title: Preoperative diagnosis of gangrenous acute cholecystitis: usefulness of CEUS.
abstract: OBJECTIVE
  To evaluate CEUS for the preoperative diagnosis of gangrenous acute cholecystitis.
  
  
  METHODS
  This prospective study was approved by our institution's ethical committee. Fifty-six patients who underwent both US and CEUS and were confirmed as presenting with acute cholecystitis at pathology were included. Clinical data, mean time until surgery, macroscopic appearance of the GB, and the presence of gangrene at pathology were noted. Baseline US images and CEUS cine clips were analyzed by two experienced radiologists. Statistical analyses were performed.
  
  
  RESULTS
  Gangrenous acute cholecystitis was diagnosed in 23 (41%) patients and uncomplicated acute cholecystitis in 33 (59%). Patients with gangrenous acute cholecystitis were found to be older (p = 0.048). Mean time from CEUS to surgery was found to be shorter in patients presenting with gangrenous acute cholecystitis (p = 0.052). At US, GB short axis ≥4 cm (p = 0.039) and GB wall interruption (p = 0.037) showed a statistically significant association with the diagnosis of gangrenous acute cholecystitis. On CEUS, discontinuous or irregular GB wall enhancement was reported in 19/23 (83%) patients with gangrenous acute cholecystitis and showed association with the presence of gangrene at pathology (p = 0.001). The interobserver agreement for the presence of discontinuous or irregular GB wall enhancement on CEUS images was good.
  
  
  CONCLUSIONS
  Performing CEUS on patients presenting with US findings of acute cholecystitis is relevant, since the presence of a discontinuous or irregular enhancement of the GB wall appears to be correlated with the diagnosis of gangrenous acute cholecystitis.
authors.affiliation: Department of Radiology, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France.
authors.forename: Lucie
authors.initials: L
authors.lastname: Revel
authors.forename: Jean
authors.initials: J
authors.lastname: Lubrano
authors.forename: Nicolas
authors.initials: N
authors.lastname: Badet
authors.forename: Philippe
authors.initials: P
authors.lastname: Manzoni
authors.forename: Séverine Valmary
authors.initials: SV
authors.lastname: Degano
authors.forename: Eric
authors.initials: E
authors.lastname: Delabrousse
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D041881:Cholecystitis, Acute / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D005734:Gangrene / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010743:Phospholipids; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride