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Gallbladder Carcinoma Imaging

Practice Essentials

Although uncommon, carcinoma of the gallbladder (GB) is the most common primary hepatobiliary carcinoma, is the fifth most common malignancy of the gastrointestinal (GI) tract, and predominantly affects older persons with long-standing cholecystolithiasis. GB epithelial tumors tend to behave similarly to other GI adenocarcinomas. When the diagnosis is made incidentally at the time of cholecystectomy, surgical resection can be curative
; however, more commonly, the tumor is unresectable and rarely diagnosed preoperatively despite patients’ symptoms. Early diagnosis can improve the clinical outcome and cure rate of GB carcinoma.

Ultrasonography (US), which is readily available, noninvasive, and cost-effective, is the imaging modality of choice for GB carcinoma.
However, US cannot stage the tumor. The visualization of lymph nodes, intraperitoneal disease, and distant metastases is difficult.

CT scans can detect GB masses and thickening of the GB wall.

Plain abdominal radiographic films have a limited role in GB carcinoma. The images may demonstrate porcelain GB, calcified gallstones, and, rarely, biliary gas from GB-enteric fistula. Mucinous tumors may produce vague or punctate calcification in the primary tumor or in metastatic foci that may be visible on plain films. Barium studies, if positive, show duodenal invasion and displacement. Transverse colon invasion may occasionally be seen.

Magnetic resonance imaging (MRI) is not commonly used in the diagnostic process for GB carcinoma. The findings are analogous to those from CT scanning. The tumor is usually bright on T2-weighted images and is poorly marginated. On T1-weighted images, relative to the liver, the GB carcinoma ranges from isointense to hypointense.

Nonopacification of the GB on cholescintigraphy with technetium-99m (99mTc) iminodiacetic acid analogue scanning is a nonspecific sign that indicates the possibility of carcinoma. This modality is not commonly used, having generally been replaced by US.

Fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)-CT has been used to determine management of biliary tumors.

Angiography may demonstrate the neovascularity that arises from the cystic arteries, as well as arterial and venous encasement in the area of the GB, although this modality is not used as a diagnostic tool.

(See the images of gallbladder carcinoma below.)

Sagittal sonogram in a 71-year-old woman. This ima

Sagittal sonogram in a 71-year-old woman. This image demonstrates heterogeneous thickening of the gallbladder wall (arrows). The diagnosis was primary papillary adenocarcinoma of the gallbladder.

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Computed tomography scan in a 65-year-old man. Thi

Computed tomography scan in a 65-year-old man. This image depicts squamous cell carcinoma of the gallbladder and invasion of the liver.

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