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MR Cholangiography: Technical Advances and Clinical Applications

¹ Department of Radiology, Medical College of Virginia, Virginia Commonwealth University, 401 N 12th St, Richmond, VA 23298-0615.

View larger version (161K): [in a new window]   Figure 1a. Figures 1, 2. (1) Normal bile duct. (a) MR cholangiogram demonstrates the proximal extrahepatic duct (arrow) and the proximal right and left hepatic ducts. (b) MR cholangiogram obtained 5 mm anterior to a demonstrates the middle and distal thirds of the extrahepatic bile duct (arrows). (2) Normal gallbladder and cystic duct. MR cholangiogram shows the gallbladder (G) and cystic duct (arrow). The extrahepatic bile duct is also seen (arrowheads).

View larger version (141K): [in a new window]   Figure 1b. Figures 1, 2. (1) Normal bile duct. (a) MR cholangiogram demonstrates the proximal extrahepatic duct (arrow) and the proximal right and left hepatic ducts. (b) MR cholangiogram obtained 5 mm anterior to a demonstrates the middle and distal thirds of the extrahepatic bile duct (arrows). (2) Normal gallbladder and cystic duct. MR cholangiogram shows the gallbladder (G) and cystic duct (arrow). The extrahepatic bile duct is also seen (arrowheads).

View larger version (129K): [in a new window]   Figure 2. Figures 1, 2. (1) Normal bile duct. (a) MR cholangiogram demonstrates the proximal extrahepatic duct (arrow) and the proximal right and left hepatic ducts. (b) MR cholangiogram obtained 5 mm anterior to a demonstrates the middle and distal thirds of the extrahepatic bile duct (arrows). (2) Normal gallbladder and cystic duct. MR cholangiogram shows the gallbladder (G) and cystic duct (arrow). The extrahepatic bile duct is also seen (arrowheads).

View larger version (127K): [in a new window]   Figure 3a.  Metallic biliary stent in a 69-year-old woman with pancreatic carcinoma. (a) Endoscopic retrograde cholangiopancreatogram obtained prior to injection of contrast material into the bile duct reveals a metallic biliary stent (arrows). (b) MR cholangiogram demonstrates the fluid-filled bile duct (arrows) despite the presence of the stent. The filling defects within the stent represent adherent debris and may be distinguished from stones by their indistinct margins and their peripheral location within the duct on axial images.

View larger version (144K): [in a new window]   Figure 3b.  Metallic biliary stent in a 69-year-old woman with pancreatic carcinoma. (a) Endoscopic retrograde cholangiopancreatogram obtained prior to injection of contrast material into the bile duct reveals a metallic biliary stent (arrows). (b) MR cholangiogram demonstrates the fluid-filled bile duct (arrows) despite the presence of the stent. The filling defects within the stent represent adherent debris and may be distinguished from stones by their indistinct margins and their peripheral location within the duct on axial images.

View larger version (152K): [in a new window]   Figure 4a.  Absence of artifacts secondary to a transjugular intrahepatic portosystemic shunt and spinal fixation rods in a 51-year-old man with elevated alkaline phosphatase levels. MR cholangiography was performed to assess for bile duct obstruction. (a) Digital angiogram obtained during placement of a transjugular intrahepatic portosystemic shunt shows the metallic shunt (arrows) and spinal fixation rods (arrowheads). (b, c) Subsequent MR cholangiograms demonstrate the proximal (b) and distal (c) extrahepatic bile duct (arrows) and help exclude biliary obstruction despite the presence of the transjugular intrahepatic portosystemic shunt and the spinal fixation rods. Note the signal void (*) caused by the shunt.

View larger version (132K): [in a new window]   Figure 4b.  Absence of artifacts secondary to a transjugular intrahepatic portosystemic shunt and spinal fixation rods in a 51-year-old man with elevated alkaline phosphatase levels. MR cholangiography was performed to assess for bile duct obstruction. (a) Digital angiogram obtained during placement of a transjugular intrahepatic portosystemic shunt shows the metallic shunt (arrows) and spinal fixation rods (arrowheads). (b, c) Subsequent MR cholangiograms demonstrate the proximal (b) and distal (c) extrahepatic bile duct (arrows) and help exclude biliary obstruction despite the presence of the transjugular intrahepatic portosystemic shunt and the spinal fixation rods. Note the signal void (*) caused by the shunt.

