A study by Byott and Harris [49] advocated for the use of limited MRI (rapid acquisition half-Fourier acquisition single shot turbo spin echo [HASTE] coronal and axial sequences, without IV contrast) for evaluation of AC, especially in younger patients. As with CT without IV contrast, noncontrast MRI will not be able to detect all the imaging features or potential complications of AC. However, noncontrast MRI with MRCP has excellent accuracy for visualization of normal and dilated bile ducts and the detection of stone disease compared to noncontrast CT. Standard T2-weighted imaging can better demonstrate gallbladder wall edema and pericholecystic fluid than noncontrast CT. Variant 5: Right upper quadrant pain. Suspected acalculous cholecystitis. Negative or equivocal ultrasound. Next imaging study. CT Abdomen Patients with suspected acalculous cholecystitis are typically critically ill, and CT has a role in evaluating these patients [31]; however, as with US, the frequent prevalence of nonspecific abnormal imaging findings in the gallbladders of critically ill patients limit its diagnostic value. Nevertheless, when the gallbladder appears completely normal on CT, there is a low probability of any surgical finding in the gallbladder [50]. CT without IV contrast can detect some features and complications of acalculous cholecystitis, such as gallbladder wall thickening, pericholecystic inflammation, gas formation, and hemorrhage. However, some important features, such as wall enhancement and adjacent liver parenchymal hyperemia, cannot be detected on noncontrast CT and so IV contrast is preferred. Adjacent liver hyperemia is actually one of the earlier findings in acalculous cholecystitis and can be a very useful problem-solving tool [7]. Right Upper Quadrant Pain CT without and with IV contrast is not often viewed as helpful in assessing patients admitted with right upper quadrant abdominal pain.
Right Upper Quadrant Pain. A study by Byott and Harris [49] advocated for the use of limited MRI (rapid acquisition half-Fourier acquisition single shot turbo spin echo [HASTE] coronal and axial sequences, without IV contrast) for evaluation of AC, especially in younger patients. As with CT without IV contrast, noncontrast MRI will not be able to detect all the imaging features or potential complications of AC. However, noncontrast MRI with MRCP has excellent accuracy for visualization of normal and dilated bile ducts and the detection of stone disease compared to noncontrast CT. Standard T2-weighted imaging can better demonstrate gallbladder wall edema and pericholecystic fluid than noncontrast CT. Variant 5: Right upper quadrant pain. Suspected acalculous cholecystitis. Negative or equivocal ultrasound. Next imaging study. CT Abdomen Patients with suspected acalculous cholecystitis are typically critically ill, and CT has a role in evaluating these patients [31]; however, as with US, the frequent prevalence of nonspecific abnormal imaging findings in the gallbladders of critically ill patients limit its diagnostic value. Nevertheless, when the gallbladder appears completely normal on CT, there is a low probability of any surgical finding in the gallbladder [50]. CT without IV contrast can detect some features and complications of acalculous cholecystitis, such as gallbladder wall thickening, pericholecystic inflammation, gas formation, and hemorrhage. However, some important features, such as wall enhancement and adjacent liver parenchymal hyperemia, cannot be detected on noncontrast CT and so IV contrast is preferred. Adjacent liver hyperemia is actually one of the earlier findings in acalculous cholecystitis and can be a very useful problem-solving tool [7]. Right Upper Quadrant Pain CT without and with IV contrast is not often viewed as helpful in assessing patients admitted with right upper quadrant abdominal pain.