Pearl necklace sign

Last revised by Naim Qaqish on 8 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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