization. Some previous literature reports, and our experience, suggest that, when available, MRI should be recommended to provide prompt and efficient triage of patients with suspected cholecystitis and inconclusive clinical, laboratory, and sonographic findings. It facilitates appropriate therapeutic planning, including the timing of surgery (emergency or delayed), approach (laparoscopic or laparotomic), and need for preoperative or intraoperative removal of stone(s) in the common bile duct.

Diagnosis of complications associated with acute cholecystitis using computed tomography and diffusion-weighted imaging with background body signal suppression/T2 image fusion

“…Age, yearsDiscussion MRI imaging typically reveals gallbladder wall thickening and pericholecystic fluid in patients with acute cholecystitis (23), and is reported to be superior to CT for the diagnosis of acute cholecystitis (24). In the present study, DWIBS/T2 was as successful as CT imaging in identifying wall thickening and pericholecystic inflammation.…”

Diffusion-weighted whole-body magnetic resonance imaging with background body signal suppression/T2 image fusion for the diagnosis of acute cholecystitis

“…Therefore, measurements of wall thickness may be useful in aiding the diagnosis of acute cholecystitis and in evaluating its severity (22). In particular, the detection of wall thickening and pericholecystic fluid by MRI may be a useful diagnostic tool (23). In the present study, the gallbladder wall of patients with acute cholecystitis was thickened.…”

Performance of the Choledocholithiasis Diagnostic Score in Patients with Acute Cholecystitis

“…Recent studies have even suggested the systematic use of MRCP in patients with acute cholecystitis to exclude CBDS [1,15,16] . Another option is EUS, an invasive test with a sensitivity of 93% and a specificity of 96% for detection of choledocholithiasis [14] but with a lower morbidity than ERCP.…”