Current Radiology Reports

, 6:46 | Cite as

Imaging of the Gallbladder with Multi-energy CT

  • Yee Seng Ng
  • Lakshmi AnanthakrishnanEmail author
Computed Tomography (S Nicolaou and M Mohammed, Section Editors)
Part of the following topical collections:
  1. Computed Tomography


Purpose of Review

The goal of this review article is to provide an overview of applications of multi-energy CT as they pertain to gallbladder imaging. We discuss benefits and shortcomings of MECT of various gallbladder pathology, with an emphasis on the imaging of gallstones and cholecystitis. It also touches on promising areas that warrant further investigation.

Recent Findings

MECT has demonstrated improved sensitivity for cholelithiasis compared to conventional single-energy CT, with added value of MECT reconstructions, particularly virtual monoenergetic reconstructions, to detect isoattenuating gallstones. MECT iodine maps and virtual monoenergetic images potentially add value in evaluating other gallbladder pathologies, including detecting complications of acute cholecystitis, characterization of xanthogranulomatous cholecystitis and adenomyomatosis, and identifying and evaluating the extent of gallbladder carcinoma.


MECT is emerging as a useful exam to evaluate the gallbladder, particularly in the setting of acute abdominal pain, and has the potential to eliminate the need for other imaging exams such as ultrasound.


Gallbladder Dual-energy CT Cholelithiasis Adenomyosis Gallbladder carcinoma Xanthogranulomatous cholecystitis 


Compliance with Ethical Guidelines

Conflict of interest

Both Yee Seng Ng and Lakshmi Ananthakrishnan declare that there is an institutional research agreement between UT Southwestern Medical Center and both Philips Healthcare and Siemens Healthcare, but neither of the authors has any personal conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Recently published papers of particular interest have been highlighted as: ∙ Of importance ∙∙ Of major importance

