title: Clinical analysis of contributors to the delayed gallbladder opacification following the use of water-soluble contrast medium.
abstract: OBJECTIVE
  Gallbladder opacification (GBO) on computed tomography (CT) imaging may obscure certain pathological or emergent conditions in the gallbladder, such as neoplasms, stones, and hemorrhagic cholecystitis. This study aimed to investigate the clinical contributing factors that could predict the presence of delayed GBO determined by CT.
  
  
  METHODS
  This study retrospectively evaluated 243 consecutive patients who received enhanced CT or intravenous pyelography imaging and then underwent abdominal CT imaging within 5 days. According to the interval between imaging, the patients were divided into group A (1 day), group B (2 or 3 days), and group C (4 or 5 days). Three radiologists evaluated CT images to determine GBO. Fisher's exact test and multivariate backward stepwise elimination logistic regression were performed.
  
  
  RESULTS
  Positive GBO was significantly associated with the interval between imaging studies, contrast type, contrast volume, renal function, and hypertransaminasemia (P<0.05). Multivariate backward stepwise elimination logistic regression analysis of the three groups identified contrast type and hypertransaminasemia as independent predictors of GBO in group B patients (odds ratio [OR], 13.52, 95% confidence interval [CI], 1.72-106.38 and OR, 3.43, 95% CI, 1.31-8.98, respectively; P<0.05). Hypertransaminasemia was the only independent predictor of GBO in group C patients with an OR of 7.2 (95% CI, 1.62-31.73). Hypertransaminasemia was noted in three patients (100%) who initially underwent imaging 5 days prior to GBO.
  
  
  CONCLUSIONS
  Delayed GBO on CT imaging may be associated with laboratory hypertransaminasemia, particularly in patients receiving contrast medium over a period of ≥4 days. A detailed clinical history, physical examination, and further workup are of paramount importance for investigating the underlying cause behind the hypertransaminasemia.
authors.affiliation: Department of Radiology, Kuang Tien General Hospital, Taichung; Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli.
authors.forename: Ming-Chang
authors.initials: MC
authors.lastname: Ku
authors.affiliation: Department of Internal Medicine, Division of Medical Oncology, Kuang Tien General Hospital; Department of Bioinformatics and Medical Engineering, Asia University.
authors.forename: Victor C
authors.initials: VC
authors.lastname: Kok
authors.affiliation: Department of Statistics and Informatics Science, Providence University.
authors.forename: Ming-Yung
authors.initials: MY
authors.lastname: Lee
authors.affiliation: Department of Radiology, Kuang Tien General Hospital, Taichung.
authors.forename: Soa-Min
authors.initials: SM
authors.lastname: Hsu
authors.affiliation: Department of Radiology, Kuang Tien General Hospital, Taichung.
authors.forename: Pei-Yu
authors.initials: PY
authors.lastname: Lee
authors.affiliation: Department of Radiology, Kuang Tien General Hospital, Taichung.
authors.forename: Che-Wei
authors.initials: CW
authors.lastname: Chang
authors.affiliation: Department of Medical Imaging, Chung Shan Medical University Hospital.
authors.forename: Yeu-Sheng
authors.initials: YS
authors.lastname: Tyan
authors.affiliation: Department of Emergency Medicine, Kuang Tien General Hospital; Department of Nursing, HungKuang University, Taichung, Taiwan.
authors.forename: Chi-Wen
authors.initials: CW
authors.lastname: Juan
keywords: computed tomography; hemorrhagic cholecystitis; hypertransaminasemia; logistic regression; vicarious contrast medium excretion