View larger version (124K): [in a new window]   Figure 4c.  Absence of artifacts secondary to a transjugular intrahepatic portosystemic shunt and spinal fixation rods in a 51-year-old man with elevated alkaline phosphatase levels. MR cholangiography was performed to assess for bile duct obstruction. (a) Digital angiogram obtained during placement of a transjugular intrahepatic portosystemic shunt shows the metallic shunt (arrows) and spinal fixation rods (arrowheads). (b, c) Subsequent MR cholangiograms demonstrate the proximal (b) and distal (c) extrahepatic bile duct (arrows) and help exclude biliary obstruction despite the presence of the transjugular intrahepatic portosystemic shunt and the spinal fixation rods. Note the signal void (*) caused by the shunt.

View larger version (130K): [in a new window]   Figure 5.  Percutaneous biliary drainage catheter in a 75-year-old man. MR cholangiogram demonstrates a biliary drainage catheter (arrows) that has not produced artifacts. The intrahepatic bile ducts are minimally dilated (arrowhead).

View larger version (118K): [in a new window]   Figure 6.  Choledocholithiasis and cholelithiasis in a pregnant 33-year-old woman with right upper quadrant pain. Sonography revealed gallbladder calculi and bile duct dilatation but no common bile duct stones. MR cholangiogram demonstrates multiple calculi in both the dilated extrahepatic bile duct (arrows) and gallbladder (arrowheads).

View larger version (117K): [in a new window]   Figure 7a.  Single, small common bile duct calculus and gallbladder calculi in an 18-year-old woman with chronic right upper quadrant pain. (a) Scout MR cholangiogram shows a 3-mm calculus (straight arrow) in the normal-caliber distal common bile duct. The gallbladder (curved arrow) is filled with multiple small calculi. (b) Endoscopic retrograde cholangiopancreatogram helps confirm the distal common bile duct calculus (arrow).

View larger version (143K): [in a new window]   Figure 7b.  Single, small common bile duct calculus and gallbladder calculi in an 18-year-old woman with chronic right upper quadrant pain. (a) Scout MR cholangiogram shows a 3-mm calculus (straight arrow) in the normal-caliber distal common bile duct. The gallbladder (curved arrow) is filled with multiple small calculi. (b) Endoscopic retrograde cholangiopancreatogram helps confirm the distal common bile duct calculus (arrow).

View larger version (155K): [in a new window]   Figure 8a.  Mirizzi syndrome in a 46-year-old woman with cholangitis. (a) MR cholangiogram reveals a 1.2-cm calculus (arrow) resulting in biliary ductal dilatation. Gallbladder calculi are also seen (arrowheads). (b) MR cholangiogram obtained 5 mm anterior to a shows two calculi in the dilated cystic duct (arrowheads), which parallels the extrahepatic bile duct. The inferior calculus (arrow) corresponds to the calculus seen in a. This calculus eroded through the wall of the cystic duct into the extrahepatic bile duct, bridged the two structures, and resulted in obstruction of the bile duct (Mirizzi syndrome). (c) Endoscopic retrograde cholangiogram demonstrates a calculus in the cystic duct (arrowhead) outlined inferiorly by a small amount of contrast material, as well as the larger, inferior calculus (arrow) causing bile duct obstruction.

View larger version (137K): [in a new window]   Figure 8b.  Mirizzi syndrome in a 46-year-old woman with cholangitis. (a) MR cholangiogram reveals a 1.2-cm calculus (arrow) resulting in biliary ductal dilatation. Gallbladder calculi are also seen (arrowheads). (b) MR cholangiogram obtained 5 mm anterior to a shows two calculi in the dilated cystic duct (arrowheads), which parallels the extrahepatic bile duct. The inferior calculus (arrow) corresponds to the calculus seen in a. This calculus eroded through the wall of the cystic duct into the extrahepatic bile duct, bridged the two structures, and resulted in obstruction of the bile duct (Mirizzi syndrome). (c) Endoscopic retrograde cholangiogram demonstrates a calculus in the cystic duct (arrowhead) outlined inferiorly by a small amount of contrast material, as well as the larger, inferior calculus (arrow) causing bile duct obstruction.