  1. 1.
    Stoker J, van Randen A, Lameris W, Boermeester MA. Imaging patients with acute abdominal pain. Radiology. 2009;253(1):31–46. Scholar
  2. 2.
    Trowbridge RL, Rutkowski NK, Shojania KG. Does this patient have acute cholecystitis? JAMA. 2003;289(1):80–6.CrossRefGoogle Scholar
  3. 3.
    ∙∙Fagenholz PJ, Fuentes E, Kaafarani H, Cropano C, King D, de Moya M, Butler K, Velmahos G, Chang Y, Yeh DD. Computed tomography is more sensitive than ultrasound for the diagnosis of acute cholecystitis. Surg Infect (Larchmt). 2015;16(5):509–12. Original research demonstrating that CT is more sensitive than ultrasound for acute cholecystitis (contrary to popular opinion). CrossRefGoogle Scholar
  4. 4.
    ∙∙McCollough CH, Leng S, Yu L, Fletcher JG. Dual- and multi-energy CT: principles, technical approaches, and clinical applications. Radiology. 2015;276(3):637–53. Excellent review which provides a good foundation for understanding the principles of MECT.CrossRefGoogle Scholar
  5. 5.
    ∙∙Marin D, Boll DT, Mileto A, Nelson RC. State of the art: dual-energy CT of the abdomen. Radiology. 2014;271(2):327–42. Excellent review which provides a good foundation for understanding the principles of MECT.CrossRefGoogle Scholar
  6. 6.
    Ruhl CE, Everhart JE. Gallstone disease is associated with increased mortality in the United States. Gastroenterology. 2011;140(2):508–16. Scholar
  7. 7.
    Baron RL, Rohrmann CA Jr, Lee SP, Shuman WP, Teefey SA. CT evaluation of gallstones in vitro: correlation with chemical analysis. Am J Roentgenol. 1988;151(6):1123–8. Scholar
  8. 8.
    Chan WC, Joe BN, Coakley FV, Prien EL Jr, Gould RG, Prevrhal S, Barber WC, Kirkwood KS, Qayyum A, Yeh BM. Gallstone detection at CT in vitro: effect of peak voltage setting. Radiology. 2006;241(2):546–53. Scholar
  9. 9.
    Anderson SW, Lucey BC, Varghese JC, Soto JA. Accuracy of MDCT in the diagnosis of choledocholithiasis. Am J Roentgenol. 2006;187(1):174–80. Scholar
  10. 10.
    Hessler PC, Hill DS, Deforie FM, Rocco AF. High accuracy sonographic recognition of gallstones. Am J Roentgenol. 1981;136(3):517–20. Scholar
  11. 11.
    ∙∙Uyeda JW, Richardson IJ, Sodickson AD. Making the invisible visible: improving conspicuity of noncalcified gallstones using dual-energy CT. Abdom Radiol (NY). 2017. Original research article assessing use of commercially available MECT reconstructions to improve identification of isoattenuating gallstones.CrossRefGoogle Scholar
  12. 12.
    ∙∙Yang CB, Zhang S, Jia YJ, Duan HF, Ma GM, Zhang XR, Yu Y, He TP. Clinical application of dual-energy spectral computed tomography in detecting cholesterol gallstones from surrounding bile. Acad Radiol. 2017;24(4):478–82. Original research article assessing use of MECT to detect cholesterol gallstones.CrossRefGoogle Scholar
  13. 13.
    ∙∙Chen AL, Liu AL, Wang S, Liu JH, Ju Y, Sun MY, Liu YJ. Detection of gallbladder stones by dual-energy spectral computed tomography imaging. World J Gastroenterol. 2015;21(34):9993–8. Original research article assessing use of MECT to detect cholesterol gallstones.CrossRefGoogle Scholar
  14. 14.
    ∙Lee HA, Lee YH, Yoon KH, Bang DH, Park DE. Comparison of virtual unenhanced images derived from dual-energy CT with true unenhanced images in evaluation of gallstone disease. Am J Roentgenol. 2016;206(1):74–80. Original research article assessing use of virtual unenhanced images to detect gallstones.CrossRefGoogle Scholar
  15. 15.
    Kim JE, Lee JM, Baek JH, Han JK, Choi BI. Initial assessment of dual-energy CT in patients with gallstones or bile duct stones: can virtual nonenhanced images replace true nonenhanced images? Am J Roentgenol. 2012;198(4):817–24. Scholar
  16. 16.
    Soesbe TC, Lewis MA, Leyendecker JR, Ananthakrishnan L, Lenkinski JR. Differentiating and segmenting isoattenuating cholesterol gallstones from bile using spectral CT material attenuation decomposition (MAD) plots. In: Society of computed body tomography and magnetic resonance, Nashville, TN, 11 September 2017.Google Scholar
  17. 17.
    Lewis MA, Soesbe TC, Do QN, Nasr K, Moore WA, Duan X, Gotman S, Lenkinski RE. Spectral CT “Fingerprinting” on a pre-clinical detection based spectral CT scanner: tools for exploration and examples. In: Radiological Society of North America, Chicago, IL, 28 November 2016.Google Scholar
  18. 18.
    Lewis MA, Soesbe TC, Ananthakrishnan L, Abbara S, Peshock R, Lenkinski RE. Spectral CT analysis using custom plugins for a clinical DICOM viewer. In: Radiological Society of North America, Chicago, IL, 27 November 2017.Google Scholar
  19. 19.
    Gore RM, Thakrar KH, Newmark GM, Mehta UK, Berlin JW. Gallbladder imaging. Gastroenterol Clin N Am. 2010;39(2):265–87. Scholar
  20. 20.
    Harvey RT, Miller WT Jr. Acute biliary disease: initial CT and follow-up US versus initial US and follow-up CT. Radiology. 1999;213(3):831–6. Scholar
  21. 21.
    ∙∙Wertz JR, Lopez JM, Olson D, Thompson WM. Comparing the diagnostic accuracy of ultrasound and CT in evaluating acute cholecystitis. Am J Roentgenol. 2018;211(2):W92–7. This original research article compares the diagnostic accuracy of the two most common imaging modalities (ultrasound and CT) in assessment of acute cholecystitis.CrossRefGoogle Scholar
