Ring down artifact6/10/2023 ![]() ![]() US is widely used as a primary imaging modality for evaluating suspected gallbladder disease in patients with right upper quadrant pain or jaundice. In addition, diagnostic tips are offered with respect to the roles that pertinent imaging techniques may play in delineating benign conditions and ruling out malignancy. Herein, we have classified various benign gallbladder diseases by imaging appearance and briefly reviewed the respective clinical manifestations. Recent technologic advancements have now prompted the use of contrast-enhanced US (CEUS), high-resolution ultrasound (HRUS), and advanced MRI sequences for gallbladder evaluations, enabling greater diagnostic precision and facilitating the distinction between benign and malignant gallbladder disease. Given its rapid ascendancy, computed tomography (CT) has also become a mainstay in evaluating gallbladder disease, whereas magnetic resonance imaging (MRI) is generally considered a problem-solving tool. Traditionally, ultrasound (US) has been the preferred first-line imaging technique for suspected gallbladder disease. In evaluating the gallbladder, a variety of imaging modalities are useful. Therefore, it is imperative to differentiate such diseases for treatment and prognostic purposes. In addition, the benign gallbladder diseases present with various imaging appearances and may mimic those of gallbladder malignancies. Required treatments and management strategies vary accordingly. Patients may be asymptomatic or stricken with acute biliary colic, jaundice, and fever. The benign conditions, which also include polyps, adenomyomatosis, acute cholecystitis, and more, show a range of clinical signs and symptoms. Gallstones and gallbladder cancer are the two most prevalent benign and malignant disorders, respectively. Gallbladder disease is common in clinical practice. ![]() Such distinctions require a familiarity with typical imaging features of various gallbladder diseases and an understanding of the roles that assorted imaging modalities play in gallbladder evaluations. Magnetic resonance imaging in conjunction with diffusion-weighted imaging helps to differentiate xathogranulomatous cholecystitis from gallbladder cancer by identifying the presence of fat and degree of diffusion restriction. In chronic cholecystitis, preservation of a two-layered wall and weak wall enhancement are diagnostic clues for excluding malignancy. Ultrasound used alone is limited in evaluating complicated cholecystitis and often requires complementary computed tomography. Nevertheless, it is important to check for coexistent cancer in instances of acute cholecystitis. A diffusely thickened wall is frequently seen in inflammatory processes of the gallbladder. High-resolution ultrasound is especially useful for analyzing the layering of gallbladder wall. The layered pattern, degree of enhancement, and integrity of the wall are imaging clues that help discriminate innocuous thickening from gallbladder cancer. Identification of Rokitansky-Aschoff sinuses is pivotal in diagnosing adenomyomatosis. Localized gallbladder wall thickening is largely due to segmental or focal gallbladder adenomyomatosis, although infiltrative cancer may present similarly. Polyp size, stalk width, and enhancement intensity on contrast-enhanced ultrasound and degree of diffusion restriction may help differentiate cholesterol polyps and adenomas from gallbladder cancer. ![]() Intraluminal lesions of the gallbladder include gallstones, cholesterol polyps, adenomas, or sludge and polypoid type of gallbladder cancer must subsequently be excluded. Benign gallbladder diseases usually present with intraluminal lesions and localized or diffuse wall thickening. ![]()
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