View larger version (145K): [in a new window]   Figure 8c.  Mirizzi syndrome in a 46-year-old woman with cholangitis. (a) MR cholangiogram reveals a 1.2-cm calculus (arrow) resulting in biliary ductal dilatation. Gallbladder calculi are also seen (arrowheads). (b) MR cholangiogram obtained 5 mm anterior to a shows two calculi in the dilated cystic duct (arrowheads), which parallels the extrahepatic bile duct. The inferior calculus (arrow) corresponds to the calculus seen in a. This calculus eroded through the wall of the cystic duct into the extrahepatic bile duct, bridged the two structures, and resulted in obstruction of the bile duct (Mirizzi syndrome). (c) Endoscopic retrograde cholangiogram demonstrates a calculus in the cystic duct (arrowhead) outlined inferiorly by a small amount of contrast material, as well as the larger, inferior calculus (arrow) causing bile duct obstruction.

View larger version (114K): [in a new window]   Figure 9a.  Hilar cholangiocarcinoma with proximal extension into the right and left hepatic bile ducts in a 75-year-old man. (a) MR cholangiogram demonstrates dilatation of the intrahepatic bile ducts (arrowheads) secondary to hilar cholangiocarcinoma, which has extended proximally to involve the right and left hepatic ducts (arrows). (b) MR cholangiogram obtained after injection of contrast material into biliary drainage catheters helps confirm the obstructing hilar lesion and its proximal extent (arrows) as demonstrated in a. (Reprinted, with permission, from reference 6.)

View larger version (140K): [in a new window]   Figure 9b.  Hilar cholangiocarcinoma with proximal extension into the right and left hepatic bile ducts in a 75-year-old man. (a) MR cholangiogram demonstrates dilatation of the intrahepatic bile ducts (arrowheads) secondary to hilar cholangiocarcinoma, which has extended proximally to involve the right and left hepatic ducts (arrows). (b) MR cholangiogram obtained after injection of contrast material into biliary drainage catheters helps confirm the obstructing hilar lesion and its proximal extent (arrows) as demonstrated in a. (Reprinted, with permission, from reference 6.)

View larger version (140K): [in a new window]   Figure 10.  Gallbladder carcinoma with nodal metastasis in a 56-year-old man who presented with right upper quadrant pain and jaundice. Maximum-intensity-projection MR cholangiogram demonstrates a necrotic nodal metastasis (*) resulting in proximal bile duct obstruction. The mass (M) noted in the gallbladder (arrows) represents adenocarcinoma.

View larger version (157K): [in a new window]   Figure 11a.  Pancreatic metastasis from mucinous colon carcinoma in a 34-year-old woman. (a) MR cholangiogram demonstrates obstruction of the intrapancreatic segment of the bile duct (arrow) caused by a pancreatic metastasis. Note the dilated gallbladder (G). Enlarged lymph nodes with high signal intensity (arrowheads) represent metastases from mucinous colon carcinoma. (b) Endoscopic retrograde cholangiogram helps confirm the abrupt obstruction of the intrapancreatic bile duct (arrow) and the proximal bile duct dilatation.

View larger version (152K): [in a new window]   Figure 11b.  Pancreatic metastasis from mucinous colon carcinoma in a 34-year-old woman. (a) MR cholangiogram demonstrates obstruction of the intrapancreatic segment of the bile duct (arrow) caused by a pancreatic metastasis. Note the dilated gallbladder (G). Enlarged lymph nodes with high signal intensity (arrowheads) represent metastases from mucinous colon carcinoma. (b) Endoscopic retrograde cholangiogram helps confirm the abrupt obstruction of the intrapancreatic bile duct (arrow) and the proximal bile duct dilatation.

View larger version (143K): [in a new window]   Figure 12a.  Gastric outlet obstruction preventing ERCP in a 56-year-old woman who presented with weight loss and intractable nausea and vomiting. (a) MR cholangiogram shows obstruction of the extrahepatic bile duct (straight arrow) secondary to lymphadenopathy. The scalloped appearance of the peritoneum (arrowheads) represents carcinomatosis. Gallbladder calculi are also seen (curved arrow). (b) MR cholangiogram of the stomach demonstrates marked antral wall thickening (arrows) secondary to adenocarcinoma, resulting in outlet obstruction.

