Published online Oct 28, 2020. doi: 10.3748/wjg.v26.i40.6163
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
Processing time: 141 Days and 19 Hours
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.
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.