1
|
de Paula Reis Guimarães V, Miranda J, Tamura Sttefano Guimarães C, Leão Filho H, Blasbalg R, Lahan-Martins D, Velloni FG. A comprehensive exploration of gallbladder health: from common to rare imaging findings. Abdom Radiol (NY) 2024:10.1007/s00261-024-04431-4. [PMID: 38953999 DOI: 10.1007/s00261-024-04431-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 07/04/2024]
Abstract
This comprehensive review explores a wide range of imaging findings associated with the gallbladder (GB), from anatomic variants to rare diseases. Through an in-depth review of diagnostic modalities including ultrasound, magnetic resonance cholangiopancreatography, CT, and MRI, we aim to highlight the crucial role of imaging techniques in diagnosing GB disorders, as congenital anomalies, inflammatory diseases, neoplasms, and surgical complications. Employing a detailed analysis and comparison of imaging findings across various modalities, this review seeks to improve diagnostic accuracy for GB-related pathologies, facilitating optimal patient management.
Collapse
Affiliation(s)
- Vivianne de Paula Reis Guimarães
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil.
| | - Joao Miranda
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
- Department of Radiology, University of São Paulo, R. Dr. Ovídio Pires de Campos, 75 - Cerqueira César, São Paulo, SP, 05403-010, Brazil
| | - Cássia Tamura Sttefano Guimarães
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
| | - Hilton Leão Filho
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
| | - Roberto Blasbalg
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
| | - Daniel Lahan-Martins
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
- Department of Radiology, Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), R. Tessália Vieira de Camargo, 126-Cidade Universitária, Campinas, SP, 13083-887, Brazil
| | - Fernanda Garozzo Velloni
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
| |
Collapse
|
2
|
Kirby JW, Horst KK, Boyum JH, Thiels CA, Froemming AT, Khandelwal A. The Acute Abdomen: A Case-based Survival Guide to What the Surgeon Wants to Know. Radiographics 2024; 44:e230161. [PMID: 38662589 DOI: 10.1148/rg.230161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Affiliation(s)
- John W Kirby
- From Mayo Clinic Rochester, 200 1st St SW, Rochester, MN 55905
| | - Kelly K Horst
- From Mayo Clinic Rochester, 200 1st St SW, Rochester, MN 55905
| | - James H Boyum
- From Mayo Clinic Rochester, 200 1st St SW, Rochester, MN 55905
| | | | | | | |
Collapse
|
3
|
Portincasa P, Di Ciaula A, Bonfrate L, Stella A, Garruti G, Lamont JT. Metabolic dysfunction-associated gallstone disease: expecting more from critical care manifestations. Intern Emerg Med 2023; 18:1897-1918. [PMID: 37455265 PMCID: PMC10543156 DOI: 10.1007/s11739-023-03355-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
About 20% of adults worldwide have gallstones which are solid conglomerates in the biliary tree made of cholesterol monohydrate crystals, mucin, calcium bilirubinate, and protein aggregates. About 20% of gallstone patients will definitively develop gallstone disease, a condition which consists of gallstone-related symptoms and/or complications requiring medical therapy, endoscopic procedures, and/or cholecystectomy. Gallstones represent one of the most prevalent digestive disorders in Western countries and patients with gallstone disease are one of the largest categories admitted to European hospitals. About 80% of gallstones in Western countries are made of cholesterol due to disturbed cholesterol homeostasis which involves the liver, the gallbladder and the intestine on a genetic background. The incidence of cholesterol gallstones is dramatically increasing in parallel with the global epidemic of insulin resistance, type 2 diabetes, expansion of visceral adiposity, obesity, and metabolic syndrome. In this context, gallstones can be largely considered a metabolic dysfunction-associated gallstone disease, a condition prone to specific and systemic preventive measures. In this review we discuss the key pathogenic and clinical aspects of gallstones, as the main clinical consequences of metabolic dysfunction-associated disease.
Collapse
Affiliation(s)
- Piero Portincasa
- Clinica Medica "A. Murri", Division of Internal Medicine, Department of Preventive and Regenerative Medicine and Ionian Area (DiMePrev-J), University of Bari Aldo Moro, p.zza Giulio Cesare 11, 70124, Bari, Italy.
| | - Agostino Di Ciaula
- Clinica Medica "A. Murri", Division of Internal Medicine, Department of Preventive and Regenerative Medicine and Ionian Area (DiMePrev-J), University of Bari Aldo Moro, p.zza Giulio Cesare 11, 70124, Bari, Italy
| | - Leonilde Bonfrate
- Clinica Medica "A. Murri", Division of Internal Medicine, Department of Preventive and Regenerative Medicine and Ionian Area (DiMePrev-J), University of Bari Aldo Moro, p.zza Giulio Cesare 11, 70124, Bari, Italy
| | - Alessandro Stella
- Laboratory of Medical Genetics, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari, Italy
| | - Gabriella Garruti
- Section of Endocrinology, Department of Preventive and Regenerative Medicine and Ionian Area (DiMePrev-J), University of Bari Aldo Moro, Bari, Italy
| | - John Thomas Lamont
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| |
Collapse
|
4
|
Choi R, Lee M, Choi JW, Kim HC. Safety of Radioembolization via the Cystic Artery in Patients with Hepatocellular Carcinoma and Parasitized Arterial Supply. J Vasc Interv Radiol 2023; 34:1802-1808. [PMID: 37364731 DOI: 10.1016/j.jvir.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/17/2023] [Accepted: 06/18/2023] [Indexed: 06/28/2023] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of radioembolization through the cystic artery supplying hepatocellular carcinoma (HCC) adjacent to the gallbladder. MATERIALS AND METHODS This retrospective, single-center study included 24 patients who underwent radioembolization via the cystic artery between March 2017 and October 2022. The median tumor size was 8.3 cm (range, 3.4-20.4 cm). Twenty-two (92%) patients had Child-Pugh Class A disease, and 2 (8%) patients had Class B cirrhosis. Technical issues, adverse events, and tumor response were analyzed. RESULTS Infusion of radioactive microspheres was performed from the main cystic artery (n = 6), the deep cystic artery (n = 9), and small feeders from the cystic artery (n = 9). The cystic artery supplied the primary index tumor in 21 patients. The median radiation activity delivered via the cystic artery was 0.19 GBq (range, 0.02-0.43 GBq). The median total radiation activity administered was 4.1 GBq (range, 0.9-10.8 GBq). There was no case of symptomatic cholecystitis requiring invasive intervention. One patient experienced abdominal pain during injection of radioactive microspheres via the cystic artery. Eleven (46%) patients received pain medication during or within 2 days of the procedure. Twelve (50%) patients had gallbladder wall thickening on a 1-month follow-up computed tomography scan. Based on follow-up imaging, 23 (96%) patients showed an objective response (complete or partial response) of the tumor supplied by the cystic artery. CONCLUSION Radioembolization via the cystic artery may be safe in patients with HCC partially supplied by the cystic artery.
