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- Title
Evaluation of early sonographic predictors of gangrenous cholecystitis: mucosal discontinuity and echogenic pericholecystic fat.
- Authors
Tse, Justin R.; Gologorsky, Rebecca; Shen, Luyao; Bingham, David B.; Jeffrey, R. Brooke; Kamaya, Aya
- Abstract
Purpose: To identify early sonographic features of gangrenous cholecystitis. Materials and methods: 101 patients with acute cholecystitis and a pre-operative sonogram were retrospectively reviewed by three radiologists in this IRB-approved and HIPAA-compliant study. Imaging data were correlated with histologic findings and compared using the Fisher's exact test or Student t test with p < 0.05 to determine statistical significance. Results: Forty-eight patients had gangrenous cholecystitis and 53 had non-gangrenous acute cholecystitis. Patients with gangrenous cholecystitis tended to be older (67 ± 17 vs 48 ± 18 years; p = 0.0001), male (ratio of male:female 2:1 vs 0.6:1; p = 0.005), tachycardic (60% vs 28%; p = 0.001), and diabetic (25% vs 8%; p = 0.001). Median time between pre-operative sonogram and surgery was 1 day. On imaging, patients with gangrenous cholecystitis were more likely to have echogenic pericholecystic fat (p = 0.001), mucosal discontinuity (p = 0.010), and frank perforation (p = 0.004), while no statistically significant differences were seen in the presence of sloughed mucosa (p = 0.104), pericholecystic fluid (p = 0.523) or wall striations (p = 0.839). In patients with gangrenous cholecystitis and echogenic pericholecystic fat, a smaller subset had concurrent mucosal discontinuity (57%), and a smaller subset of those had concurrent frank perforation (58%). The positive likelihood ratios for gangrenous cholecystitis with echogenic fat and mucosal discontinuity were 4.6 (95% confidence interval 1.9–11.3) and 14.4 (2.0–106), respectively. Conclusion: Echogenic pericholecystic fat and mucosal discontinuity are early sonographic findings that may help identify gangrenous cholecystitis prior to late findings of frank perforation.
- Subjects
ULTRASONIC imaging -- Evaluation; CONFIDENCE intervals; CHOLECYSTITIS; RETROSPECTIVE studies; GANGRENE; DESCRIPTIVE statistics
- Publication
Abdominal Radiology, 2022, Vol 47, Issue 3, p1061
- ISSN
2366-004X
- Publication type
Article
- DOI
10.1007/s00261-021-03320-4