View larger version (140K): [in a new window]   Figure 12b.  Gastric outlet obstruction preventing ERCP in a 56-year-old woman who presented with weight loss and intractable nausea and vomiting. (a) MR cholangiogram shows obstruction of the extrahepatic bile duct (straight arrow) secondary to lymphadenopathy. The scalloped appearance of the peritoneum (arrowheads) represents carcinomatosis. Gallbladder calculi are also seen (curved arrow). (b) MR cholangiogram of the stomach demonstrates marked antral wall thickening (arrows) secondary to adenocarcinoma, resulting in outlet obstruction.

View larger version (154K): [in a new window]   Figure 13.  Periampullary diverticulum resulting in failed ERCP in a 92-year-old woman with suspected common bile duct stones. MR cholangiopancreatogram reveals a periampullary diverticulum (arrowhead) and a slightly dilated extrahepatic bile duct (straight arrow) but no common bile duct stones. Minute gallbladder calculi are also seen (curved arrow).

View larger version (142K): [in a new window]   Figure 14a.  Primary sclerosing cholangitis in a 51-year-old woman with increasing alkaline phosphatase levels. (a) MR cholangiogram shows stenosis of a right hepatic duct branch (arrows). (b) MR cholangiogram demonstrates stenoses and irregularities of the left hepatic ducts (arrows), indicative of primary sclerosing cholangitis, as well as third-order bile ducts (arrowheads).

View larger version (156K): [in a new window]   Figure 14b.  Primary sclerosing cholangitis in a 51-year-old woman with increasing alkaline phosphatase levels. (a) MR cholangiogram shows stenosis of a right hepatic duct branch (arrows). (b) MR cholangiogram demonstrates stenoses and irregularities of the left hepatic ducts (arrows), indicative of primary sclerosing cholangitis, as well as third-order bile ducts (arrowheads).

View larger version (142K): [in a new window]   Figure 15a.   AIDS cholangiopathy in a 32-year-old man with elevated alkaline phosphatase levels. (a) MR cholangiogram shows multiple ductal stenoses and irregularities of the right hepatic ducts (arrows) and beading of the left hepatic ducts (arrowheads). (b) Endoscopic retrograde cholangiogram performed with balloon occlusion (arrowhead) helps confirm the ductal stenoses (arrows) noted at MR cholangiography.

View larger version (130K): [in a new window]   Figure 15b.   AIDS cholangiopathy in a 32-year-old man with elevated alkaline phosphatase levels. (a) MR cholangiogram shows multiple ductal stenoses and irregularities of the right hepatic ducts (arrows) and beading of the left hepatic ducts (arrowheads). (b) Endoscopic retrograde cholangiogram performed with balloon occlusion (arrowhead) helps confirm the ductal stenoses (arrows) noted at MR cholangiography.

View larger version (107K): [in a new window]   Figure 16.  Stricture resulting from choledochojejunostomy in a 66-year-old man who had undergone a Whipple procedure for pancreatic carcinoma. Scout MR cholangiogram shows a stricture of the common hepatic duct (arrow) extending to the anastomosis between the duct and the jejunum (J). The intrahepatic bile ducts are dilated (arrowheads).

View larger version (139K): [in a new window]   Figure 17a.  Stricture resulting from hepaticojejunostomy in a 33-year-old woman with jaundice. The patient had undergone hepaticojejunostomy because of a bile duct injury sustained during laparoscopic cholecystectomy. (a) MR cholangiogram shows castlike filling defects (arrows) representative of stones in the dilated bile ducts immediately above the strictured hepaticojejunostomy. A small amount of fluid in the jejunum (arrowhead) demarcates the hepaticojejunostomy. (b) Percutaneous transhepatic cholangiogram demonstrates the intraductal stones (arrows), dilated ducts, and anastomotic stricture (arrowhead).

View larger version (133K): [in a new window]   Figure 17b.  Stricture resulting from hepaticojejunostomy in a 33-year-old woman with jaundice. The patient had undergone hepaticojejunostomy because of a bile duct injury sustained during laparoscopic cholecystectomy. (a) MR cholangiogram shows castlike filling defects (arrows) representative of stones in the dilated bile ducts immediately above the strictured hepaticojejunostomy. A small amount of fluid in the jejunum (arrowhead) demarcates the hepaticojejunostomy. (b) Percutaneous transhepatic cholangiogram demonstrates the intraductal stones (arrows), dilated ducts, and anastomotic stricture (arrowhead).

