0:01

The following is a patient is a 45-year-old

0:03

female and the history here, they wanted to

0:05

evaluate for stones in the common bile duct.

0:09

They got an MRI of the abdomen with intravenous

0:12

contrast with an MRCP to evaluate for that

0:15

particular indication and also for any

0:17

other cause of this patient's symptoms.

0:19

And so we'll scroll through the axial, uh, T2

0:22

HASTE images over here, T2 non-fat saturated images.

0:25

And as we scroll through again, focusing on the

0:27

gallbladder, we see somewhat familiar finding.

0:30

It's a round T2 hypo-intense

0:32

structure within the gallbladder.

0:34

We can look at on the T2 fat-saturated

0:37

images, it remains T2 hypo-intense.

0:40

And so this is a gallstone.

0:41

We know what these look like.

0:43

We see another gallstone here, right?

0:46

Very similar appearance, probably cholesterol

0:48

gallstone based on its imaging appearance so far.

0:51

The reason I wanted to show this case is if you

0:53

sort of ignore the gallstone, especially this one

0:55

and look around it, you'll see that there is a

1:00

discrete area of layering T2 hypo-intense signal

1:04

that doesn't conform to the shape of anything.

1:06

It's just sort of layering inside the gallbladder.

1:09

Perhaps it's on the T2 fat-saturated image

1:12

you can see the gallstone nicely here but look

1:14

what's around in that little layering T2 hypo-

1:17

intense stuff and you can see that continues

1:19

even more inferiorly to this on the T1

1:23

fat-saturated images without intravenous contrast.

1:26

I want to showcase some of these findings again.

1:28

Again, the gallstone will be nice and hypo-

1:30

intense, hypo-intense here, but let's look around

1:33

that gallstone. Again, you can see that there

1:36

is content that is, in this case, relatively T1

1:39

hyper-intense that's surrounding this gallstone.

1:42

It continues over here as well.

1:44

And when you look at your post-contrast

1:45

sequences, it looks like it's enhancing, right?

1:47

It is bright on the T1 post-contrast images.

1:50

However, we need to look at our subtracted

1:52

images to really know if it's bright or not.

1:54

To, uh, eliminate all that

1:56

inherent T1 hyper-intense content.

1:58

When we look at it on the subtracted

2:00

images, we see that, in fact, there is no

2:03

enhancement associated with that layering

2:05

T1 hyper-intense content in the gallbladder.

2:08

And so this appearance is

2:10

characteristic of gallbladder sludge.

2:13

And gallbladder sludge, like gallstones,

2:15

is quite commonly seen in our patients

2:18

when we evaluate the gallbladder.

2:20

And what it is, it's really a suspension of bile and/or

2:24

all sorts of particulate matter within the gallbladder.

2:28

It's typically composed of cholesterol crystals,

2:32

calcium bilirubinate, various amounts of mucus.

2:35

And it's thought that in about 15 percent of patients.

2:39

This gallbladder sludge could, uh, progress to

2:42

form gallstones, but, you know, we see it so often

2:46

and its appearance is quite characteristic as

2:48

what we see in this instance, which, uh, is really

2:51

layering, uh, content within the gallbladder that's

2:54

relatively hypo-intense on the T2 weighted images.

2:57

Generally, it tends to be hyper-intense

2:59

on the T1 weighted images, and when

3:01

we give contrast, it doesn't enhance.

3:04

And so this is a characteristic appearance of

3:07

gallbladder sludge that we can see in a lot of

3:09

patients, particularly if they're fasting, if they've

3:11

hadn't eaten for a while, if the gallbladder has really

3:13

not been in use for a while because they're fasting,

3:16

you can get this appearance of gallbladder sludge.