CT Findings for Detecting the Presence of Gangrenous Ischemia in Cholecystitis

被引:37
作者
Chang, Wei-Chou [1 ,2 ]
Sun, Yuxin [3 ]
Wu, En-Haw [4 ,5 ]
Kim, So Yeon [6 ,7 ]
Wang, Z. Jane [3 ]
Huang, Guo-Shu [1 ,2 ]
Yeh, Benjamin M. [3 ]
机构
[1] Triserv Gen Hosp, Dept Radiol, 325,Sec 2,Cheng Kung Rd, Taipei, Taiwan
[2] Natl Def Med Ctr, 325,Sec 2,Cheng Kung Rd, Taipei, Taiwan
[3] Univ Calif San Francisco, Dept Radiol & Biomed Imaging, San Francisco, CA 94143 USA
[4] Chang Gung Mem Hosp, Dept Med Imaging & Intervent, Linkou, Taoyuan County, Taiwan
[5] Chang Gung Univ, Coll Med, Taoyuan, Taoyuan County, Taiwan
[6] Univ Ulsan, Coll Med, Dept Radiol, Seoul, South Korea
[7] Univ Ulsan, Coll Med, Res Inst Radiol, Asan Med Ctr, Seoul, South Korea
关键词
acute; cholecystitis; chronic; CT; gangrene; OPEN CHOLECYSTECTOMY; MULTIDETECTOR CT; MANAGEMENT; DIAGNOSIS;
D O I
10.2214/AJR.15.15658
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
100231 [临床病理学]; 100902 [航空航天医学];
摘要
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 (kappa = 0.77) and decreased mural enhancement (kappa = 0.64). CONCLUSION. A markedly distended gallbladder associated with decreased wall enhancement is highly specific for gangrenous cholecystitis.
引用
收藏
页码:302 / 309
页数:8
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