0:01

This patient is a 70-year-old female and got a

0:04

CT scan for, uh, some clinical indication, and

0:07

on that, they were worried about the appearance of

0:10

the gallbladder, and that prompted the MRI study.

0:14

Start off by looking at the T2 non-

0:16

fat-saturated images over here.

0:18

We'll focus on the gallbladder over here in the right

0:21

upper quadrant, and let's just scroll through it fully

0:23

and you can dissect the appearance a little bit more.

0:30

Zoom up on it.

0:32

And so what do we see here?

0:33

So certainly there's areas that look like thickening

0:36

of the gallbladder wall over here, T2 hyper-

0:38

intense, but really there's a lot of discrete

0:41

outpouchings associated, these cystic outpouchings.

0:43

You can see it over here, a cystic

0:46

outpouching over here, over here, over here.

0:49

You can see some larger ones on the

0:50

other side of the gallbladder wall itself

0:54

on the axial T2 fat-saturated image.

0:57

Once again, you can see an outpouching

0:58

here, an outpouching here, another smaller

1:01

one over here, perhaps one over there.

1:03

So it's quite a diffuse process,

1:05

uh, involving this gallbladder.

1:09

Try to make sense of it on the

1:10

coronal T2 non-fat-saturated images.

1:13

I think this is a pretty good

1:14

image showing some of the findings.

1:16

You can see one outpouching here, a cluster that are

1:18

sort of forming around the gallbladder wall over here.

1:21

Another cluster in the inferior aspect of the

1:23

gallbladder, clusters along the other aspects

1:25

of the gallbladder, and then covering, uh, sort

1:28

of the fundus of the gallbladder wall itself.

1:31

Post-contrast image, uh, axial T1.

1:36

None of the outpouchings themselves, at least

1:39

the internal content, is not enhancing, but the

1:42

periphery of it is enhancing, uh, in this instance.

1:46

And so, uh, overall this is a pretty benign

1:50

looking finding in that the T2 signal is quite

1:53

bright and we typically don't worry about

1:55

things when we have that sort of T2 signal.

1:57

And indeed what this is, is a, an

1:59

example of diffuse adenomyomatosis.

2:03

So one of the other clinical vignettes, we saw an

2:05

example of focal adenomyomatosis, which is more

2:08

common, and it is quite commonly seen at the fundus,

2:12

but adenomyomatosis can also be a relatively diffuse

2:14

process, but it sort of has the same principles that

2:17

you'll see in areas of gallbladder wall thickening that

2:20

are composed of discrete T2 hyperintense lesions.

2:25

And so when you see that, something you

2:27

don't really need to worry about, it's

2:28

not associated with any complications.

2:31

So it can be focal adenomyomatosis, it can be diffuse

2:33

adenomyomatosis, and one of the other manifestations

2:36

can be segmental adenomyomatosis, but again, in

2:40

those instances, they'll be associated with discrete

2:44

sort of T2 hyperintense cystic space, I think that's

2:47

going to be the key finding that one needs to look

2:49

for to suggest a diagnosis of adenomyomatosis.