title: CT Findings for Detecting the Presence of Gangrenous Ischemia in Cholecystitis.
abstract: OBJECTIVE
  The objective of our study was to evaluate the diagnostic accuracy of CT in differentiating gangrenous cholecystitis from uncomplicated cholecystitis and healthy gallbladders.
  
  
  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 (κ = 0.77) and decreased mural enhancement (κ = 0.64).
  
  
  CONCLUSIONS
  A markedly distended gallbladder associated with decreased wall enhancement is highly specific for gangrenous cholecystitis.
authors.affiliation: 1 Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Rd, Neihu, Taipei, Taiwan.
authors.forename: Wei-Chou
authors.initials: WC
authors.lastname: Chang
authors.affiliation: 2 Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA.
authors.forename: Yuxin
authors.initials: Y
authors.lastname: Sun
authors.affiliation: 3 Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Taoyuan County, Taiwan.
authors.forename: En-Haw
authors.initials: EH
authors.lastname: Wu
authors.affiliation: 4 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Kim
authors.affiliation: 2 Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA.
authors.forename: Z Jane
authors.initials: ZJ
authors.lastname: Wang
authors.affiliation: 1 Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Rd, Neihu, Taipei, Taiwan.
authors.forename: Guo-Shu
authors.initials: GS
authors.lastname: Huang
authors.affiliation: 2 Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Yeh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002764:Cholecystitis / Q000000981:diagnostic imaging*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D005734:Gangrene / Q000000981:diagnostic imaging*; D006801:Humans; D007472:Iohexol; D007511:Ischemia / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007472:Iohexol
keywords: CT; acute; cholecystitis; chronic; gangrene