Collapse
Affiliation(s)
- Rebecca Choi
- Department of Radiology, the Johns Hopkins Hospital, Baltimore, Maryland
| | - Myungsu Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
5
|
Khafaji MA, Bagasi JT, Albahiti SK, Alsayegh LA, Alsayyad SA, Algarni SS, Bahowarth SY, Baghdadi ES. Accuracy of Ultrasound and Computed Tomography in Diagnosing Acute Cholecystitis Patients in a Tertiary Care Center in Saudi Arabia. Cureus 2023; 15:e44934. [PMID: 37818501 PMCID: PMC10560961 DOI: 10.7759/cureus.44934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 10/12/2023] Open
Abstract
Background Acute cholecystitis (AC) is a gallbladder inflammatory disease often associated with gallbladder stones. It accounts for up to 5% of emergency department visits. The majority of patients present with pain in the right upper quadrant, Murphy's sign, and fever. Furthermore, Saudi Arabia has been noted to have a significant prevalence of AC. According to the 2018 Tokyo Guidelines, imaging is an essential element, combined with local and systemic evidence of inflammation, for a confirmed diagnosis of AC. The definitive therapy is conducted surgically by cholecystectomy either urgently or electively. However, there are insufficient studies that focus on the accuracy of imaging in diagnosing AC patients in Saudi Arabia. Objective The aim of this study is to assess the accuracy of ultrasound (US) versus computed tomography (CT) in diagnosing AC patients at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. Methods and material A retrospective record review was conducted at KAUH during the period of June to July 2022. The study included 192 patients diagnosed with AC in the emergency department or outpatient department by US or CT or both and confirmed by laparoscopic cholecystectomy and histopathology between 2016 and 2022. Results The most common modality used was US (79.7%), followed by both US and contrast CT (10.9%). For CT, sensitivity was 81.3%, specificity was 62.5%, positive predictive value (PPV) was 59.1%, and negative predictive value (NPV) was 83.3%. For US, sensitivity was 37.9%, specificity was 81.7%, PPV was 50%, and NPV was 73.1%. A significant relationship was observed between both genders and high use of US (P = 0.0001). Conclusion We found that CT is more sensitive than US, while US is more specific in diagnosing AC.
Collapse
Affiliation(s)
- Mawya A Khafaji
- Radiology Department, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Juman T Bagasi
- Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Sarah K Albahiti
- Radiology Department, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Lama A Alsayegh
- Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Shahd A Alsayyad
- Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Seba S Algarni
- Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Sarah Y Bahowarth
- Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | | |
Collapse
|
6
|
Russo GK, Zaheer A, Kamel IR, Porter KK, Archer-Arroyo K, Bashir MR, Cash BD, Fung A, McCrary M, McGuire BM, Shih RD, Stowers J, Thakrar KH, Vij A, Wahab SA, Zukotynski K, Carucci LR. ACR Appropriateness Criteria® Right Upper Quadrant Pain: 2022 Update. J Am Coll Radiol 2023; 20:S211-S223. [PMID: 37236744 DOI: 10.1016/j.jacr.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Acute right upper quadrant pain is one of the most common presenting symptoms in hospital emergency departments, as well as outpatient settings. Although gallstone-related acute cholecystitis is a leading consideration in diagnosis, a myriad of extrabiliary sources including hepatic, pancreatic, gastroduodenal, and musculoskeletal should also be considered. This document focuses on the diagnostic accuracy of imaging studies performed specifically to evaluate acute right upper quadrant pain, with biliary etiologies including acute cholecystitis and its complications being the most common. An additional consideration of extrabiliary sources such as acute pancreatitis, peptic ulcer disease, ascending cholangitis, liver abscess, hepatitis, and painful liver neoplasms remain a diagnostic consideration in the right clinical setting. The use of radiographs, ultrasound, nuclear medicine, CT, and MRI for these indications are discussed. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
| | | | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristin K Porter
- Panel Vice-Chair, University of Alabama Medical Center, Birmingham, Alabama; Council Steering Committee, ACR
| | | | | | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - Alice Fung
- Oregon Health & Science University, Portland, Oregon; Liver Reporting & Data System Technique Working Group
| | - Marion McCrary
- Duke Signature Care, Durham, North Carolina; American College of Physicians
| | - Brendan M McGuire
- University of Alabama at Birmingham, Birmingham, Alabama; Primary care physician
| | - Richard D Shih
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; American College of Emergency Physicians
| | - John Stowers
- Oregon Health & Science University, Portland, Oregon; American College of Surgeons
| | | | - Abhinav Vij
- New York University Langone Medical Center, New York, New York
| | - Shaun A Wahab
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Katherine Zukotynski
- McMaster University, Hamilton, Ontario, Canada; Commission on Nuclear Medicine and Molecular Imaging
| | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
| |
Collapse
|
7
|
The gallbladder: what's new in 2022? ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:2-28. [PMID: 35348807 DOI: 10.1007/s00261-022-03429-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 01/21/2023]
Abstract
This review focuses mainly on the imaging diagnosis, treatment, and complications of acute cholecystitis which is the most common benign disease of the gallbladder. The American College of Radiology appropriateness criteria for the imaging evaluation of patients with right upper quadrant pain and the Tokyo Guidelines for evaluating patients with acute cholecystitis and acute cholangitis are presented. The recent articles for using US, CT, MR, and HIDA in the evaluation of patients with suspected acute cholecystitis are reviewed in detail. The clinical management and postoperative complications are described. Because gallbladder polyps and adenomyomatosis can mimic gallbladder malignancies and acute cholecystitis, their imaging findings and management are presented. Finally, due the recent literature reporting better results with CT than US in the diagnosis of acute cholecystitis, a suggested approach for imaging patients with right upper quadrant pain and possible acute cholecystitis is presented in an addendum.
Collapse
|
8
|
Sandomenico F, Sanduzzi L, La Verde E, Vicenzo E, Pirolo L, Maione S, Setola FR, Macchia V, Dello Iacono U, Barbato D, Peluso G, Santangelo M, Brunetti A. Multidetector Computed Tomography (MDCT) Findings of Complications of Acute Cholecystitis. A Pictorial Essay. Tomography 2022; 8:1159-1171. [PMID: 35448729 PMCID: PMC9025054 DOI: 10.3390/tomography8020095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 12/19/2022] Open
Abstract
Acute cholecystitis stands out as one of the most common surgical pathologies that should always be considered in a right-upper abdominal pain emergency. For this, the importance of a correct diagnosis is well described. However, it has been demonstrated that the simple combination of clinical (pain, Murphy’s sign) and laboratory (leukocytosis) parameters alone does not provide for ruling in or ruling out the diagnosis of this condition, unless accompanied by a radiological exam. For a long time, and still today, ultrasonography (US) is by far the first-to-proceed radiologic exam to perform, thanks to its rapidity and very high sensibility and specificity for the diagnosis of simple acute cholecystitis. However, acute cholecystitis can undergo some complications that US struggles to find. In addition to that, studies suggest that multidetector computed tomography (MDCT) is superior in showing complicated forms of cholecystitis in relation to sensibility and specificity and for its capability of reformatting multiplanar (MPR) reconstructions that give a more detailed view of complications. They have shown to be useful for a precise evaluation of vascular complications, the anatomy of the biliary tree, and the extension of inflammation to surrounding structures (i.e., colitis). Therefore, based also on our experience, in patients with atypical presentation, or in cases with high suspicion for a complicated form, a MDCT abdomen scan is performed. In this review, the principal findings are listed and described to create a CT classification of acute complications based on anatomical and topographic criteria.
Collapse
Affiliation(s)
- Fabio Sandomenico
- Radiology Unit, Buon Consiglio Fatebenefratelli Hospital, 80123 Naples, Italy; (E.V.); (L.P.); (S.M.); (F.R.S.); (V.M.); (U.D.I.)
