Wei-Chou Chang MD, Presenter: Nothing to Disclose

Yuxin Sun, Abstract Co-Author: Nothing to Disclose

En-Haw Wu MD, Abstract Co-Author: Nothing to Disclose

So Yeon Kim MD, Abstract Co-Author: Nothing to Disclose

Liqin Zhao MD, Abstract Co-Author: Nothing to Disclose

Benjamin M. Yeh MD, Abstract Co-Author: Research Grant, General Electric Company Consultant, General Electric Company

To evaluate the diagnostic accuracy of CT findings for differentiating gangrenous cholecystitis from uncomplicated acute cholecystitis, with histopathological findings as reference standard.

Our Institutional Review Board approved this retrospective study. We retrospectively reviewed 141 consecutive patients over a 4-year period with histologically proven gangrenous cholecystitis or uncomplicated acute cholecystitis. Of the 141 patients, those who received percutaneous drainage before CT scan were excluded, (n=15). We reviewed the CT scans to record the transverse gallbladder diameter, the presence of intraluminal membranes, or mural striation. We recorded the presence of gallbladder-wall enhancement (on contrast enhanced CT) and hyperdense wall (on unenhanced CT) on a 3-point scale (1, definitely absent; 2, probably present, 3, definitely present). Univariate and multivariate logistic regression was used to correlate with histopathology.

Of the total 126 patients. 28 cases (22.2%) had gangrenous and 98 had uncomplicated acute cholecystitis at histopathology. CT findings of gallbladder distension (n= 26 of 28 versus 38 of 98, p< .001), intraluminal membranes (n= 9 of 28 versus 8 of 98, p= .001), mural striation (n= 14 of 28 versus 12 of 98, p< .001), probability of decreased gallbladder-wall enhancement (absent, probably, and present, n= 2, 4, 14 of 28 versus 53, 24, 5 of 98, p< .001), probability of hyperdense wall on non-contrast images (absent, probably, and present, n= 2, 4, 3 of 28 versus 27, 9, 2 of 98, p= .01), and fluid accumulation (n= 6 of 28 versus 7 of 98, p= .03) were more often seen in gangrenous cholecystitis than in uncomplicated acute cholecystitis. At multivariate analysis, gallbladder distension (odds ratio, OR, 31.4, p< 0.01), mural striation (OR, 9.5, p< 0.02) and decreased gallbladder-wall enhancement (OR, 10.6, p< 0.02) independently predicted gangrenous cholecysititis.

A markedly distended gallbladder with mural striation and decreased wall enhancement is highly specific for gangrenous cholecystitis at CT.

Pre-operative CT findings of marked gallbladder distension and decreased wall enhancement are highly predictive of gangrenous cholesystitis.

Chang, W, Sun, Y, Wu, E, Kim, S, Zhao, L, Yeh, B, Gangrenous Cholecystitis versus Uncomplicated Acute Cholecystitis: Which CT Findings Differentiate between the Two?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007630.html