Pericholecystic Rim Sign and Gallbladder Nonvisualization Indicating Acute Gangrenous Cholecystitis on 99mTc-MIBI Myocardial Perfusion SPECTQutbi, Mohsen, MD; Ahmadi, Reyhana, MDClinical Nuclear Medicine: April 2019 - Volume 44 - Issue 4 - p 339–340 doi: 10.1097/RLU.0000000000002472 Interesting Images Buy SDC Abstract Author InformationAuthors Article MetricsMetrics Rim sign is assumed as an ominous sign of gangrenous cholecystitis and mandates an urgent surgery. The main mechanism by which this phenomenon arises is increased regional blood flow as a result of an inflammatory process. Therefore, it is expected that this finding be visualized in varieties of scans with various radiopharmaceuticals, including myocardial perfusion scan with 99mTc-MIBI as an extracardiac finding. Herein, we present a case of acute cholecystitis with a rim sign on preoperative myocardial perfusion SPECT using 99mTc-MIBI, which posed the possibility of gangrene and perforation and thus the need for urgent surgical intervention. From the Department of Nuclear Medicine, Taleghani Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Received for publication December 5, 2018; revision accepted December 13, 2018. Conflicts of interest and sources of funding: none declared. Correspondence to: Mohsen Qutbi, MD, Department of Nuclear Medicine, Taleghani hospital, Yaman St, Velenjak, Tehran 1985711151, Iran. E-mail: email@example.com, firstname.lastname@example.org. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.