  22. 22.
    Young N, Kinsella S, Raio CC, Nelson M, Chiricolo G, Johnson A, Malcolm G, Drumheller BC, Ward MF, Sama A. Economic impact of additional radiographic studies after registered diagnostic medical sonographer (RDMS)-certified emergency physician-performed identification of cholecystitis by ultrasound. J Emerg Med. 2010;38(5):645–51. Scholar
  23. 23.
    ∙∙Ratanaprasatporn L, Uyeda JW, Wortman JR, Richardson I, Sodickson AD. Multimodality imaging, including dual-energy CT, in the evaluation of gallbladder disease. Radiographics. 2018;38(1):75–89. This excellent review article provides an overview of gallbladder evaluation using MECT and other modalities.CrossRefGoogle Scholar
  24. 24.
    Zhao F, Lu PX, Yan SX, Wang GF, Yuan J, Zhang SZ, Wang YX. CT and MR features of xanthogranulomatous cholecystitis: an analysis of consecutive 49 cases. Eur J Radiol. 2013;82(9):1391–7. Scholar
  25. 25.
    Catalano OA, Sahani DV, Kalva SP, Cushing MS, Hahn PF, Brown JJ, Edelman RR. MR imaging of the gallbladder: a pictorial essay. Radiographics. 2008;28(1):135–155; quiz 324. Scholar
  26. 26.
    Chun KA, Ha HK, Yu ES, Shinn KS, Kim KW, Lee DH, Kang SW, Auh YH. Xanthogranulomatous cholecystitis: CT features with emphasis on differentiation from gallbladder carcinoma. Radiology. 1997;203(1):93–7. Scholar
  27. 27.
    Haradome H, Ichikawa T, Sou H, Yoshikawa T, Nakamura A, Araki T, Hachiya J. The pearl necklace sign: an imaging sign of adenomyomatosis of the gallbladder at MR cholangiopancreatography. Radiology. 2003;227(1):80–8. Scholar
  28. 28.
    ∙Bonatti M, Vezzali N, Lombardo F, Ferro F, Zamboni G, Tauber M, Bonatti G. Gallbladder adenomyomatosis: imaging findings, tricks and pitfalls. Insights Imaging. 2017;8(2):243–253. This excellent review article provides overview of imaging findings of gallbladder adenomyomatosis. CrossRefGoogle Scholar
  29. 29.
    ∙Yang HK, Lee JM, Yu MH, Lee SM, Park J, Han NY, Lee K, Jang JY, Han JK. CT diagnosis of gallbladder adenomyomatosis: importance of enhancing mucosal epithelium, the “cotton ball sign”. Eur Radiol. 2018. Original research evaluating the “cotton ball sign” as a feature associated with adenomyomatosis. CrossRefGoogle Scholar
  30. 30.
    Kanthan R, Senger JL, Ahmed S, Kanthan SC. Gallbladder Cancer in the 21st Century. J Oncol. 2015;2015:967472. Scholar
  31. 31.
    Lai CH, Lau WY. Gallbladder cancer—a comprehensive review. Surgeon. 2008;6(2):101–10.CrossRefGoogle Scholar
  32. 32.
    ∙Kim SW, Kim HC, Yang DM, Ryu JK, Won KY. Gallbladder carcinoma: causes of misdiagnosis at CT. Clin Radiol. 2016;71(1):e96–109. This excellent review provides an overview of the imaging features of gallbladder carcinoma and common imaging pitfalls. CrossRefGoogle Scholar
  33. 33.
    Kim SJ, Lee JM, Lee JY, Kim SH, Han JK, Choi BI, Choi JY. Analysis of enhancement pattern of flat gallbladder wall thickening on MDCT to differentiate gallbladder cancer from cholecystitis. Am J Roentgenol. 2008;191(3):765–71. Scholar
  34. 34.
    Pfeiffer D, Parakh A, Patino M, Kambadakone A, Rummeny EJ, Sahani DV. Iodine material density images in dual-energy CT: quantification of contrast uptake and washout in HCC. Abdom Radiol (NY). 2018. Scholar
  35. 35.
    Sun K, Han R, Han Y, Shi X, Hu J, Lu B. Accuracy of combined computed tomography colonography and dual energy iodine map imaging for detecting colorectal masses using high-pitch dual-source CT. Sci Rep. 2018;8(1):3790. Scholar
  36. 36.
    Wei J, Zhao J, Zhang X, Wang D, Zhang W, Wang Z, Zhou J. Analysis of dual energy spectral CT and pathological grading of clear cell renal cell carcinoma (ccRCC). PLoS ONE. 2018;13(5):e0195699. Scholar
  37. 37.
    Gerstenmaier JF, Hoang KN, Gibson RN. Contrast-enhanced ultrasound in gallbladder disease: a pictorial review. Abdom Radiol (NY). 2016;41(8):1640–52. Scholar
  38. 38.
    ∙Liu XS, Gu LH, Du J, Li FH, Wang J, Chen T, Zhang YH. Differential diagnosis of polypoid lesions of the gallbladder using contrast-enhanced sonography. J Ultrasound Med. 2015;34(6):1061–9. Original research evaluating various useful MDCT findings in addition to size to differentiate benign and malignant polyps. CrossRefGoogle Scholar
  39. 39.
    Song ER, Chung WS, Jang HY, Yoon M, Cha EJ. CT differentiation of 1-2-cm gallbladder polyps: benign vs malignant. Abdom Imaging. 2014;39(2):334–41. Scholar
  40. 40.
    Chen S, Zhong X, Hu S, Dorn S, Kachelriess M, Lell M, Maier A. Automatic multi-organ segmentation in dual energy CT using 3D fully convolutional network. 2018. Paper presented at the 1st Conference on Medical Imaging with Deep Learning, Amsterdam, The Netherlands, 11 April 2018.Google Scholar
  41. 41.
    Uhrig M, Sedlmair M, Schlemmer HP, Hassel JC, Ganten M. Monitoring targeted therapy using dual-energy CT: semi-automatic RECIST plus supplementary functional information by quantifying iodine uptake of melanoma metastases. Cancer Imaging. 2013;13(3):306–13. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of RadiologyUT Southwestern Medical CenterDallasUSA

Personalised recommendations