Jeremy Green MD, Presenter: Nothing to Disclose

Benjamin M. Yeh MD, Abstract Co-Author: Nothing to Disclose

Bonnie N. Joe MD, PhD, Abstract Co-Author: Nothing to Disclose

Aliya Qayyum MD, Abstract Co-Author: Nothing to Disclose

Kimberly S Kirkwood, Abstract Co-Author: Nothing to Disclose

Fergus Vincent Coakley MD, Abstract Co-Author: Nothing to Disclose

To evaluate the performance of CT in the diagnosis of acute and gangrenous cholecystitis in a surgical population.

We retrospectively reviewed CT scans in 403 patients with surgically proven gallbladder disease (86 with acute cholecystitis, 35 with gangrenous cholecystitis, 310 with chronic cholecystitis, 8 with gallbladder carcinoma, and 44 with normal gallbladders. Multiple histopathological diagnoses were present in 80 patients). The patients comprised 204 men and 199 women with a mean age of 56. The following CT findings were evaluated: diffuse mural thickening > 3mm, focal mural thickening, transmural enhancement, segmental mural enhancement, inner mucosal mural enhancement, absence of mural enhancement, pericholecystic fluid, pericholecystic fat stranding, gallstones, and enhancement of adjacent liver parenchyma. CT findings were correlated with pathologic diagnoses using univariate and multivariate analyses.

Multivariate analysis revealed diffuse mural thickening, transmural enhancement, pericholecystic fat stranding, and enhancement of adjacent liver parenchyma were independent predictors of acute cholecystitis (p < 0.05 for each). Among these signs, pericholecystic fat stranding and enhancement of adjacent liver parenchyma showed specificity of 86% (250/292) and 85% (270/318) respectively. Independent predictors of gangrenous cholecystitis were diffuse mural thickening, absence of mural enhancement, and pericholecystic fat stranding (p < 0.05 for each). These achieved a maximum sensitivity of 85% (30/35) for diffuse mural thickening, and maximum specificity of 98% (324/331) for absent mural enhancement in the presence of diffuse mural thickening.

Our results demonstrate CT findings highly specific for both acute and gangrenous cholecystitis. The value of CT for identifying patients with acute surgical causes of inflammatory gallbladder disease is likely underestimated.

Green, J, Yeh, B, Joe, B, Qayyum, A, Kirkwood, K, Coakley, F, Acute and Gangrenous Cholecystitis: Diagnosis by CT in a Surgical Population.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4418073.html