- Correspondence: ; Tel.: +39-0815981470 or +39-3356368805
| | - Luca Sanduzzi
- Diagnostic Imaging and Radiotherapy Department, Azienda Ospedaliera Universitaria “Federico II”, 80131 Naples, Italy; (L.S.); (E.L.V.); (A.B.)
| | - Emilia La Verde
- Diagnostic Imaging and Radiotherapy Department, Azienda Ospedaliera Universitaria “Federico II”, 80131 Naples, Italy; (L.S.); (E.L.V.); (A.B.)
| | - Emilio Vicenzo
- Radiology Unit, Buon Consiglio Fatebenefratelli Hospital, 80123 Naples, Italy; (E.V.); (L.P.); (S.M.); (F.R.S.); (V.M.); (U.D.I.)
| | - Luigi Pirolo
- Radiology Unit, Buon Consiglio Fatebenefratelli Hospital, 80123 Naples, Italy; (E.V.); (L.P.); (S.M.); (F.R.S.); (V.M.); (U.D.I.)
| | - Salvatore Maione
- Radiology Unit, Buon Consiglio Fatebenefratelli Hospital, 80123 Naples, Italy; (E.V.); (L.P.); (S.M.); (F.R.S.); (V.M.); (U.D.I.)
| | - Francesca Rosa Setola
- Radiology Unit, Buon Consiglio Fatebenefratelli Hospital, 80123 Naples, Italy; (E.V.); (L.P.); (S.M.); (F.R.S.); (V.M.); (U.D.I.)
| | - Valeria Macchia
- Radiology Unit, Buon Consiglio Fatebenefratelli Hospital, 80123 Naples, Italy; (E.V.); (L.P.); (S.M.); (F.R.S.); (V.M.); (U.D.I.)
| | - Umberto Dello Iacono
- Radiology Unit, Buon Consiglio Fatebenefratelli Hospital, 80123 Naples, Italy; (E.V.); (L.P.); (S.M.); (F.R.S.); (V.M.); (U.D.I.)
| | - Domenico Barbato
- Surgery Unit, Buon Consiglio Fatebenefratelli Hospital, 80123 Naples, Italy; (D.B.); (G.P.); (M.S.)
| | - Gaia Peluso
- Surgery Unit, Buon Consiglio Fatebenefratelli Hospital, 80123 Naples, Italy; (D.B.); (G.P.); (M.S.)
| | - Michele Santangelo
- Surgery Unit, Buon Consiglio Fatebenefratelli Hospital, 80123 Naples, Italy; (D.B.); (G.P.); (M.S.)
| | - Arturo Brunetti
- Diagnostic Imaging and Radiotherapy Department, Azienda Ospedaliera Universitaria “Federico II”, 80131 Naples, Italy; (L.S.); (E.L.V.); (A.B.)
| |
Collapse
|
9
|
Chen BQ, Xie F, Chen GD, Li X, Mao X, Jia B. Value of nonenhanced CT combined with laboratory examinations in the diagnosis of acute suppurative cholecystitis treated with percutaneous cholecystostomy: a retrospective study. BMC Gastroenterol 2022; 22:155. [PMID: 35350979 PMCID: PMC8966294 DOI: 10.1186/s12876-022-02224-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/17/2022] [Indexed: 12/07/2022] Open
Abstract
PURPOSES In this study, we aimed to identify the distribution of presenting laboratory and nonenhanced computed tomography (CT) imaging features within 48 h before percutaneous cholecystostomy (PC) and create a model to appropriately guide the diagnosis of acute suppurative cholecystitis (ASC). METHODS The study population included 204 acute cholecystitis patients who underwent PC. Based on the timing of the last laboratory and CT examinations before PC, the patients were divided into two groups: within 48 h before PC (Group 1, n = 138) and over 48 h before PC (Group 2, n = 63). The clinical features of the ASC patients in the two groups were compared. A multivariable model for the diagnosis of ASC in the patients in Group 1 was developed. RESULTS Thirty-nine patients in Group 1 had ASC (28.3%). Gallbladder stones, common bile duct stones, gallbladder wall thickness > 2.85 mm, and neutrophil granulocytes > 82.55% were confirmed to be independent risk factors for ASC. The receiver operating characteristic curve of the recurrence prediction model verified its accuracy (area under the curve: 0.803). Compared with the ASC patients in Group 2, the ASC patients in Group 1 had a higher proportion of pericholecystic exudation or fluid (P = 0.013) and thicker gallbladder walls (P = 0.033). CONCLUSIONS Using nonenhanced CT imaging features and cutoffs for neutrophil granulocytes, we were able to identify a simple algorithm to discriminate ASC. The degree of local inflammation of the gallbladder in ASC patients progressively increases over time, and these changes can be observed on nonenhanced CT images. However, the symptoms of abdominal pain are of little help in estimating the disease duration in elderly patients.
Collapse
Affiliation(s)
- Bai-Qing Chen
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China.,Dalian Medical University, 9 Western Sections, Lvshun South Street, Lvshunkou District, Dalian, 116044, China
| | - Feng Xie
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China.
| | - Guo-Dong Chen
- Department of Radiology, Panjin Liaohe Oilfield Gem Flower Hospital, 26 Yingbin Road, Xinglongtai District, Panjin, 124010, China
| | - Xue Li
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
| | - Xue Mao
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
| | - Bao Jia
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
| |
Collapse
|
10
|
Park YS, Yoon H, Kang SY, Jo IJ, Woo S, Lee G, Park JE, Kim T, Lee SU, Hwang SY, Cha WC, Shin TG. Use of Gallbladder Width Measurement by Computed Tomography in the Diagnosis of Acute Cholecystitis. Diagnostics (Basel) 2022; 12:diagnostics12030721. [PMID: 35328274 PMCID: PMC8946906 DOI: 10.3390/diagnostics12030721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 02/01/2023] Open
Abstract
This study aimed to evaluate the diagnostic value of gallbladder width measurement with computed tomography (CT) in patients with acute cholecystitis. This retrospective case−control study was conducted between March 2016 and March 2020 at a tertiary emergency department. Of 310 patients, 254 patients with acute cholecystitis confirmed by surgery were compared with 254 patients diagnosed with other diseases (controls). In the acute cholecystitis group, the number of older patients with underlying illnesses was much higher (64% of men). Upon CT, the median (interquartile range [IQR]) gallbladder width was significantly longer in patients with acute cholecystitis (2.26 [1.82−2.78] cm vs. 3.73 [3.32−4.16] cm, p < 0.001). The optimal cut-off value of gallbladder width for differentiating acute cholecystitis was 3.12 cm, showing a sensitivity of 88% and specificity of 86%. In a multivariable analysis using a logistic regression model for diagnosing acute cholecystitis with CT findings (gallbladder width, length, stone, wall thickening, and pericholecystic fluid), a gallbladder width of ≥3.12 cm was significantly meaningful, even when adjusting for other variables (odds ratio 37.9; p < 0.001). Therefore, an increase in gallbladder width (≥3.12 cm) measured with CT can be a simple and sensitive diagnostic sign of acute cholecystitis, supporting the underlying pathophysiology of bile outflow obstruction.
Collapse
Affiliation(s)
- Yong Suk Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
- Correspondence:
| | - Soo Yeon Kang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Sookyoung Woo
- Biomedical Statistics Center, Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea;
| | - Guntak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Jong Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| |
Collapse
|
11
|
ATABEY M, AYKOTA MR, YILMAZ S. May complete blood count parameters be predictive in estimation of gallbladder wall thickness? Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.20.05200-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
|
12
|
Retrospective analysis of the sonographic and computed tomographic features of gallbladder empyema. Emerg Radiol 2021; 29:281-289. [PMID: 34811585 DOI: 10.1007/s10140-021-01996-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Early detection of complicated cholecystitis, particularly gallbladder empyema, is important. Yet only a handful of patients are correctly diagnosed prior to intervention. The purpose of this study was to evaluate the sonographic and computed tomography features associated with gallbladder empyema compared with the intraoperative findings and histopathological examination. MATERIALS AND METHODS We retrospectively reviewed ultrasound and CT images for 146 patients with clinical suspicion of cholecystitis from January 2013 until December 2018. Ultrasound criteria reviewed included calculus, wall thickening, pericholecystic fluid, gallbladder distension and presence of echogenic material within the gallbladder. For CT, criteria reviewed were wall thickening, gallbladder distension, mucosal enhancement, pericholecystic fluid and hyperdense bile with an attenuation value of more than 20 HU. Association of these findings was made with intraoperative and pathological findings of 85 patients with proven gallbladder empyema. RESULTS Sonographic signs that were statistically significantly associated with gallbladder empyema (p < 0.05) were thickened gallbladder wall (mean 5.4 versus 3.0 mm), distended gallbladder (mean 8.5 versus 6.4cm), pericholecystic fluid and echogenic material within the gallbladder. No significant association between gallstones and gallbladder empyema. Scores of two and more out of four significant sonographic findings were found to have an association with higher chances of developing gallbladder empyema (p < 0.05, odds ratio: 10). None of the CT features was found to be significant with gallbladder empyema (p > 0.05). CONCLUSION A combination of few ultrasound features has a high significant association with gallbladder empyema. Thus, in the proper clinical setting, these findings should alarm the sonographic operator on the possibility of gallbladder empyema.
