Myocardial Perfusion Imaging - Beyond the Left Ventricle by M. Elizabeth Oates & Vincent L. Sorrell

Author:M. Elizabeth Oates & Vincent L. Sorrell
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

A distended “cold” gallbladder is distinctly abnormal and indicates underlying gallbladder disease (Fig. 20.10). Focal increased uptake in the liver adjacent to a “cold” or non-visualized gallbladder is termed the “pericholecystic rim sign” and signals acute cholecystitis. This imaging finding raises the likelihood of more complicated or advanced gallbladder disease (Lamont et al. 1996). There may be an associated incomplete common bile duct stricture or a common bile duct stone in chronic calculous cholecystitis; radioactivity in the small intestine excludes complete or high-grade common bile duct obstruction (Meesala et al. 2006; Panjrath et al. 2004).

Fig. 20.10“Cold” gallbladder due to chronic calculous cholecystitis. The gallbladder is not simply non-visualized; it actually appears round, distended, and frankly “cold.” It is located in the usual position at the inferior aspect of the right hepatic lobe (a). Note the small gallstone in a distended gallbladder by CT (b). The “whole-field-of-view” fusion images confirm the relationship between the “cold” scintigraphic finding and the bile-filled, stone-containing gallbladder (c). Interestingly, comparison with previous MPI (d, e) shows a similar pattern in this chronic condition.(a) Stress raw projection images (Video 20.10a, frame 1), 99mTc sestamibi. (b) Coronal CT at level of gallbladder and gallstone. (c) Coronal SPECT/CT fusion, whole-field-of-view reconstruction, gallbladder with gallstone (yellow box). (d) Two years previously: stress raw projection images (Video 20.10b, frame 1), 99mTc sestamibi. (e) Two years previously: stress raw projection image (Video 20.10c, frame 6), 99mTc sestamibi, gallbladder fossa (yellow circle), common bile duct (green lines)

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