Adenomyomatosis presents usually asymptomatic, however in most cases It is associated with chronic biliary inflammation, most commonly gallstones in 25 - 75% but also seen in cholesterolosis in 33% and pancreatitis.
The pearl necklace sign is seen in patients with adenomyomatosis of the gallbladder, on both oral cholecystograms and MRCP. It represents the contrast / fluid filled intramural mucosal diverticula (Rokitansky-Aschoff sinuses) which line up reminiscent of pearls on a necklace.
MRI images demonstrate adenomyomatosis at the gallbladder fundus This case was donated to Radiopaedia.org by Radswiki.net
It is said to be highly specific (92%) for the diagnosis of adenomyomatosis, however is frequently not seen, only present in ~70% of cases.