Collapse
|
13
|
Nepal P, Wells M, Ojili V, Khandelwal K, Lalwani N, Khandelwal A. Problem-solving with MRI in acute abdominopelvic conditions, part 1: gastrointestinal, hepatobiliary, and pancreatic diseases. Emerg Radiol 2021; 28:1161-1172. [PMID: 34247289 DOI: 10.1007/s10140-021-01960-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/25/2021] [Indexed: 01/11/2023]
Abstract
The purpose of this article is to review the benefit and added value and advantages of magnetic resonance imaging (MRI) compared with other cross-sectional imaging in patients presenting with abdominopelvic emergencies. During the past decade, there has been increased utilization of MRI in the emergency department with widespread availability of MR scanners, improvement in rapid imaging techniques, and methods to overcome motion-related artifacts. This has benefited patients at higher risk of radiation, particularly children and pregnant women, and patients with contraindications to iodinated contrast including allergy and renal dysfunction. Still the challenges are: on site MR scanner in the emergency department, after-hour services, as well as availability of time slot to rapidly scan emergency patient. MRI has additional advantages over other imaging modalities due to its high contrast resolution, which allows it to better characterize tissue and fluid collections, and may avoid the need for intravenous contrast. Radiologists must be familiar with the role and added value of MRI, spectrum of imaging findings, and problem-oriented modified MR protocols in abdominal and pelvic emergencies. In part 1, we will discuss the utility of MRI in gastrointestinal, hepatobiliary, and pancreatic diseases. In part 2, the authors will focus on the key MR imaging features of female pelvic gynecological diseases, pregnancy related complications, abdominal vascular complications, and renal diseases.
Collapse
Affiliation(s)
- Pankaj Nepal
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Michael Wells
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health, San Antonio, TX, USA
| | - Kanika Khandelwal
- Department of Hospital Internal Medicine, Mayo Clinic, Austin, MN, USA
| | - Neeraj Lalwani
- Department of Radiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Ashish Khandelwal
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| |
Collapse
|
14
|
Complications of cholecystitis: a comprehensive contemporary imaging review. Emerg Radiol 2021; 28:1011-1027. [PMID: 34110530 DOI: 10.1007/s10140-021-01944-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/10/2021] [Indexed: 01/12/2023]
Abstract
Acute cholecystitis is a common cause of right upper quadrant pain in patients presenting to the emergency department. Ultrasound, computed tomography, HIDA scans, and magnetic resonance imaging are increasingly utilized to evaluate suspected cases. The prognosis of acute cholecystitis is usually excellent with timely diagnosis and management. However, complications associated with cholecystitis pose a considerable challenge to the clinician and radiologist. Complications of acute cholecystitis may result from secondary bacterial infection or mural ischemia secondary to increased intramural pressure. The recognized subtypes of complicated cholecystitis are hemorrhagic, gangrenous, and emphysematous cholecystitis, as well as gallbladder perforation. Acute acalculous cholecystitis is a form of cholecystitis that occurs as a complication of severe illness in the absence of gallstones or without gallstone-related inflammation. Complicated cholecystitis may cause significant morbidity and mortality, and early diagnosis and recognition play a pivotal role in the management and early surgical planning. As appropriate utilization of imaging resources plays an essential role in diagnosis and management, the emergency radiologist should be aware of the spectrum of complications related to cholecystitis and the characteristic imaging features. This article aims to offer a comprehensive contemporary review of clinical and cross-sectional imaging findings of complications associated with cholecystitis. In conclusion, cross-sectional imaging is pivotal in identifying the complications related to cholecystitis. Preoperative detection of this complicated cholecystitis can help the care providers and operating surgeon to be prepared for a potentially more complicated procedure and course of recovery.
Collapse
|
15
|
Gas Where It Shouldn't Be! Imaging Spectrum of Emphysematous Infections in the Abdomen and Pelvis. AJR Am J Roentgenol 2021; 216:812-823. [DOI: 10.2214/ajr.20.23545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
16
|
Hui CL, Loo ZY. Vascular disorders of the gallbladder and bile ducts: Imaging findings. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:825-836. [PMID: 33639040 DOI: 10.1002/jhbp.930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 01/30/2021] [Accepted: 02/09/2021] [Indexed: 12/29/2022]
Abstract
Vascular disorders of the gallbladder and biliary tree are many and varied. In the acute setting, the clinical presentation of vascular conditions such as hemorrhagic cholecystitis and gangrenous cholecystitis are non-specific and rely on imaging for diagnosis and triaging for emergent surgery. These hemorrhagic and ischemic complications of acute cholecystitis are uncommon but potentially fatal. Hemorrhage into the gallbladder and biliary tree, from other causes, may itself result in acute cholecystitis. Knowledge of vascular anatomy of the gallbladder and biliary tree is essential for surgeons to prevent significant operative bleeding complications, particularly in laparoscopic cholecystectomy. The unique venous drainage of the gallbladder and biliary tree, with their connections to the portal venous system, lends itself to less well-recognised vascular phenomena such as gallbladder varices, portal biliopathy, and gallbladder bed perfusion abnormalities.
Collapse
|
17
|
Abstract
Gallbladder disorders encompass a wide breadth of diseases that vary in severity. We present a comprehensive review of literature for the clinical presentation, pathophysiology, diagnostic evaluation, and management of cholelithiasis-related disease, acute acalculous cholecystitis, functional gallbladder disorder, gallbladder polyps, gallbladder hydrops, porcelain gallbladder, and gallbladder cancer.
Collapse
|
18
|
Lopes Vendrami C, Magnetta MJ, Mittal PK, Moreno CC, Miller FH. Gallbladder Carcinoma and Its Differential Diagnosis at MRI: What Radiologists Should Know. Radiographics 2020; 41:78-95. [PMID: 33306452 DOI: 10.1148/rg.2021200087] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gallbladder carcinoma is the most common cancer of the biliary system. It is challenging to diagnose because patients are often asymptomatic or present with nonspecific symptoms that mimic common benign diseases. Surgical excision is the only curative therapy and is best accomplished at early non-locally advanced stages. Unfortunately, gallbladder cancer often manifests at late locally advanced stages, precluding cure. Early tumors are often incidentally detected at imaging or at cholecystectomy performed for another indication. Typical imaging features of localized disease include asymmetric gallbladder wall thickening, polyps larger than 1.0 cm, and a solid mass replacing the gallbladder lumen. Advanced tumors are often infiltrative and can be confusing at CT and MRI owing to their large size. Determination of the origin of the lesion is paramount to narrow the differential diagnosis but is often challenging. It is important to identify gallbladder cancer and distinguish it from other benign and malignant hepatobiliary processes. Since surgical resection is the only curative treatment option, radiologist understanding and interpretation of pathways of nodal and infiltrative tumor spread can direct surgery or preclude patients who may not benefit from surgery. While both CT and MRI are effective, MRI provides superior soft-tissue characterization of the gallbladder and biliary tree and is a useful imaging tool for diagnosis, staging, and evaluation of treatment response. ©RSNA, 2020.
