Role of multidetector CT (MDCT) in differentiation between adenomyomatois and gall bladder cancer

IntroductionAdenomyomatosis, or diverticular disease of the gallbladder, is an acquired hyperplastic lesion characterized by excessive proliferation of the surface epithelium with deepened invaginations extending into the thickened muscular layer of the gallbladder wall. The radiologic evidence of both adenomyomatosis and gallbladder cancer is focal or diffuse thickening of the gallbladder wall (1).Focal or diffuse gallbladder wall thickening is a relatively frequent observation on CT and is often incidental. It can be a dilemma for interpreting radiologists (2).Aim of the workThe purpose of this study is to determine the role of MDCT in differentiating adenomyomatosis from gallbladder cancer.PatientsThe study included 20 patients already pathologically diagnosed as adenomyomatosis or gall bladder cancer, and who had undergone pre-operative CT.MethodsPreoperative CT is reviewed for the presence and nature of morphologic gallbladder abnormalities, including the presence of intramural diverticula (Pearl necklace sign) and the presence of a non-interrupted mucosal enhancement line.ResultsPearl necklace sign was 80% accurate for the diagnosis of adenomyomatosis. Mucosal enhancement line was 100% accurate for the same diagnosis.ConclusionMDCT is an accurate technique for differentiating between gall bladder adenomayomatosis and cancer.