0:01

The following patient is a 40 year old female

0:03

who presents with the right upper quadrant

0:05

pain, and we have an MRI to go through to

0:09

figure out the cause of this patient's symptoms.

0:12

And we'll start off with the T2, uh, non

0:15

fat saturated image that really is one that

0:19

I often start with for, for most, uh, exam

0:22

indications in the abdomen, MRI of the abdomen.

0:24

Focusing on the gallbladder, a couple of

0:26

things I want to show you in this gallbladder

0:28

looks a little bit different than some

0:29

of the gallbladders we've seen so far.

0:32

And I think the major thing when I look

0:34

at this is that there's a lot of little

0:35

filling defects inside this gallbladder.

0:37

On the T2 weighted sequence, you can see

0:39

that they're all really hypo intense.

0:42

And if you were to zoom up and look at them, they

0:44

have sort of a geographic configuration, right?

0:48

Like this one looks like a little bit of a triangle.

0:50

This one may have discreetly four

0:52

sides, so they have sharp angles to it.

0:54

This one definitely looks like a triangle over there.

0:57

Look at it on the kernel T2 weighted images.

1:00

You can see a similar appearance of multiple, multiple

1:03

T2 hypo intense filling defects inside the gallbladder.

1:07

On the T2 fat saturated image,

1:09

it appears again quite similar.

1:11

Hypo T2 hypo intense filling defects.

1:14

Pre contrast.

1:16

Again, look quite similar,

1:18

hypo intense fill in defects.

1:19

In fact, it's quite difficult to

1:21

differentiate those fill in defects from

1:23

the T2 hypo intensity of bile itself.

1:25

But there is a signal difference

1:27

if you were to look at it closely.

1:28

These filling defects look much darker.

1:30

And if you were to give contrast,

1:33

as we did in this instance,

1:35

you'll see that these filling defects do not enhance.

1:38

And so I'm sure most of the viewers who are looking

1:40

at this know what these are, but I sort of

1:43

wanted to go through this process systematically.

1:45

These are gallstones, and I'm sure you know

1:47

what they are because gallstones are so common.

1:49

By some estimates, about 10 percent of the population.

1:52

By some estimates, even more, maybe

1:53

20 percent of the population.

1:56

If you were to look at it as a whole, they

1:57

tend to be found more commonly in women.

2:00

They tend to increase in prevalence with increased age.

2:04

And we can classify gallstones in general as

2:07

cholesterol gallstones or pigmented gallstones.

2:11

And cholesterol stones make up the vast

2:13

majority of gallstones in the United States.

2:15

About 80 percent of them will

2:16

be cholesterol gallstones.

2:19

And they're classified as cholesterol if they contain

2:21

at least 50 percent cholesterol within them.

2:24

And this is what they look like.

2:25

They have T2 hypointensity on the T2-weighted

2:29

images, T1 hypointensity on the T1-weighted images.

2:32

There's not going to be any contrast enhancement.

2:34

Essentially all cholesterol

2:36

gallstones will look like this.

2:37

It's a common thing.

2:38

This is what you're looking for in cases

2:40

when patients present with biliary colic.

2:42

You're looking for these sorts

2:43

of stones inside the gallbladder.