Collapse
Affiliation(s)
- Camila Lopes Vendrami
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (C.L.V., M.J.M., F.H.M.); Department of Radiology, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.C.M.)
| | - Michael J Magnetta
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (C.L.V., M.J.M., F.H.M.); Department of Radiology, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.C.M.)
| | - Pardeep K Mittal
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (C.L.V., M.J.M., F.H.M.); Department of Radiology, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.C.M.)
| | - Courtney C Moreno
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (C.L.V., M.J.M., F.H.M.); Department of Radiology, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.C.M.)
| | - Frank H Miller
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (C.L.V., M.J.M., F.H.M.); Department of Radiology, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.C.M.)
| |
Collapse
|
19
|
Affiliation(s)
- Nicole M Kapral
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA
| | - Arthur J Pesch
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA
| | - Rachita Khot
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA..
| |
Collapse
|
20
|
Combined hyperdense gallbladder wall-lumen sign: new computed tomography sign in acute gangrenous cholecystitis. Pol J Radiol 2020; 85:e183-e187. [PMID: 32419883 PMCID: PMC7218447 DOI: 10.5114/pjr.2020.94337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 03/09/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose The objective of our study was to evaluate the combined hyperdense gallbladder wall-lumen sign on computed tomography (CT) in diagnosing gangrenous cholecystitis. Material and methods We retrospectively reviewed the unenhanced CT scans of surgically proven cases of acute gangrenous (GCh) and non-gangrenous cholecystitis (nonGCh). Eleven cases of pathologically proven acute gangrenous cholecystitis and 12 consecutive cases of surgically proven acute non-gangrenous cholecystitis that underwent CT at our institute were included in the study so as to have 1 : 1 control. The Hounsfield unit (HU) value of the gallbladder wall and intraluminal bile was measured. Interobserver variability for individual CT findings was also assessed. Results The gangrenous cholecystitis group had significantly higher HU values of wall and bile (median value of 33 HU vs. 21 HU and median value of 21 HU vs. 8.5 HU, respectively, p < 0.05). The area under the receiver operator characteristic curve for HU lumen was 0.80 (95% CI: 0.62-0.98, p = 0.014) with an ideal cut-off at 31.5 HU, where the sensitivity was 54.5% and specificity was 91.7%. HU lumen has an even better assessment for gangrenous cholecystitis with AUC of its ROC as 0.92 (95% CI: 0.80-1.00, p = 0.001) with an ideal cut-off at 12.5 HU, where the sensitivity was 81.8% and specificity was 91.7%. The combined wall-lumen cut-off is 35 HU with sensitivity of 100% and specificity of 75%. Conclusion A cut-off CT density value of the gallbladder wall of more than 31.5 HU, intraluminal bile more than 12.5 HU, and combined wall-lumen HU of more than 35 can predict GCh.
Collapse
|
21
|
A pictorial review of gall stones and its associated complications. Clin Imaging 2020; 60:228-236. [DOI: 10.1016/j.clinimag.2019.11.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/13/2019] [Accepted: 11/04/2019] [Indexed: 01/11/2023]
|
22
|
Ko A, Lee ES, Park HJ, Park SB, Kim HS, Choi BI. Added value of 2D shear wave imaging of the gallbladder bed of the liver for acute cholecystitis. Ultrasonography 2020; 39:384-393. [PMID: 32962334 PMCID: PMC7515659 DOI: 10.14366/usg.19060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/23/2020] [Indexed: 12/07/2022] Open
Abstract
Purpose The purpose of this study was to evaluate whether shear wave elastography (SWE) and the shear wave dispersion slope (SWD) obtained from 2-dimensional shear wave imaging (2D-SWI) of the gallbladder (GB) bed of the liver could be helpful in the diagnosis of acute cholecystitis. Methods We included 44 patients referred for abdominal ultrasonography (US) under the impression of acute cholecystitis from April 2018 to March 2019. Patients with chronic liver disease were excluded from this study. In addition to routine upper abdominal US, we performed 2D-SWI including liver stiffness measurements by SWE and SWD, which reflects tissue viscosity. 2D-SWI was performed at the GB bed of the liver through the right intercostal approach at least 3 times with different frames. We assessed typical US findings and the added value of 2D-SWI in diagnosing acute cholecystitis. Histopathologic results of surgical specimens were used as the standard of reference. If a surgical specimen was unavailable, a bile fluid test or clinical follow-up for more than 3 months served as the reference standard. Results The optimal cutoff values for SWE and SWD were 8 kPa and 10.9 (m/sec)/kHz, respectively. In the univariate analysis, SWE, GB distension, and sludge were predictive factors of acute cholecystitis. In the multivariate analysis, categorized SWE was the only significant predictor (P<0.01). By using 2D-SWI, the diagnostic performance of two readers did not significantly increase, although the inter-reader agreement improved (k=0.654-0.778). Conclusion 2D-SWI of the GB bed of the liver could be helpful for diagnosing acute cholecystitis.
Collapse
Affiliation(s)
- Ara Ko
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hee Sung Kim
- Department of Pathology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| |
Collapse
|
23
|
Role of Ultrasound and CT in the Workup of Right Upper Quadrant Pain in Adults in the Emergency Department: A Retrospective Review of More Than 2800 Cases. AJR Am J Roentgenol 2020; 214:1305-1310. [PMID: 32160055 DOI: 10.2214/ajr.19.22188] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE. The purpose of this study was to compare ultrasound and CT in the diagnostic evaluation of right upper quadrant pain in adults in the emergency department. MATERIALS AND METHODS. A retrospective review was conducted of adult emergency department encounters for right upper quadrant pain over a 5-year period, excluding those for prior cholecystectomy, current pregnancy, and trauma. Imaging study reports were reviewed for gallbladder and nongallbladder explanations of right upper quadrant pain and were considered positive for cholecystitis when two or more supportive features were present. Encounter outcomes were evaluated on the basis of pathology data and clinical management. RESULTS. Among the encounters, 2859 met the study inclusion criteria, and 18% met the study definition of cholecystitis by pathologic or clinical criteria. The following metrics showed no statistically significant difference between ultrasound and CT, respectively: sensitivity, 61% and 55%; specificity, 91% and 92%; positive predictive value, 63% and 63%; and negative predictive value, 91% and 90%. Both modalities were performed in 20% of encounters. In the subgroup analysis, ultrasound showed an acute nongallbladder abnormality that was missed at a preceding CT examination in only 1 of 238 cases (0.4%). CT showed an acute nongallbladder abnormality missed at a preceding ultrasound examination in 103 of 322 cases (32%). CONCLUSION. CT is noninferior to ultrasound in both ruling in and ruling out the diagnosis of cholecystitis in adult patients undergoing emergency evaluation of right upper quadrant pain and offers the advantage of depicting acute nongallbladder abnormalities.
