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AJR Am J Roentgenol. 2016 Aug;207(2):302-9. doi: 10.2214/AJR.15.15658. Epub 2016 Jun 1.

CT Findings for Detecting the Presence of Gangrenous Ischemia in Cholecystitis.

Author information

1
1 Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Rd, Neihu, Taipei, Taiwan.
2
2 Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA.
3
3 Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Taoyuan County, Taiwan.
4
4 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

OBJECTIVE:

The objective of our study was to evaluate the diagnostic accuracy of CT in differentiating gangrenous cholecystitis from uncomplicated cholecystitis and healthy gallbladders.

MATERIALS AND METHODS:

We performed a retrospective review of 308 patients with histologically proven gangrenous cholecystitis who underwent preoperative CT 1 month before gallbladder removal over a 4-year period. Two readers who were blinded to the histologic diagnosis independently recorded CT features of and overall likelihood of gangrenous cholecystitis on a 5-point scale (1, definitely absent; 5, definitely present). Ratings were dichotomized such that a diagnosis was considered present at a rating of 4 or 5 and considered absent at lower ratings. Interobserver variability for individual CT findings was also assessed.

RESULTS:

Patients had gangrenous cholecystitis (n = 28), acute cholecystitis (n = 98), chronic cholecystitis (n = 118), or healthy gallbladders (n = 64). Multivariate analysis showed that CT findings of gallbladder distention greater than 4.0 cm (odds ratio [OR], 9.63; p < 0.01), mural striation (OR, 11.39; p < 0.01), and decreased mural enhancement (OR, 3.55; p < 0.05) independently predicted gangrenous cholecystitis. Using these CT features, the diagnosis of gangrenous cholecystitis was made with a specificity of 93.9% and 89.6% for readers 1 and 2, respectively, and accuracy of 90.9% and 87.0%, respectively. Good agreement was seen between the two readers with respect to gallbladder distention greater than 4.0 cm (κ = 0.77) and decreased mural enhancement (κ = 0.64).

CONCLUSION:

A markedly distended gallbladder associated with decreased wall enhancement is highly specific for gangrenous cholecystitis.

KEYWORDS:

CT; acute; cholecystitis; chronic; gangrene

PMID:
27249326
DOI:
10.2214/AJR.15.15658
[Indexed for MEDLINE]

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