The Many Hidden Faces of Gallbladder Carcinoma on CT and MRI Imaging—From A to Z

Gallbladder cancer is the most common malignancy of the biliary tract and the sixth most common cancer of the gastrointestinal system [1]. According to GLOBOCAN estimates, gallbladder cancer is relatively rare and stands in 24th place among the most frequent type of cancers worldwide with more than 115,949 new cases in 2020 [2,3]. In the majority of cases, gallbladder carcinoma is asymptomatic or the clinical presentation is often vague, non-specific and discovered at an advanced stage [4,5]. Imaging plays a crucial and decisive role in the diagnosis, staging and subsequent management planning [6]. Occasionally, gallbladder cancer might be discovered following a cholecystectomy. Moreover, gallbladder cancer is thought to be favored by chronic cholelithiasis, cholecystolithiasis, gallbladder polyps and porcelain gallbladder [7]. The prevalence of the disease is primarily among elderly women over 60 years-old. The highest incidence occurs in South American countries, Chile, Ecuador, India, Pakistan, Japan and South Korea. Incidence of gallbladder cancer is 1–2 cases per 100,000 people [3,8,9]. However, gallbladder carcinoma still remains a relatively rare pathology with a poor prognosis and it usually presents at a very advanced stage [1]. Late-stage illness frequently manifests with anorexia, weight loss, abdominal pain and jaundice [3].

Diagnostic imaging modalities for the gallbladder cancer include ultrasound, computerized tomography (CT) and magnetic resonance imaging (MRI). CT and MRI are both effective imaging modalities, but MRI provides superior soft-tissue characterization of the gallbladder and biliary tree. The use of hepatobiliary contrast agents (gadolinium chelates) with increased hepatobiliary excretion in abdominal MRI imaging may offer valuable information by providing enhanced images of the biliary tree [10].

We hereby fully illustrate the case of a 67-year-old female patient, who was admitted to the Emergency Department with intense pain localized in the right renal fossa, radiating to the right abdominal flank, accompanied by nausea with an onset of approximately two weeks. During the physical examination, a reduced abdominal wall mobility with respiratory movements was observed, along with pain in the right hypochondrium and muscular defense. Her medical history included hypertension grade 3 and congestive heart failure. Laboratory tests showed elevated inflammatory markers (leukocytosis, procalcitonin, CRP) and hypochromic microcytic anemia.

Biphasic (arterial phase followed by venous phase) contrast-enhanced emergency CT was performed (Figure 1), which clearly highlighted a gallbladder hydrops, with asymmetric,...