Collapse
|
24
|
Alghamdi KA, Rizk HA, Jamal WH, Bakhshween AA, Maqboul AA, Saggaf AM, Almusallam SA, Basourrah MK. Risk Factors of Gangrenous Cholecystitis in General Surgery Patient Admitted for Cholecystectomy in King Abdul-Aziz University Hospital (KAUH), Saudi Arabia. Mater Sociomed 2020; 31:286-289. [PMID: 32082095 PMCID: PMC7007620 DOI: 10.5455/msm.2019.31.286-289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction Gangrenous cholecystitis (GC) is known as perforation and necrosis of the gallbladder wall caused by ischemia ensuing to vascular insufficiency. Gangrenous cholecystitis is associated with a high risk of morbidity. Aim With a percentage of patients needing emergent help, our objective is to determine the risk factor of GC in KAUH. Methods Retrospective review of 334 patients who underwent cholecystectomy during 2016 to 2018 In king Abdul-Aziz University Hospital (KAUH). The data was gained from the medical record of KAUH. The variables are defined as follows: age, gender, AST, ALT, WBC, DM, bilirubin and stone. In order to determine the risk factors that influence (GC). the data entry done by using Google forms while the analysis was done by using SPSS version 21. Results Of 334 patients who underwent cholecystectomy, 57 patient (17.1%) had histologically confirmed gangrenous cholecystitis. Most of them female, 13 variables were identified that were associated with GC by univariate analysis: age 46.8 years, stone (82.5%), bilirubin is normal 9.9, mean white blood cell count 7.8, diabetes, fever, nausea, vomiting, CT finding, asparate aminotransferase, alanine aminotransferase and alkaline phosphatase. Conclusion Patient age was a clear factor for developing GC, male gender was a factor but no correlation was found, normal range of WBC, total bilirubin was in a normal level, vomiting and fever and nausea was less compared to other researchers, at last computed Tomography was not supportive and do not give any importance in detecting GC.
Collapse
Affiliation(s)
- Khalid A Alghamdi
- Faculty of Medicine, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Hesham A Rizk
- Department of Surgery, University of Jeddah, Jeddah, Saudi Arabia
| | - Wisam H Jamal
- Department of Surgery, University of Jeddah, Jeddah, Saudi Arabia
| | - Amro A Bakhshween
- Faculty of Medicine, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | | | - Ahmad M Saggaf
- Faculty of Medicine, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | | | | |
Collapse
|
25
|
Abstract
Abdominal pain is a common cause for emergency department visits in the United States, and biliary tract disease is the fifth most common cause of hospital admission. Common causes of acute hepatobiliary include gallstones and its associated complications and multiple other hepatobiliary etiologies, including infectious, inflammatory, vascular, and neoplastic causes. Postoperative complications of the biliary tract can result in an acute abdomen. Imaging of the hepatobiliary tree is integral in the diagnostic evaluation of acute hepatobiliary dysfunction, and imaging of the biliary tree requires a multimodality approach utilizing ultrasound, computed tomography, nuclear medicine, and MR imaging.
Collapse
Affiliation(s)
- HeiShun Yu
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Jennifer W Uyeda
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| |
Collapse
|
26
|
Abstract
CLINICAL/METHODICAL ISSUE Diagnostic imaging plays a crucial role in the assessment and stratification of pathologic conditions causing acute abdomen. This report provides information on etiology, clinical manifestations and therapeutic options for six common diseases resulting in acute abdomen-appendicitis, cholecystitis, bowel obstruction, diverticulitis, acute pancreatitis, and viscus perforation. PERFORMANCE Besides initial ultrasound, CT scans often represent the imaging gold standard for the diagnostic evaluation of acute abdomen. PRACTICAL RECOMMENDATIONS Depending on the underlying pathologic condition, sonography or CT is suitable for the stratification of the gastrointestinal disease causing acute abdomen.
Collapse
Affiliation(s)
- V Schwarze
- Klinik und Poliklinik für Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland.
| | - C Marschner
- Klinik und Poliklinik für Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland
| | - C Schulz
- Medizinische Klinik und Poliklinik II, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - F Streitparth
- Klinik und Poliklinik für Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland
| |
Collapse
|
27
|
Biolato M, Tarli C, Marrone G, Barbaro B, Liguori A, Gasbarrini A, Grieco A. Gallbladder perforation without cholecystitis in a patient awaiting liver transplantation: a peculiar case report of anaemia in cirrhosis. BMC Gastroenterol 2019; 19:112. [PMID: 31248359 PMCID: PMC6598236 DOI: 10.1186/s12876-019-1018-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 06/07/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Acute anaemia in decompensated liver cirrhosis is commonly caused due to gastrointestinal bleeding; however, sometimes, detecting the site of blood loss is challenging. A patient on waitlist for orthotopic liver transplantation because of decompensated liver cirrhosis was admitted with acute anaemia and recurrence of ascites. Their abdomen CT showed migration of gallbladder stones in the pelvis while paracentesis documented hemoperitoneum. A diagnosis of gallbladder perforation was performed. CONCLUSION Challenging choice of a "wait and see" strategy with conservative therapy, avoiding high-risk cholecystectomy, resulted in a successful liver transplant.
Collapse
Affiliation(s)
- Marco Biolato
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Claudia Tarli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giuseppe Marrone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Brunella Barbaro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonio Liguori
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonio Gasbarrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonio Grieco
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| |
Collapse
|
28
|
ACR Appropriateness Criteria® Right Upper Quadrant Pain. J Am Coll Radiol 2019; 16:S235-S243. [DOI: 10.1016/j.jacr.2019.02.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/08/2019] [Indexed: 12/17/2022]
|
29
|
Portincasa P, Molina-Molina E, Garruti G, Wang DQH. Critical Care Aspects of Gallstone Disease. J Crit Care Med (Targu Mures) 2019; 5:6-18. [PMID: 30766918 PMCID: PMC6369569 DOI: 10.2478/jccm-2019-0003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/08/2019] [Indexed: 12/15/2022] Open
Abstract
Approximately twenty per cent of adults have gallstones making it one of the most prevalent gastrointestinal diseases in Western countries. About twenty per cent of gallstone patients requires medical, endoscopic, or surgical therapies such as cholecystectomy due to the onset of gallstone-related symptoms or gallstone-related complications. Thus, patients with symptomatic, uncomplicated or complicated gallstones, regardless of the type of stones, represent one of the largest patient categories admitted to European hospitals. This review deals with the important critical care aspects associated with a gallstone-related disease.
Collapse
Affiliation(s)
- Piero Portincasa
- Clinica Medica "A. Murri", Department of Biomedical Sciences & Human Oncology, University of Bari Medical School, Bari, Italy
| | - Emilio Molina-Molina
- Clinica Medica "A. Murri", Department of Biomedical Sciences & Human Oncology, University of Bari Medical School, Bari, Italy
| | - Gabriella Garruti
- Section of Endocrinology, Department of Emergency and Organ Transplantations, University of Bari "Aldo Moro" Medical School, Piazza G. Cesare 11, 70124Bari, Italy
| | - David Q.-H. Wang
- Department of Medicine, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, "Albert Einstein" College of Medicine, Bronx, NY 10461, USA
| |
Collapse
|
30
|
The hot rim sign. Abdom Radiol (NY) 2018; 43:3530-3531. [PMID: 29869101 DOI: 10.1007/s00261-018-1655-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
31
|
Ra JC, Lee ES, Park HJ, Kim HS, Lee JB, Do JH, Park SB, Choi BI. Efficacy of Superb Microvascular Imaging for Diagnosing Acute Cholecystitis: Comparison with Conventional Ultrasonography. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1968-1977. [PMID: 29936027 DOI: 10.1016/j.ultrasmedbio.2018.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 05/08/2018] [Accepted: 05/14/2018] [Indexed: 06/08/2023]
Abstract
We evaluated the diagnostic performance of ultrasonography (US) plus superb microvascular imaging (SMI) compared with conventional US alone for diagnosing acute cholecystitis. We included 54 patients with suspected biliary disease. The SMI pixel count showing flow signal was measured in the region of interest of the gallbladder bed of the liver. Two radiologists independently evaluated imaging features and rated five-point diagnostic likelihood level before versus after the additional SMI using the cutoff SMI pixel count. The SMI pixel count was significantly higher in acute than in non-acute cholecystitis (169.84 vs. 27.48, p < 0.001). The optimal SMI cutoff pixel count for predicting acute cholecystitis obtained by receiver operating characteristic curve was 56.67(82.8% sensitivity, 92.0% specificity). The area under the curve value was significantly higher after the additional SMI than before (0.798-0.863 vs. 0.701-0.736, p < 0.05). US plus SMI could objectively improve diagnostic performance compared with conventional US for acute cholecystitis.
