Gallbladder Patterns in Acute Pancreatitis

Rationale and Objectives

The aim of this study was to assess the gallbladder patterns on magnetic resonance imaging (MRI) associated with acute pancreatitis (AP).

Materials and Methods

There were 197 patients with AP, all of whom had undergone abdominal MRI. AP was categorized as either edematous or necrotizing according to its findings on MRI and graded as mild (0–3 points), moderate (4–6 points), or severe (7–10 points) according to the magnetic resonance severity index. The changes to the walls and dimensions of the gallbladder and common bile duct, in addition to the presence of biliary stones and pericholecystic fluid, were noted and compared with the severity of AP on the basis of the magnetic resonance severity index.

Results

Of the 197 patients with AP, 81% were classified as edematous and 19% as necrotizing on MRI. There were 35%, 59%, and 6% of patients with mild, moderate, and severe AP according to the magnetic resonance severity index, respectively. Seventy-six percent of patients had at least one gallbladder abnormality on MRI, including a thickened gallbladder wall (42%), pericholecystic fluid (38%), gallbladder stones (35%), an enlarged gallbladder (24%), dilatation of the common bile duct (16%), and subserosal edema (15%). Eighty-nine percent of patients (34 of 38) with necrotizing AP had gallbladder abnormalities, which was significantly higher than the 72% of patients (115 of 159) with edematous AP ( P < .05). The prevalence of gallbladder abnormalities was 64% in patients with mild AP, 81% in those with moderate AP, and 91% in those with severe AP ( P < .05 among the three groups).

Conclusions

Most patients with AP have gallbladder abnormalities on MRI, including a thickened gallbladder wall and pericholecystic fluid. The prevalence of gallbladder abnormalities has a positive correlation with the severity of AP on MRI.

Acute pancreatitis (AP) is a common cause of acute abdominal presentation in the clinic. Its median mortality is 10%, but it may reach 20% to 30% in necrotizing pancreatitis with multiple organ dysfunction syndrome . AP inflammation often spreads, and the surrounding organ tissues are often involved. The gallbladder is affected by a variety of pathologic conditions that are often associated with nonspecific conditions . Because the pancreas and gallbladder are connected anatomically and functionally, pancreatic diseases are closely related to gallbladder disorders .

Understanding gallbladder patterns on magnetic resonance imaging (MRI) can help with the diagnosis and management of AP. Laparoscopic cholecystectomy has become the gold standard to avoid the recurrence of gallstone pancreatitis with gallstone disease , while percutaneous transhepatic gallbladder cholangio-drainage is a useful method for severe acute obstructive gallstone pancreatitis .

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Materials and methods

Patient Selection

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MRI Technique

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MR Image Analysis

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Statistical Analyses

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Results

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Table 1

Number of Patients According to MRSI

MRSI Total 1 2 3 4 5 6 7 8 9 10 Patients 11 32 26 93 3 21 1 7 0 3 197

MRSI, magnetic resonance severity index.

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Table 2

MRI Diagnosis of Cholecystitis

MRI Surgery and Pathology Total Positive Negative Positive 46 0 46 Negative 2 1 3 Total 48 1 49

MRI, magnetic resonance imaging.

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Table 3

Agreement of the Two Raters for Gallbladder Abnormalities on Magnetic Resonance Imaging ( n = 197)

Abnormality Rater 1 Rater 2 κ Thickened gallbladder wall 87 70 0.57 Pericholecystic fluid 35 48 0.62 Gallbladder stone 65 70 0.72 Subserosal edema 38 30 0.68 Enlarged gallbladder 35 48 0.62 Dilatation of CBD 25 35 0.57 CBD stone 19 16 0.66 Dilatation of cystic duct 14 17 0.76 Cystic duct stone 3 5 0.75

CBD, common bile duct.

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Table 4

Frequencies of Gallbladder Abnormalities in Acute Pancreatitis on Magnetic Resonance Imaging ( n = 197)

Gallbladder Pattern_n_ (%) Thickened gallbladder wall 83 (42) Pericholecystic fluid 75 (38) Gallbladder stone 69 (35) Subserosal edema 29 (15) Enlarged gallbladder 47 (24) Dilatation of CBD 32 (16) CBD stone 18 (9) Dilatation of cystic duct 15 (8) Cystic duct stone 5 (3)

CBD, common bile duct.

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Discussion

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Conclusions

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References

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Gallbladder Patterns in Acute Pancreatitis

Rationale and Objectives

Materials and Methods

Results

Conclusions

Materials and methods

Patient Selection

MRI Technique

MR Image Analysis

Statistical Analyses

Results

Discussion

Conclusions

References

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