View larger version (151K): [in a new window]   Figure 18a.  Isolated duct obstruction in an 18-year-old woman who sustained bile duct transection during laparoscopic cholecystectomy. The transection was repaired with a duct-to-duct anastomosis. (a) MR cholangiopancreatogram reveals a stricture (arrow) of the left hepatic duct and proximal ductal dilatation (arrowhead). (b) T-tube cholangiogram shows incomplete filling of the dilated left hepatic duct (arrowhead) and a partially retracted T tube (arrow). Note the surgical clips adjacent to the duct.

View larger version (148K): [in a new window]   Figure 18b.  Isolated duct obstruction in an 18-year-old woman who sustained bile duct transection during laparoscopic cholecystectomy. The transection was repaired with a duct-to-duct anastomosis. (a) MR cholangiopancreatogram reveals a stricture (arrow) of the left hepatic duct and proximal ductal dilatation (arrowhead). (b) T-tube cholangiogram shows incomplete filling of the dilated left hepatic duct (arrowhead) and a partially retracted T tube (arrow). Note the surgical clips adjacent to the duct.

View larger version (138K): [in a new window]   Figure 19a.  Normal bile duct in a 46-year-old woman who had undergone orthotopic liver transplantation and primary duct-to-duct anastomosis. (a–c) Multiple MR cholangiograms (a most anterior, c most posterior) are required to show the entire extent of the tortuous bile duct (arrow in a and c). Arrowhead in b indicates the anastomosis. (d) Endoscopic retrograde cholangiogram helps confirm the duct tortuosity and the duct-to-duct anastomosis (arrowhead).

View larger version (139K): [in a new window]   Figure 19b.  Normal bile duct in a 46-year-old woman who had undergone orthotopic liver transplantation and primary duct-to-duct anastomosis. (a–c) Multiple MR cholangiograms (a most anterior, c most posterior) are required to show the entire extent of the tortuous bile duct (arrow in a and c). Arrowhead in b indicates the anastomosis. (d) Endoscopic retrograde cholangiogram helps confirm the duct tortuosity and the duct-to-duct anastomosis (arrowhead).

View larger version (149K): [in a new window]   Figure 19c.  Normal bile duct in a 46-year-old woman who had undergone orthotopic liver transplantation and primary duct-to-duct anastomosis. (a–c) Multiple MR cholangiograms (a most anterior, c most posterior) are required to show the entire extent of the tortuous bile duct (arrow in a and c). Arrowhead in b indicates the anastomosis. (d) Endoscopic retrograde cholangiogram helps confirm the duct tortuosity and the duct-to-duct anastomosis (arrowhead).

View larger version (147K): [in a new window]   Figure 19d.  Normal bile duct in a 46-year-old woman who had undergone orthotopic liver transplantation and primary duct-to-duct anastomosis. (a–c) Multiple MR cholangiograms (a most anterior, c most posterior) are required to show the entire extent of the tortuous bile duct (arrow in a and c). Arrowhead in b indicates the anastomosis. (d) Endoscopic retrograde cholangiogram helps confirm the duct tortuosity and the duct-to-duct anastomosis (arrowhead).

View larger version (129K): [in a new window]   Figure 20a.  Ischemic changes of the bile duct in a 43-year-old man 6 months after orthotopic liver transplantation. (a) MR cholangiogram demonstrates smooth narrowing of the common hepatic duct and the central intrahepatic bile ducts (arrows). The more peripheral branches of the intrahepatic bile ducts are dilated. (b) Endoscopic retrograde cholangiogram shows narrowing of the right hepatic duct (arrow); the narrowing of the left hepatic duct is obscured by overlying ducts.

View larger version (145K): [in a new window]   Figure 20b.  Ischemic changes of the bile duct in a 43-year-old man 6 months after orthotopic liver transplantation. (a) MR cholangiogram demonstrates smooth narrowing of the common hepatic duct and the central intrahepatic bile ducts (arrows). The more peripheral branches of the intrahepatic bile ducts are dilated. (b) Endoscopic retrograde cholangiogram shows narrowing of the right hepatic duct (arrow); the narrowing of the left hepatic duct is obscured by overlying ducts.