Collapse
Affiliation(s)
- Joon Chul Ra
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hee Sung Kim
- Department of Pathology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jong Beum Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae Hyuk Do
- Department of Gastroenterology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| |
Collapse
|
32
|
Yeo DM, Jung SE. Differentiation of acute cholecystitis from chronic cholecystitis: Determination of useful multidetector computed tomography findings. Medicine (Baltimore) 2018; 97:e11851. [PMID: 30113479 PMCID: PMC6112975 DOI: 10.1097/md.0000000000011851] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The purpose of this study was to determine the diagnostic value of multidetector computed tomography (MDCT) imaging findings, to identify the most predictive findings, and to assess diagnostic performance in the diagnosis and differentiation of acute cholecystitis from chronic cholecystitis.In this retrospective study, we enrolled 382 consecutive patients with pathologically proven acute or chronic cholecystitis who underwent computed tomography (CT) within 1 month before surgery. The CT findings were compared and logistic regression analysis was used to identify significant CT findings in predicting acute cholecystitis. Diagnostic performance of each CT finding and of combined findings was also assessed.Statistically significant CT findings distinguishing acute cholecystitis from chronic cholecystitis were increased gallbladder dimension (85.5% vs 50.6%, P < .001), increased wall enhancement (61.8% vs 78.9%, P = .001), increased wall thickness (67.9% vs 31.1%, P < .001), mural striation (64.9% vs 28.3%, P < .001), pericholecystic haziness or fluid (66.4% vs 21.2%, P < .001), increased adjacent hepatic enhancement (80.0% vs 32.4%, P < .001), focal wall defect (9.2% vs 0, P < .001), and pericholecystic abscess (10.7% vs 0, P < .001). Subsequent multivariate logistic regression analysis revealed that increased adjacent hepatic enhancement [P = .006, odds ratio (OR) = 3.82], increased gallbladder dimension (P = .027, OR = 3.12), increased wall thickening or mural striation (P = .019, OR = 2.89), and pericholecystic haziness or fluid (P = .032, OR = 2.61) were significant predictors of acute cholecystitis. When 2 of these 4 CT findings were observed together, the sensitivity, specificity, and accuracy for the detection of acute cholecystitis were 83.2%, 65.7%, and 71.7%, respectively. When 3 of these 4 CT findings were observed together, the sensitivity, specificity, and accuracy were 56.5%, 84.5%, and 74.9%, respectively. When none of these 4 CT findings were observed, the negative predictive value was 96.4%.Increased adjacent hepatic enhancement, increased gallbladder dimension, increased wall thickening or mural striation, and pericholecystic fat haziness or fluid were the most discriminative MDCT findings for the diagnosis and differentiation of acute cholecystitis from chronic cholecystitis.
Collapse
Affiliation(s)
- Dong Myung Yeo
- Department of Radiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | |
Collapse
|
33
|
Wertz JR, Lopez JM, Olson D, Thompson WM. Comparing the Diagnostic Accuracy of Ultrasound and CT in Evaluating Acute Cholecystitis. AJR Am J Roentgenol 2018; 211:W92-W97. [PMID: 29702020 PMCID: PMC6082629 DOI: 10.2214/ajr.17.18884] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE In 2013, a multidisciplinary group at our Veterans Administration hospital collaborated to improve the diagnosis and treatment of patients with acute cholecystitis (AC) at our facility. Our role in this project was to evaluate the diagnostic accuracies of ultrasound (US) and CT. MATERIALS AND METHODS AC was diagnosed in 60 patients (62 patient encounters) between July 1, 2013, and July 1, 2015. Of these patients, 56 underwent US, 48 underwent CT, and 42 underwent both. For the same time period, 60 patients without AC underwent US and 60 patients without AC underwent CT, and these imaging studies served as comparison studies. The groups were combined for a total of 182 unique patient encounters. A single radiologist reviewed the studies and tabulated the data. RESULTS The sensitivity of CT for detecting AC was significantly greater than that of US: 85% versus 68% (p = 0.043), respectively; however, the negative predictive values of CT and US did not differ significantly: 90% versus 77% (p = 0.24-0.26). Because there were no false-positives, the specificity and positive predictive values for both modalities were 100%. Among the 42 patients who underwent CT and US, both modalities were positive for AC in 25 patients, CT was positive and US was negative in 10 patients, and US was positive and CT was negative in two patients; in five patients, both US and CT were negative. CONCLUSION CT was significantly more sensitive for diagnosing AC than US. CT and US are complementary, and the other modality should be considered if there is high clinical suspicion for AC and the results of the first examination are negative.
Collapse
Affiliation(s)
- Joss R Wertz
- 1 Department of Radiology, University of New Mexico, MSC 10 5530, 1 University of New Mexico, Albuquerque, NM 87131
- 2 Department of Radiology, Raymond G. Murphy VA Medical Center, Albuquerque, NM
| | - Juliet M Lopez
- 3 Department of Surgery, Raymond G. Murphy VA Medical Center, Albuquerque, NM
| | - David Olson
- 4 Department of Medicine, Raymond G. Murphy VA Medical Center, Albuquerque, NM
| | - William M Thompson
- 1 Department of Radiology, University of New Mexico, MSC 10 5530, 1 University of New Mexico, Albuquerque, NM 87131
- 2 Department of Radiology, Raymond G. Murphy VA Medical Center, Albuquerque, NM
| |
Collapse
|
34
|
Mohammed MF, Elbanna KY, Mohammed AME, Murray N, Azzumea F, Almazied G, Nicolaou S. Practical Applications of Dual-Energy Computed Tomography in the Acute Abdomen. Radiol Clin North Am 2018; 56:549-563. [PMID: 29936947 DOI: 10.1016/j.rcl.2018.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With new developments in workflow automation, as well as technological advances enabling faster imaging with improved image quality and dose profile, dual-energy computed tomography is being used more often in the imaging of the acutely ill and injured patient. Its ability to identify iodine, differentiate it from hematoma or calcification, and improve contrast resolution has proven invaluable in the assessment of organ perfusion, organ injury, and inflammation.
