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Incidental Gallbladder / Biliary (ACR)
Guided recommendation from the ACR Incidental Findings Committee II white paper on gallbladder and biliary findings (Sebastian et al., JACR 2013, Part 4, Table 1). For incidental CT/MRI findings.
Encodes the ACR Incidental Findings Committee II gallbladder and biliary recommendations (Table 1 and text). Applies to incidentally detected CT/MRI findings; not for symptomatic or known gallbladder or biliary disease. Recommendations, not standard of care.
Reference — ACR GB/Biliary white paper (Table 1)
Sebastian S, Araujo C, Neitlich JD, Berland LL. Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 4: White Paper of the ACR Incidental Findings Committee II on Gallbladder and Biliary Findings. J Am Coll Radiol 2013;10:953-956.
| Gallstones, no mass | If symptomatic, ultrasound |
| Wall calcification (porcelain), no mass | No follow-up recommended; if followed, use postcontrast CT |
| Dense contents (20-100 HU) | No evaluation/follow-up for this finding alone |
| Diffuse wall thickening >3 mm, no mass | No evaluation/follow-up (exclude secondary causes) |
| Polyp ≤6 mm | No evaluation/follow-up |
| Polyp 7-9 mm | Yearly ultrasound; surgical consult if grows |
| Polyp ≥10 mm / mass | Surgical consult |
| Pericholecystic fluid | Individual assessment |
| Distended gallbladder | If asymptomatic, no evaluation |
| Ductal dilation >6 mm (GB present) or >10 mm (GB absent) | If labs normal, no evaluation; if abnormal, ERCP/EUS/MRCP/CT cholangiography |
