Gangrenous cholecystitis: prediction with CT imaging

Area of Science:

• Radiology
• Gastroenterology
• Surgical Pathology

Background:

• Acute cholecystitis is a common surgical emergency.
• Differentiating gangrenous from uncomplicated acute cholecystitis is crucial for timely surgical intervention.
• Accurate preoperative diagnosis impacts patient management and outcomes.

Purpose of the Study:

• To evaluate the diagnostic utility of gallbladder mucosal enhancement patterns on contrast-enhanced CT.
• To determine if specific enhancement patterns can reliably distinguish gangrenous from uncomplicated acute cholecystitis.
• To assess the sensitivity and positive predictive value of identified CT patterns.

Main Methods:

• Retrospective analysis of 56 patients with histopathologically confirmed acute cholecystitis.
• Review of preoperative contrast-enhanced computed tomography (CT) scans.
• Categorization of gallbladder mucosal enhancement patterns into continuous, discontinuous, and/or irregular.
• Correlation of CT findings with histopathological diagnoses.

Main Results:

• Discontinuous and/or irregular mucosal enhancement was observed in 18 patients, with 17 diagnosed with gangrenous cholecystitis (94.4% PPV).
• Continuous mucosal enhancement was seen in 20 patients, with 17 diagnosed with uncomplicated acute cholecystitis (85.5% PPV for uncomplicated).
• A statistically significant difference (p=0.0005) was found in the predictive value for gangrenous cholecystitis between enhancement patterns.

Conclusions:

• Gallbladder mucosal enhancement patterns on contrast-enhanced CT are valuable for differentiating acute cholecystitis types.
• Discontinuous/irregular patterns are highly indicative of gangrenous cholecystitis.
• Continuous patterns are associated with uncomplicated acute cholecystitis, aiding in clinical decision-making.