View larger version (136K): [in a new window]   Figure 21a.  Aberrant right hepatic duct detected incidentally in a 38-year-old woman. (a) MR cholangiogram shows an aberrant right hepatic duct (arrow) draining into the cystic duct remnant (arrowheads). (b) Endoscopic retrograde cholangiogram demonstrates communication of the aberrant right hepatic duct (arrow) with the cystic duct remnant (arrowheads). Note the surgical clips adjacent to the cystic duct remnant.

View larger version (131K): [in a new window]   Figure 21b.  Aberrant right hepatic duct detected incidentally in a 38-year-old woman. (a) MR cholangiogram shows an aberrant right hepatic duct (arrow) draining into the cystic duct remnant (arrowheads). (b) Endoscopic retrograde cholangiogram demonstrates communication of the aberrant right hepatic duct (arrow) with the cystic duct remnant (arrowheads). Note the surgical clips adjacent to the cystic duct remnant.

View larger version (144K): [in a new window]   Figure 22a.  Low medial insertion of the cystic duct detected incidentally in a 38-year-old woman with abdominal pain. (a) MR cholangiopancreatogram demonstrates low medial insertion of the cystic duct (arrows) into the extrahepatic bile duct (arrowhead). (b) Intraoperative cholangiogram helps confirm the insertion location (arrows).

View larger version (162K): [in a new window]   Figure 22b.  Low medial insertion of the cystic duct detected incidentally in a 38-year-old woman with abdominal pain. (a) MR cholangiopancreatogram demonstrates low medial insertion of the cystic duct (arrows) into the extrahepatic bile duct (arrowhead). (b) Intraoperative cholangiogram helps confirm the insertion location (arrows).

View larger version (165K): [in a new window]   Figure 23.  Type 1 choledochal cyst in a 25-year-old woman. MR cholangiopancreatogram demonstrates fusiform dilatation of the suprapancreatic portion of the extrahepatic bile duct (arrow), indicative of a type 1 choledochal cyst. An anomalous union of the bile and pancreatic ducts is also seen (arrowhead).

View larger version (143K): [in a new window]   Figure 24a.  Pancreas divisum in a 36-year-old man with recurrent pancreatitis. (a) MR cholangiogram shows the distal bile duct (arrowhead), which joins with the ventral pancreatic duct (arrows) to enter the major ampulla. (b) MR cholangiogram shows the dorsal pancreatic duct (arrows) entering the minor ampulla (arrowhead) cephalad to the major ampulla. Subsequent images helped confirm the absence of communication between the ventral and dorsal pancreatic ducts.

View larger version (158K): [in a new window]   Figure 24b.  Pancreas divisum in a 36-year-old man with recurrent pancreatitis. (a) MR cholangiogram shows the distal bile duct (arrowhead), which joins with the ventral pancreatic duct (arrows) to enter the major ampulla. (b) MR cholangiogram shows the dorsal pancreatic duct (arrows) entering the minor ampulla (arrowhead) cephalad to the major ampulla. Subsequent images helped confirm the absence of communication between the ventral and dorsal pancreatic ducts.

View larger version (150K): [in a new window]   Figure 25.  Large gallbladder calculus in a 30-year-old man with sickle cell disease. MR cholangiogram demonstrates a large calculus in the gallbladder (arrow). Note the normal-caliber bile duct (arrowhead).

View larger version (167K): [in a new window]   Figure 26.  Small gallbladder calculi in a 58-year-old woman with right upper quadrant pain. MR cholangiogram reveals multiple small calculi filling the gallbladder (arrows). The cystic duct (arrowhead) does not contain calculi.

View larger version (141K): [in a new window]   Figure 27a.  Adenomyomatosis detected incidentally in a 68-year-old man. (a) MR cholangiogram that includes the gallbladder demonstrates small, fluid-filled outpouchings arising from the gallbladder (arrows), representative of Rokitansky-Aschoff sinuses characteristic of adenomyomatosis. (b) MR cholangiogram of the gallbladder fundus reveals additional fluid-filled sinuses (arrows), seen en face.

View larger version (135K): [in a new window]   Figure 27b.  Adenomyomatosis detected incidentally in a 68-year-old man. (a) MR cholangiogram that includes the gallbladder demonstrates small, fluid-filled outpouchings arising from the gallbladder (arrows), representative of Rokitansky-Aschoff sinuses characteristic of adenomyomatosis. (b) MR cholangiogram of the gallbladder fundus reveals additional fluid-filled sinuses (arrows), seen en face.