Pearl necklace sign

Last revised by Dr Naim K 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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