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KMID : 0870420080120010058
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
2008 Volume.12 No. 1 p.58 ~ p.63
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CT Findings of Acute Gangrenous Cholecystitis
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Sul Young-Hoon
Song In-Sang
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Abstract
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Purpose: Acute gangrenous cholecystitis (AGC) is a severe advanced form of cholecystitis, and it has a higher morbidity and mortality rate than that of acute nongangrenous cholecystitis (ANGC). Identifying the CT findings of gangrenous cholecystitis will enable physicians to make an early diagnosis and administer aggressive treatment.
Methods: From January 2005 to October 2007, the CT scans in 277 patients (80 with AGC, 149 with ANGC and 45 with normal gallbladder (NGB)) were retrospectively reviewed by 2 radiologists. We evaluated the findings that included wall thickening (>3mm), distension (transverse diameter > 5cm), gallstones, pericholecystic fluid, pericholecystic inflammation, mural striation, adjacent hepatic enhancement, pericholecystic abscess, an intraluminal membrane, an irregular or absent wall, gas in the wall or lumen, and intraperitoneal fluid. The sensitivity and specificity of the each CT finding for diagnosing AGC were calculated. The dimension and wall thickness of the gallbladder were also measured.
Results: The sensitivity, specificity and accuracy of CT for diagnosing AGC were 27%, 94% and 74%, respectively. The findings with the highest specificity for AGC were gas in the wall or lumen (100%), intraluminal membranes (99.5%), pericholecystic abscess (99.5%), an irregular or absent wall (98.5%), adjacent hepatic enhancement (97.9%), intraperitoneal fluid (96.9%), pericholecystitic fluid (95.6%), and mural striation (93.8%). The difference of the mean
gallbladder wall thickness between the groups was statistically significant.
Conclusion: These specific CT findings, including the GB wall thickness, will assist clinicians in making an earlier and more exact diagnosis of gangrenous cholecystitis.
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KEYWORD
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Acute gangrenous cholecystits (AGC), CT findings
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