Pearl necklace sign

Last revised by Naim Qaqish on 08 Apr 2021

The pearl necklace sign occurs in adenomyomatosis of the gallbladder, on both oral cholecystograms and MRCP. It represents the contrast/fluid-filled intramural mucosal diverticula (Rokitansky-Aschoff sinuses); lined up, these are reminiscent of pearls on a necklace. It is synonymous with the CT rosary sign.

It is said to be highly specific (92%) for the diagnosis of adenomyomatosis, however it has limited sensitivity, present in ~70% of cases 1.

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Cases and figures

  • Figure 1: pearl necklace (photo)
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  • Case 1 : MRCP
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  • Figure 2: adenomyomatsis (illustration)
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  • Case 2
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  • Case 3 : MRCP
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