Elsevier

Clinical Imaging

Volume 33, Issue 4, July–August 2009, Pages 274-280
Clinical Imaging

CT findings of mild forms or early manifestations of acute cholecystitis

https://doi.org/10.1016/j.clinimag.2008.11.004Get rights and content

Abstract

Objective

The objective of this study was to determine the most predictive CT feature of the mild forms or early manifestations of acute cholecystitis.

Materials and Methods

Two radiologists analyzed CT of 34 patients with mild or early acute cholecystitis and 34 control patients for pericholecystic increased attenuation on the arterial phase, indistinctness of the interface between the gallbladder (GB) and the liver, enhancement of the GB wall, and increased attenuation of the GB bile.

Results

There were significant differences in the mean values for each CT feature but increased attenuation of the GB bile between patients and control group (P<.05). The most significant predictor of mild or early acute cholecystitis on CT was the presence of pericholecystic increased attenuation on the arterial phase (sensitivity, 82.4%), followed by indistinctness of the interface between the GB and liver (sensitivity, 38.0%), which were identified by both observers with good agreement (κ=0.735 and κ=0.687).

Conclusions

The pericholecystic increased attenuation on arterial phase CT was the most significant predictor of mild forms or early manifestations of acute cholecystitis.

Introduction

Acute cholecystitis accounts for 3–10% of all patients with abdominal pain and is the most common cause of acute abdominal pain in the right upper quadrant, especially in the elderly patients [1]. Traditionally, sonography has been used as the initial imaging technique for evaluating patients with suspected gallbladder (GB) disease because of its high sensitivity at the detection of GB stones, its real-time character, and its speed and portability [2]. However, because CT has become popular for evaluating the acute abdomen, it is often the first technique used to evaluate patients with suspected GB disease [3], [4], [5], [6].

The recent introduction of the multidetector CT (MDCT) scanner for abdominal imaging has allowed acquisition of optimum dynamic imaging with high temporal resolution and a high z-axis resolution [6], [7]. Therefore, MDCT is frequently used to determine the causative factor of abdominal pain to drive an accurate clinical decision [6], [7]. Accordingly, mild forms or early manifestations of acute abdominal disease appear to be more frequently demonstrated on CT than their well-known typical imaging findings or their severe forms. In daily clinical routines, we have frequently encountered patients that were considered to have acute cholecystitis but had no well-known typical imaging findings of acute cholecystitis upon initial CT examination. If CT is performed as the initial imaging modality for evaluating the acute abdomen, recognition of CT findings of the mild forms or early manifestations of acute cholecystitis may eliminate the need for any additional imaging modalities and prevent delayed diagnosis or misdiagnosis, thereby facilitating appropriate and expedient management. Therefore, this study was conducted to determine the MDCT findings of the mild forms or early manifestations of acute cholecystitis and to identify their most reliable CT feature.

Section snippets

Patient population

Between October 2004 and March 2008, we searched the computerized medical records of our hospital to identify patients who had been diagnosed with acute cholecystitis and performed three-phasic dynamic MDCT scans at our hospital, which is a tertiary referral hospital. The protocols of this study were approved by the institutional review board at our hospital. Patient consent was not required for this study. A total of 310 patients were given a final diagnosis of acute cholecystitis on the basis

Results

The mean values of each CT score for the patient group and the control group are shown in Table 1. There were significant differences in the mean values observed for each categoric CT feature but increased attenuation of the GB bile between the patient group and the control group [pericholecystic increased attenuation at arterial phase imaging (P<.0001), indistinctness of the interface between the GB and the liver (P<.0001), enhancement of the GB wall (P<.02), and increased attenuation of the

Discussion

In this study, we analyzed the CT findings of patients who were diagnosed with acute cholecystitis but had no definitive initial CT features that fulfilled the criteria for acute cholecystitis. We considered our study cases as a mild form or early manifestation of acute cholecystitis. There were several explanations for this. First, the clinical features of all of the study populations were compatible with those of acute cholecystitis. All of the patients had been admitted to the emergency care

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    This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea (0620220).

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