Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2020; 26(40): 6163-6181
Published online Oct 28, 2020. doi: 10.3748/wjg.v26.i40.6163
Imaging-based algorithmic approach to gallbladder wall thickening
Pankaj Gupta, Yashi Marodia, Akash Bansal, Naveen Kalra, Praveen Kumar-M, Vishal Sharma, Usha Dutta, Manavjit Singh Sandhu
Pankaj Gupta, Yashi Marodia, Akash Bansal, Naveen Kalra, Manavjit Singh Sandhu, Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Praveen Kumar-M, Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Vishal Sharma, Usha Dutta, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Author contributions: Gupta P acquired the data, designed the outline of the paper, performed the writing and did the major revisions; Marodia Y and Bansal A did the majority of the writing, and prepared the figures and tables; Kumar-M P prepared the line diagrams; Sharma V and Dutta U contributed to data acquisition as well as to writing; Kalra N and Sandhu MS provided useful input for the writing of the paper; all authors have read and approve the final manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Pankaj Gupta, MD, Assistant Professor, Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India.
Received: June 8, 2020
Peer-review started: June 8, 2020
First decision: July 29, 2020
Revised: August 12, 2020
Accepted: September 16, 2020
Article in press: September 16, 2020
Published online: October 28, 2020

Gallbladder (GB) wall thickening is a frequent finding caused by a spectrum of conditions. It is observed in many extracholecystic as well as intrinsic GB conditions. GB wall thickening can either be diffuse or focal. Diffuse wall thickening is a secondary occurrence in both extrinsic and intrinsic pathologies of GB, whereas, focal wall thickening is mostly associated with intrinsic GB pathologies. In the absence of specific clinical features, accurate etiological diagnosis can be challenging. The survival rate in GB carcinoma (GBC) can be improved if it is diagnosed at an early stage, especially when the tumor is confined to the wall. The pattern of wall thickening in GBC is often confused with benign diseases, especially chronic cholecystitis, xanthogranulomatous cholecystitis, and adenomyomatosis. Early recognition and differentiation of these conditions can improve the prognosis. In this minireview, the authors describe the patterns of abnormalities on various imaging modalities (conventional as well as advanced) for the diagnosis of GB wall thickening. This paper also illustrates an algorithmic approach for the etiological diagnosis of GB wall thickening and suggests a formatted reporting for GB wall abnormalities.

Keywords: Gallbladder diseases, Cholecystitis, Rokitansky-Aschoff sinuses of the gallbladder, Xanthogranulomatous cholecystitis, Neoplasms, Acute cholecystitis

Core Tip: Etiological diagnosis of gallbladder (GB) wall thickening can be challenging. Therefore, a thorough knowledge of the patterns and causes is crucial. Diffuse GB wall thickening is mostly related to inflammatory conditions intrinsic to the GB or extra-cholecystic causes. Focal GB wall thickening, on the other hand, presents a diagnostic challenge. An understanding of the imaging patterns of GB wall thickening, including the degree of mural thickening, internal mural characteristics such as enhancement features, and relationship with adjacent structures including liver and bile ducts may point towards the likelihood of GB carcinoma. We present a concise review of the differential diagnoses of GB wall thickening on various imaging modalities. We also discuss the specific features that may aid to distinguish individual benign pathologies (chronic cholecystitis, xanthogranulomatous cholecystitis, and adenomyomatosis) from GB carcinoma. Finally, we suggest an approach to GB wall thickening and propose a reporting format.