Cholelithiasis full description radiology

KAZAKH NATIONAL MEDICAL UNIVERSITY NAMED AFTER S.D. ASFENDYAROVA
Almaty - 2023
Radiological semiotics of cholelithiasis

Plan
2
KazNMU named after . S.D.ASFENDIYAROVA
•Definition
•Pathogenesis
•Classification
•Anatomy of the gallbladder
•Diagnostic methods
•Radiological semiotics
•Differential diagnosis
•Recommendations

Cholelithiasis (cholelithiasis, or, as they are incorrectly called, gallstones)
3
This is a disease associated with a disorder in the metabolism of cholesterol and bilirubin , resulting in the formation
of stones in the gall bladder ( cholecystolithiasis ) and/or in the bile ducts ( choledocholithiasis ).

4
mixed
Types of
gallstones
pigmented cholesterol

5
Anatomy of the gallbladder and bile ducts
neck of the gallbladder
cystic duct
gallbladder
body
common bile duct
common
hepatic duct
sphincter muscles
bottom of the
gallbladder
hepatopancre
atic ampulla
pancreatic duct

FREQUENT LOCALIZATION OF STONES
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gallstone location options
this moving stone periodically
wedges into the mouth of the
gallbladder causes biliary colic
stones in the
intrahepatic bile
ducts are rare
cystic duct stone
stones in the common
bile duct - the cause of
jaundice
stones in
gallbladder this stone simultaneously blocks
both the common bile duct and
the pancreatic duct

Research methods
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Ultrasound (gold standard)
Radiography
CT
MRI
Endoscopic retrograde
cholangiopancreatography

Ultrasound semiotics of cholelithiasis
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A highly reflective echogenic focus
in the lumen of the gallbladder ,
usually with pronounced posterior
acoustic shadowing, regardless of
the type of pathology (acoustic
shadowing is independent of the
composition and calcium content)
Gravity- dependent movement is
often observed when the patient
changes position ( RollingStone
sign )

9
Color Doppler can demonstrate
Shimmering artifact and especially useful for identifying small
stones

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An accumulation of stones is detected in the neck
of the gallbladder , casting an acoustic shadow
Multiple floating
Gallbladder stones .

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Radiography
X-ray data of stones in
Gallbladder ( cholelithiasis ):
• X-ray contrast pigment
stones: 50%
• Radiopaque cholesterol stones: 5%

CT scan for gallstones
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CT without contrast enhancement :
-Calcareous stones of the gallbladder have a greater density compared to
bile
-Pure cholesterol stones have a lower density; There is an inverse
relationship between cholesterol levels and X-ray attenuation:
-May have the same density as bile and not be detected on CT
-The central part of the stone may contain nitrogen gas: a symptom of
the Mercedes-Benz

13
On an axial computed
tomogram without
contrast, a cluster of
layered and faceted
stones is determined in
the gallbladder .

14
In a patient with acute
calculous
cholecystitis on the axial
A computed tomogram with
contrast shows thickening of
the gallbladder wall and
calcified stones.

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ABDOMEB CT WITH CONTRAST
The patient's sagittal computed tomogram and 3D reconstruction reveal a large
calcified calculus.

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MRI FOR GALLBLADDER STONES
T1 – pigmented stones ( hyperintense )
- cholesterol stones ( hypointense )
• T2-VI:
A small focus of absent or weak signal limited to highly echogenic bile
within the gallbladder
• MRcholangiopancreatography :
Round lesions of absence of intragallbladder

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Axial T2 HASTE in a slightly
thickened gallbladder, multiple
stones giving a weak signal are
determined.

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Small area of absent or weak signal limited to highly echogenic bile, inside the
gallbladder

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MR tomograms in the axial and frontal planes. Cholelithiasis. Gallstones in the gallbladder cavity are
characterized by a lack of signal within the gallbladder
on T2-VI and STIR

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Endoscopic retrograde cholangiopancreatography
Mobile filling defects
inside
Contrast-filled gallbladder
blisters and stones in the
extrahepatic bile ducts
ERCP
sensitivity 68
- 93%
tubular stenosis of the common
bile duct with reflux of contrast
into the main hepatic duct against
the background of cholelithiasis
expansion of the pancreatic
duct and branches of the 2nd
and 3rd order, uneven contours
of the duct and branches

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Forforan gallbladder
General characteristics:
• Best diagnostic criterion:
o Calcification in the form of a curved “rim”
in the right hypochondrium, resembling the
shape of a gallbladder
• Morphology:
Two options:
- Limited mucosal calcification: high risk of
malignancy
- Diffuse wall calcification: low risk of
malignancy

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DIFFERENTIAL DIAGNOSTICS
Gallbladder polyp
Bladder bile sludge
Gallbladder carcinoma
Focal adenomyomatosis
Parasitic infestation of the gallbladder
Intestinal gases
Emphysematous cholecystitis

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VISUALIZATION GUIDELINES:
Ultrasound is the best imaging modality for evaluating patients with upper abdominal pain/discomfort.
➢When evaluating patients with pain/discomfort in the upper right quadrant of the abdomen after a
fatty meal, especially middle-aged obese women , remember the likely presence of cholelithiasis
➢Tips for interpreting images:
the acoustic shadow they cast is of great importance
- Stones that do not cast a shadow can be mistaken for other formations of the gallbladder, for
example, polyp, sludge , carcinoma
- Shrinking, stone-filled gallbladder: assess for wall-echo-shadow sign or examine interlobar fissure

Thank you for attention!
Mr. Almaty, st. Tole bi, 94
+7 727 338 70 90
www.kaznmu.kz
kaznmu@kaznmu.kz
KAZAKH NATIONAL MEDICAL UNIVERSITY NAMED AFTER S.D. ASFENDYAROVA
@ kaznmu
https://
www.facebook.com/KazNMU
https://www.youtube.com/kaznmu _

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