title: Usefulness of the tensile gallbladder fundus sign in the diagnosis of early acute cholecystitis.
abstract: OBJECTIVE
  The purpose of this article is to evaluate the usefulness of the tensile gallbladder fundus sign on CT in diagnosing early acute cholecystitis.
  
  
  METHODS
  The tensile gallbladder fundus sign on CT is defined as the absence of gallbladder fundus flattening by the anterior abdominal wall due to increased gallbladder pressures. Between October 2010 and March 2012, 222 patients with confirmed diagnoses of acute cholecystitis by surgery or follow-up imaging studies underwent CT scans in the emergency department because of right upper quadrant pain. Two radiologists retrospectively reviewed all CT images to determine the presence of the tensile gallbladder fundus sign and other CT findings previously reported to be suggestive of acute cholecystitis. Diagnostic performances were calculated and analyzed using pairwise comparisons of receiver operating characteristic curves. The kappa statistic was calculated to evaluate the interobserver agreement.
  
  
  RESULTS
  Using the diagnostic criteria in which acute cholecystitis is defined as the presence of three or more classic CT findings, the addition of the tensile gallbladder fundus sign increased the area under the receiver operating characteristic curve (Az) value from 0.693 to 0.739 (p = 0.003). In the subgroup of 91 patients with no other CT features suggestive of acute cholecystitis, the sensitivity, specificity, and Az value of the tensile gallbladder fundus sign for acute cholecystitis were 74.1%, 96.9%, and 0.855, respectively. Interobserver agreement was good with the tensile gallbladder fundus sign (κ = 0.721).
  
  
  CONCLUSIONS
  The tensile gallbladder fundus sign may be useful for diagnosing acute cholecystitis, especially in the early stage when other CT findings are absent.
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Chansik
authors.initials: C
authors.lastname: An
authors.forename: Sumi
authors.initials: S
authors.lastname: Park
authors.forename: Seokmin
authors.initials: S
authors.lastname: Ko
authors.forename: Mi-Suk
authors.initials: MS
authors.lastname: Park
authors.forename: Myeong-Jin
authors.initials: MJ
authors.lastname: Kim
authors.forename: Ki Whang
authors.initials: KW
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D041881:Cholecystitis, Acute / Q000000981:diagnostic imaging*; D003287:Contrast Media; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; C093233:iobitridol; D007472:Iohexol