Gallstones: CT vs MRI

Case contributed by Dr Ian Bickle

Presentation

Right upper quadrant pain. Abnormal LFTs.

Patient Data

Age: 55 years
Gender: Female
CT

Small liver cysts.

Prominent CBD.

No stones in the gallbladder or CBD.

MRI

1 day later

The gallbladder is packed with stones.

Dilated CBD with several stones in the mid and distal duct.

Simple cysts in the liver.

Case Discussion

There is nothing worse in the field of medicine than a false negative - it helps nobody.

There is a growing trend for low threshold imaging requests and minimal vetting of requests (a debate in itself), in particular with vast amounts of CT imaging. This is aside from the high radiation doses involved.

Gallbladder disease is typically best seen on good old ultrasound.

MRI for interrogating the distal CBD comes a second best.

CT as this case demonstrates is a minefield of unpredictability.

There is no tiny suggestion of any stones on the CT, but wow look at the MRI.

The best test is always the right test.

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Case information

rID: 56679
Case created: 16th Nov 2017
Last edited: 16th Nov 2017
Tag: rdgh
Inclusion in quiz mode: Included

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