title: CT findings in acute gangrenous cholecystitis.
abstract: OBJECTIVE
  The purpose of this study was to determine the CT findings in acute gangrenous cholecystitis.
  
  
  METHODS
  Four observers retrospectively reviewed CT scans in 75 patients (23 with acute gangrenous cholecystitis, 25 with acute non-gangrenous cholecystitis, and 27 without cholecystitis). The following findings were evaluated: distention, mural thickening, wall enhancement, irregular wall, wall striation, intraluminal membranes, pericholecystic inflammation, gallstones, pericholecystic fluid, enhancement of liver parenchyma, pericholecystic abscess, and gas in the wall or lumen. Sensitivity and specificity of CT for gangrenous cholecystitis and for each finding were calculated. Two reviewers in consensus measured gallbladder dimension and wall thickness. Logistic regression models were used to predict gangrenous versus non-gangrenous cholecystitis.
  
  
  RESULTS
  Sensitivity, specificity, and accuracy of CT for acute cholecystitis were 91.7%, 99.1%, and 94.3%, respectively, and for acute gangrenous cholecystitis were 29.3%, 96.0%, and 64.1%, respectively. Findings with the highest specificity for gangrenous cholecystitis were gas in the wall or lumen (100%), intraluminal membranes (99.5%), irregular or absent wall (97.6%), and abscess (96.6%). The difference between the mean gallbladder wall thickness and the short-axis dimension for the two groups with cholecystitis was statistically significant. In three patients with gangrenous cholecystitis, no mural enhancement was seen. Pericholecystic fluid also achieved statistical significance for the diagnosis of gangrene. Multivariate logistic regression analysis showed that the overall accuracy of CT for gangrenous cholecystitis was 86.7%.
  
  
  CONCLUSIONS
  CT findings most specific for acute gangrenous cholecystitis are gas in the wall or lumen, intraluminal membranes, irregular wall, and pericholecystic abscess. Gangrenous cholecystitis is associated with a lack of mural enhancement, pericholecystic fluid, and a greater degree of gallbladder distention and wall thickening.
authors.affiliation: Department of Abdominal Radiology, New York University Medical Center, Tisch Hospital, Rm. HW202, 560 First Ave., New York, NY 10016, USA.
authors.forename: Genevieve L
authors.initials: GL
authors.lastname: Bennett
authors.forename: Henry
authors.initials: H
authors.lastname: Rusinek
authors.forename: Virna
authors.initials: V
authors.lastname: Lisi
authors.forename: Gary M
authors.initials: GM
authors.lastname: Israel
authors.forename: Glenn A
authors.initials: GA
authors.lastname: Krinsky
authors.forename: Chrystia M
authors.initials: CM
authors.lastname: Slywotzky
authors.forename: Alec
authors.initials: A
authors.lastname: Megibow
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002764:Cholecystitis / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D005734:Gangrene; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed