Cystic Duct Enhancement: A Useful CT Finding in the Diagnosis of Acute Cholecystitis Without Visible Impacted Gallstones.
OBJECTIVE
The purpose of this study was to determine the incremental value of the presence of cystic duct enhancement for diagnosing acute cholecystitis without visible impacted gallstones.


METHODS
CT scans of 63 patients with acute cholecystitis and 63 control subjects were retrospectively and independently reviewed by two radiologists to determine the presence of cystic duct enhancement or impacted stones. Two additional radiologists were then asked to independently evaluate all CT images using a 5-point scoring system for diagnosing acute cholecystitis. They conducted the evaluations both before and after being informed that cystic duct enhancement could be substituted for a CT finding of impacted gallstones.


RESULTS
The prevalence of either cystic duct enhancement or stone impaction was observed to be significantly more common in the patient group (86-91%) than in the control group (6-14%) (p < 0.001) with good interobserver agreement (κ = 0.79). Diagnostic sensitivities increased significantly from 60.3% to 85.7% for reviewer 1 (p = 0.001) and from 71.4% to 87.3% for reviewer 2 (p = 0.028) after the reviewers were informed of the presence of cystic duct enhancement. Diagnostic accuracy increased significantly for the less experienced radiologist, from 75.4% to 87.3% (p = 0.015).


CONCLUSIONS
The accuracy and sensitivity of CT for the diagnosis of acute cholecystitis improved significantly when cystic duct enhancement was used as an alternative to impacted gallstones as a diagnostic criterion.
1 Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 149 Sangil-Dong, Gangdong-Gu, Seoul, 134-727, Korea.
Sang Won
SW
Kim
1 Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 149 Sangil-Dong, Gangdong-Gu, Seoul, 134-727, Korea.
Hyun Cheol
HC
Kim
1 Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 149 Sangil-Dong, Gangdong-Gu, Seoul, 134-727, Korea.
Dal Mo
DM
Yang
2 Department of Pathology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea.
Kyu Yeoun
KY
Won
3 Department of Radiology, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Seoul, Korea.
Sung Kyoung
SK
Moon
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D041881:Cholecystitis, Acute / Q000000981:diagnostic imaging*; D003549:Cystic Duct / Q000000981:diagnostic imaging*; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
MDCT; acalculous cholecystitis; acute cholecystitis; cystic duct; gallstones