Layering hyperintensity in T1-weighted magnetic resonance imaging predicts gallbladder sludge: a retrospective cohort and diagnostic accuracy study in patients with significant liver disease.

BACKGROUND

Layering hyperintensity in the gallbladder is frequently observed on T1-weighted (T1w) magnetic resonance imaging (MRI), but its association with hepatobiliary disorders is not well understood.

OBJECTIVE

This study aimed to evaluate the prevalence of T1w layering in the gallbladder and its correlation with ultrasound (US) findings and patient characteristics in a cohort with significant liver disease.

METHODS

A single-center study from 2015 to 2022 included patients who underwent MRI and abdominal US within one week. Exclusion criteria were poor imaging quality and prior cholecystectomy. MRI findings were correlated with US and analyzed against patient characteristics.

RESULTS

Among 415 patients (mean age 58.3 ± 14.8 years; mean BMI 28.0 ± 4.5 kg/m²), 67% had abnormal liver function tests, with high prevalences of cirrhosis (n = 260), transjugular intrahepatic portosystemic shunt (TIPS) (n = 233), and choledocholithiasis (n = 106). T1w layering was observed in 56% (n = 232) and associated with higher BMI (p = 0.001) and with cholecystolithiasis (p < 0.001), but not with age, sex, or liver disease indicators. T1w layering was predictive of gallbladder sludge on US (odds ratio 17.2, 95% confidence interval 9.87-31.44, p < 0.001), with a sensitivity of 92.7% but moderate specificity (57.9%).

CONCLUSION

T1w layering on MRI strongly predicts gallbladder sludge detected on US and is associated with increased BMI in this cohort of patients with liver disease. However, the moderate specificity requires cautious interpretation, and our findings suggest that T1w layering may serve as a complementary diagnostic tool.