Mount Sinai's Radiology Charts

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Author: Katharine Maglione
 Ultrasound NECT CECT MRI - T1 MRI - T2 MRI - Post-contrast T1 Gross Pathology Histology Additional comments
Adenomyomatosis Thickened wall with mucosal herniations, cholesterol crystals in Rokitansky-Aschoff sinuses leading to comet-tail artifact (bright reflections). No flow to the Rokitansky-Aschoff sinuses. Small intramural stone (arrow), calcification in thickened fundus, calcified gallbladder stones. Focal or diffuse wall thickening, usually some degree of wall enhancement. Small hyperintense foci (string of beads sign) are dilated Rokitansky-Aschoff sinuses. Focal or diffuse wall thickening and enhancement and small cystic structures (Rokitansky-Aschoff sinuses, straight arrows).

Focal or diffuse wall thickening and enhancement and small cystic structures (Rokitansky-Aschoff sinuses, straight arrows). 		MRCP image shows small cystic structures (the pearl necklace sign) within segmental wall thickening and multiple stones in the fundus of the gallbladder (arrowheads).
     
Cholelithiasis Mobile echogenic structures within gallbladder lumen with posterior acoustic shadowing. No flow to the stone. +/- stones in dependent portion of gallbladder. Difficult to visualize on CT. +/- stones in dependent portion of gallbladder. Difficult to visualize on CT. Signal Void, Hypointense (both cholesterol & pigment) material within hyperintense bile. A large gallstone (asterisk).
   
Tumefactive sludge Sludge layering within gallbladder. No flow. Hyperintense. Hypointense. MRI In/OUT ----- Hyperintense.
       
Acute calculous cholecystitis Stones in the fundus (arrowheads) and an obstructing stone in the neck (arrow) of an enlarged gallbladder. Findings that support this diagnosis are (1) gall stones (2) gallbladder wall thickening [>3mm] (3) gallbladder enlargement (4) pericholecystic fluid (5) stone impacted in neck or cystic duct (6) positive sonographic Murphy's sign. Gallstones, poorly defined gallbladder wall, pericholecystic fluid. Hypointense stones, thickened gallbladder wall with increased signal intensity, pericholecystic fluid. Cholescintigram after morphine:bowel activity, gallbladder not seen.
         
Acute acalculous cholecystitis Wall thickening and pericholecystic fluid. Diffuse hypointense thickening of the gallbladder wall, purulent bile (like a sludge forms a lower layer, hypointense relative to normal bile). Fat-suppressed T2: diffuse hyperintense thickening of the gallbladder wall (open arrows) indicative of acute inflammation.
         
Chronic cholecystitis Smooth well-defined thickened gallbladder wall , hypointense tunica muscularis (edematous). Smooth, well-defined thickened gallbladder wall, hyperintense tunica muscularis (edematous). Smooth well-defined thickened gallbladder wall with increasing homogenous enhancement from arterial to venous phase, tunica muscularis poorly enhancing.

Smooth well-defined thickened gallbladder wall with increasing homogenous enhancement from arterial to venous phase, tunica muscularis poorly enhancing.
         
Emphysematous cholecystitis Curvilinear echogenic interface in the gallbladder fossa (arrowheads) with reverberation artifact (arrows) suggesting gas in gallbladder wall.

Multiple tiny echogenic reflectors within gallbladder lumen corresponding to gas bubbles arising from the dependent wall (champagne sign). 		Gas in the gallbladder lumen and wall +/- cholelithiasis. Gas in the gallbladder lumen and wall +/- cholelithiasis. Fat-suppressed T1: gas and inflamed thick gallbladder wall with high signal intensity (suggestive of intramural hemorrhage or hemorrhagic necrosis). Numerous signal void bubbles in lumen of distended gallbladder and common bile duct.

Fat-suppressed T2-weighted shows gas bubbles, purulent bile (like a sludge forms layer of low signal intensity), thick gallbladder wall with a hyperintense focus (intramural abscess), pericholecystic fluid. 		Gross specimen shows areas of transmural infarction and hemorrhagic necrosis. Diffuse edema, foci of hemorrhage, multiple cystic gas collections in gallbladder wall. Scintigram hepatobiliary study shows region of increased hepatic activity (arrows) adjacent to photopenic gallbladder fossa (g) (rim sign), gallbladder not visualized, normal bowel activity (b).
 
Xanthogranulomatous cholecystitis Echogenic stones, diffuse wall thickening. Stone impacted in the gallbladder neck, pericholecystic fluid, and extension of the inflammatory process to the adjacent liver. Wall thickening with heterogenous enhancement, intramural nodules (xanthogranulomas). Diffuse wall thickening, mucosal hyperintensity, foci of intramural high signal (intramural collection). Diffuse wall thickening, continuous mucosal enhancement, fundus mass. Diffuse wall thickening, intramural xanthogranulomas, gallstones (frequently present). Thickened gallbladder wall, xanthogranulomatous cholecystitis lesion (arrows) containing inflammatory cells, bile pigment, and foamy pigment-laden macrophages.
 
Polyp Multiple small hyperechoic polyps (arrow). Larger polyps may have detectable flow within vascular pedicle. A multilobulated sessile polyp attached to gallbladder wall (straight arrow) [multiple gallstones also present (curved arrow)]. Tubular adenoma, fibrovascular core lined by pyloric-type glands.
         
Porcelain gallbladder Calcified gallbladder wall (with intraluminal gallstone). Dense calcifications of gallbladder wall.
           
Gallbladder adenocarcinoma Soft tissue mass in the gallbladder lumen (∗) producing posterior acoustic shadowing, gallstones also present. Flow going to mass. Soft tissue mass with linear calcifications within the gallbladder. Arterial phase: focal wall thickening with marked enhancement in gallbladder neck. Irregular wall thickening, focal mass of intermediate signal intensity. Irregular wall thickening, cannot distinguish mucosa and submucosa, gallstones (present in 90% of cases), intraluminal mass may be present (not pictured).

Heterogenously hyperintense mass within the gallbladder lumen. 		Heterogenous wall thickening, cannot distinguish mucosa and submucosa, present (not pictured).

Mass with variable enhancement, ill-defined gallbladder-liver interface suggesting liver infiltration. 		Tumor mass and gallstones within gallbladder tumor. H&E stain: variable-sized glands (arrows) infiltrate gallbladder wall. Primary tumor patterns.
Lymphoma Irregular thickening of wall and soft tissue mass, may infiltrate liver (pictured).

Image 2
             
Melanoma metastases Thick, nodular wall with hypoechoic and isoechoic nodular masses. Thickened nodular wall with enhancing nodular masses extending into the lumen. Numerous dark-brown soft polypoid lesions Infiltration of the lamina propria by malignant melanocytes.