J Korean Soc Radiol.  2011 Mar;64(3):253-259. 10.3348/jksr.2011.64.3.253.

Segmental Adenomyomatosis of Gallbladder: CT Assessment of the Patterns of Cholecystolithiasis

• Yoo YH
• Yu JS
• Chung JJ
• Kim JH
• Cho ES
• Kim DJ
• Ahn JH
• Kim KW

• KMID: 2097947
• DOI: http://doi.org/10.3348/jksr.2011.64.3.253

Abstract

PURPOSE
To clarify the relationship between the pattern of cholecystolithiasis and the gross features of segmental adenomyomatosis of the gallbladder.
MATERIALS AND METHODS
Fifty-five consecutive patients with segmental adenomyomatosis with calcified gallbladder stones defined on CT were retrospectively analyzed in terms of (i) stone location (fundal vs. neck compartment) and (ii) size of the largest stone as a function of the extent of segmental mural thickening (type A, limited at the narrow segment; type B, partially extended in the fundal direction; type C, involving the entire fundal compartment). The extent of segmental mural thickening in patients with cholecystolithiasis was compared with a control group (n = 48) lacking stones.
RESULTS
Stones were found more frequently in the fundal compartment in 48 patients compared to the neck compartment in 12 patients (p<0.001). The mean size of the largest stone in type C (5.4 +/- 4.9 mm) was larger than in type A (2.3 +/- 2.2 mm) (p=0.033). In patients with cholecystolithiasis, type C segmental thickening was predominant (69%) compared to the control group (42%) (p=0.012).
CONCLUSION
In addition to a higher prevalence of stones, a wide extent of mural thickening combined with large stone size in the fundal compartment suggests the contribution of segmental adenomyomatosis to stone formation and chronic inflammation.

MeSH Terms

Adenomyoma
Cholecystitis
Cholecystolithiasis
Gallbladder
Humans
Inflammation
Neck
Prevalence
Retrospective Studies
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Schematic drawing of the different types of segmental adenomyomatosis of the gallbladder. A. Type A represents a mural thickening limited to the narrow segment. B. Type B represents a mural thickening partially extended in the fundal direction C. Type C represents a mural thickening involving the entire fundal compartment of the gallbladder.

• 

  Fig. 2 A 64-year-old man with segmental adenomyomatosis with a calcified GB stone and mural thickening involving the entire fundal compartment (type C). A. This precontrast axial CT image shows focal luminal narrowing of GB (arrow) with a 1.8 cm calcified stone in the fundal compartment (arrowheads). B. Post-contrast axial CT image showing a diffusely thickened wall with abnormal contrast enhancement including the entire fundal compartment (arrowheads) and the narrowing segment (arrow).

• 

  Fig. 3 A 31-year-old man with segmental adenomyomatosis with multiple calcified sandy stones in the fundal compartment and mural thickening partially extended in the fundal direction (type B). A. Precontrast axial CT image showing innumerable calcified sandy stones (arrow) in the fundal portion of the GB. B, C. Post-contrast axial (B) and coronal (C) CT images showing segmental luminal narrowing (arrow) and mural thickening partially extended in the fundal direction (arrowheads).

• 

  Fig. 4 A 40-year-old woman with segmental adenomyomatosis without cholecystolithiasis showing the mural thickening limited to the narrowing segment (type A). A. This postcontrast axial CT image shows an en face view of the circumferentially thickened wall with luminal narrowing (arrow) at the body portion of the GB. B. Post-contrast coronal CT image showing segmental luminal narrowing (arrow) with no abnormal mural thickening in the remaining GB wall and no intraluminal calcified stone density.

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