MRI Abdomen with MRCP Abdominal MRI with MR cholangiopancreatography (MRCP) offers excellent soft tissue contrast, and visualization of the gallbladder, biliary tree, and structures outside of the biliary tree. The length of the examination and claustrophobia hinders this test as an initial modality for right upper quadrant pain. Patient motion artifact is another significant factor in claustrophobic, sick, and uncooperative patients. MRCP offers isolated visualization of the biliary tree and can assess for intraluminal biliary pathology including choledocholithiasis as a cause of biliary pain or an etiology for acute pancreatitis. Contrast-enhanced abdominal MRI can help characterize hepatic, pancreatic, adrenal, and renal lesions that are indeterminate on US and CT. MRI can be useful in cases in which findings on US and CT are equivocal. In such cases, MRI may better identify stones in the gallbladder neck or cystic duct, which are seen as filling defects on MRCP and T2-weighted images, and associated gallbladder wall abnormalities, including wall thickening and pericholecytic fluid [11]. MRCP provides excellent anatomic detail of the biliary tract and has a high sensitivity for detecting choledocholithiasis [12,13]. Right Upper Quadrant Pain Nuclear Medicine Scan Gallbladder Tc-99m cholescintigraphy also has both high sensitivity and specificity (96% and 90%, respectively) for the diagnosis of AC but is limited in use in clinical practice because of several factors [14]. This modality is limited to visualization of the biliary tract, and therefore, alternative extrabiliary causes of right upper quadrant pain will not be detected. Although cholescintigraphy has a higher sensitivity and specificity for the evaluation of AC, US remains the initial test of choice detailed below in the US section [15-17]. The use of cholescintigraphy should be limited to patients with a high suspicion of AC and obstructive biliary disease in the presence of an equivocal US.
Right Upper Quadrant Pain. MRI Abdomen with MRCP Abdominal MRI with MR cholangiopancreatography (MRCP) offers excellent soft tissue contrast, and visualization of the gallbladder, biliary tree, and structures outside of the biliary tree. The length of the examination and claustrophobia hinders this test as an initial modality for right upper quadrant pain. Patient motion artifact is another significant factor in claustrophobic, sick, and uncooperative patients. MRCP offers isolated visualization of the biliary tree and can assess for intraluminal biliary pathology including choledocholithiasis as a cause of biliary pain or an etiology for acute pancreatitis. Contrast-enhanced abdominal MRI can help characterize hepatic, pancreatic, adrenal, and renal lesions that are indeterminate on US and CT. MRI can be useful in cases in which findings on US and CT are equivocal. In such cases, MRI may better identify stones in the gallbladder neck or cystic duct, which are seen as filling defects on MRCP and T2-weighted images, and associated gallbladder wall abnormalities, including wall thickening and pericholecytic fluid [11]. MRCP provides excellent anatomic detail of the biliary tract and has a high sensitivity for detecting choledocholithiasis [12,13]. Right Upper Quadrant Pain Nuclear Medicine Scan Gallbladder Tc-99m cholescintigraphy also has both high sensitivity and specificity (96% and 90%, respectively) for the diagnosis of AC but is limited in use in clinical practice because of several factors [14]. This modality is limited to visualization of the biliary tract, and therefore, alternative extrabiliary causes of right upper quadrant pain will not be detected. Although cholescintigraphy has a higher sensitivity and specificity for the evaluation of AC, US remains the initial test of choice detailed below in the US section [15-17]. The use of cholescintigraphy should be limited to patients with a high suspicion of AC and obstructive biliary disease in the presence of an equivocal US.