Collapse
Affiliation(s)
- Mohammed F Mohammed
- Medical Imaging Department, Abdominal Imaging Section, Ministry of the National Guard, Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Prince Mutib Ibn Abdullah Ibn Abdulaziz Road, Ar Rimayah, Riyadh 14611, Saudi Arabia.
| | - Khaled Y Elbanna
- Department of Medical Imaging, Emergency and Trauma Radiology Division, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Abdelazim M E Mohammed
- Medical Imaging Department, Abdominal Imaging Section, Ministry of the National Guard, Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Prince Mutib Ibn Abdullah Ibn Abdulaziz Road, Ar Rimayah, Riyadh 14611, Saudi Arabia
| | - Nicolas Murray
- Department of Radiology, Vancouver General Hospital, 899 West 12th Avenue, Vancouver, British Columbia V5Z1M9, Canada
| | - Fahad Azzumea
- Medical Imaging Department, Abdominal Imaging Section, Ministry of the National Guard, Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Prince Mutib Ibn Abdullah Ibn Abdulaziz Road, Ar Rimayah, Riyadh 14611, Saudi Arabia
| | - Ghassan Almazied
- Medical Imaging Department, Abdominal Imaging Section, Ministry of the National Guard, Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Prince Mutib Ibn Abdullah Ibn Abdulaziz Road, Ar Rimayah, Riyadh 14611, Saudi Arabia
| | - Savvas Nicolaou
- Department of Radiology, Vancouver General Hospital, 899 West 12th Avenue, Vancouver, British Columbia V5Z1M9, Canada
| |
Collapse
|
35
|
Portinari M, Scagliarini M, Valpiani G, Bianconcini S, Andreotti D, Stano R, Carcoforo P, Occhionorelli S. Do I Need to Operate on That in the Middle of the Night? Development of a Nomogram for the Diagnosis of Severe Acute Cholecystitis. J Gastrointest Surg 2018; 22:1016-1025. [PMID: 29464491 DOI: 10.1007/s11605-018-3708-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/05/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Some authors have proposed different predictive factors of severe acute cholecystitis, but generally, the results of risk analyses are expressed as odds ratios, which makes it difficult to apply in the clinical practice of the acute care surgeon. The severe form of acute cholecystitis should include both gangrenous and phlegmonous cholecystitis, due to their severe clinical course, and cholecystectomy should not be delayed. The aim of this study was to create a nomogram to obtain a graphical tool to compute the probability of having a severe acute cholecystitis. METHODS This is a retrospective study on 393 patients who underwent emergency cholecystectomy between January 2010 and December 2015 at the Acute Care Surgery Service of the S. Anna University Hospital of Ferrara, Italy. Patients were classified as having a non-severe acute cholecystitis or a severe acute cholecystitis (i.e., gangrenous and phlegmonous) based on the final pathology report. The baseline characteristics, pre-operative signs, and abdominal ultrasound (US) findings were assessed with a stepwise multivariate logistic regression analysis to predict the risk of severe acute cholecystitis, and a nomogram was created. RESULTS Age as a continuous variable, WBC count ≥ 12.4 × 103/μl, CRP ≥9.9 mg/dl, and presence of US thickening of the gallbladder wall were significantly associated with severe acute cholecystitis at final pathology report. A significant interaction between the effect of age and CRP was found. Four risk classes were identified based on the nomogram total points. CONCLUSIONS Patients with a nomogram total point ≥ 74 should be considered at high risk of severe acute cholecystitis (at 74 total point, sensitivity = 78.5%; specificity = 78.2%; accuracy = 78.3%) and this finding could be useful for surgical planning once confirmed in a prospective study comparing the risk score stratification and clinical outcomes.
Collapse
Affiliation(s)
- Mattia Portinari
- Department of Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro, 8
- Stanza 2 34 39 (1C2) (Cona), 44124, Ferrara, Italy. .,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
| | | | - Giorgia Valpiani
- Research Innovation Office, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | | | - Dario Andreotti
- Department of Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro, 8
- Stanza 2 34 39 (1C2) (Cona), 44124, Ferrara, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Rocco Stano
- Department of Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro, 8
- Stanza 2 34 39 (1C2) (Cona), 44124, Ferrara, Italy.,Acute Care Surgery Service, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Paolo Carcoforo
- Department of Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro, 8
- Stanza 2 34 39 (1C2) (Cona), 44124, Ferrara, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Savino Occhionorelli
- Department of Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro, 8
- Stanza 2 34 39 (1C2) (Cona), 44124, Ferrara, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.,Acute Care Surgery Service, S. Anna University Hospital of Ferrara, Ferrara, Italy
| |
Collapse
|
36
|
Li PH, Tee YS, Fu CY, Liao CH, Wang SY, Hsu YP, Yeh CN, Wu EH. The Role of Noncontrast CT in the Evaluation of Surgical Abdomen Patients. Am Surg 2018. [DOI: 10.1177/000313481808400658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute surgical abdomen is commonly encountered in the ED and CT is widely used as an informative diagnostic tool to evaluate potential surgical indications. However, the adverse effects of contrast material used in CTscanning have been documented. We sought to delineate the role of noncontrast CT in the evaluation of patients with acute surgical abdomen. Between August 2015 and December 2015, patients with nontraumatic surgical abdomen who underwent preoperative CT were enrolled in the current study. The patients for whom the CT results permitted surgical decision-making were the focus of this study. The disease entities included acute appendicitis, acute cholecystitis, hollow organ perforation, mechanical bowel obstruction, intra-abdominal abscess that could not be drained percutaneously, and ischemic bowel disease. The results of contrast-enhanced and noncontrast CT were compared and analyzed. The surgical conditions identifiable by noncontrast CT were recorded. In total, 227 patients were enrolled in the study. In 90.7 per cent of patients overall, the findings indicating the need for surgical treatment were visualized on both the noncontrast and contrast-enhanced images (acute appendicitis: 89.3%, acute cholecystitis: 89.7%, hollow organ perforation: 97.4%, bowel obstruction: 100%, intra-abdominal abscess: 100%, and ischemic bowel disease: 55.6%). Noncontrast CT provides benefit for critical decision-making. Body mass index may affect the accuracy of noncontrast imaging in the evaluation of patients with surgical abdomen. In some specific situations, contrast enhancement remains necessary.
Collapse
Affiliation(s)
- Pei-Hua Li
- From the Departments of Trauma & Emergency Surgery and General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yu-San Tee
- From the Departments of Trauma & Emergency Surgery and General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- From the Departments of Trauma & Emergency Surgery and General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Hung Liao
- From the Departments of Trauma & Emergency Surgery and General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shang-Yu Wang
- From the Departments of Trauma & Emergency Surgery and General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Pao Hsu
- From the Departments of Trauma & Emergency Surgery and General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Nan Yeh
- From the Departments of Trauma & Emergency Surgery and General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - En-Haw Wu
- From the Departments of Trauma & Emergency Surgery and General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
37
|
Nijkamp JLG, Gerretsen SC, Stassen PM. Left-sided omental infarction: a rare cause of abdominal pain, discovered by CT scan. BMJ Case Rep 2018; 2018:bcr-2017-224138. [PMID: 29739764 DOI: 10.1136/bcr-2017-224138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Omental infarction in adults is a rarely occurring phenomenon, with left-sided omental infarction being even more seldom. The importance of this case report lies in raising awareness of the diagnosis omental infarction as a cause of acute abdomen among doctors who work in the emergency department, in order to prevent unnecessary surgical interventions as conservative treatment generally solves the problem. Omental infarction is the result of vascular obstruction and ends in tissue ischaemia. Because of the rich vasculature of the greater omentum, anastomoses reorganise the vascularisation, which explains the mostly benign course of omental infarction. By adding omental infarction to the list of differential diagnoses in patients who present with acute abdominal pain, future management of patients with an acute abdomen can be adjusted for the optimal approach to not overlook any surgery-requiring diagnosis as well as to prevent overtreatment.
Collapse
Affiliation(s)
- Jamie L G Nijkamp
- Internal Medicine, Maastricht Universitair Medisch Centrum+ Interne Geneeskunde, Maastricht, The Netherlands
| | - Suzanne C Gerretsen
- Radiology, Maastricht Universitair Medisch Centrum +, Maastricht, The Netherlands
| | - Patricia M Stassen
- Internal Medicine, Maastricht Universitair Medisch Centrum+ Interne Geneeskunde, Maastricht, The Netherlands
| |
Collapse
|
38
|
Wasnik AP, Davenport MS, Kaza RK, Weadock WJ, Udager A, Keshavarzi N, Nan B, Maturen KE. Diagnostic accuracy of MDCT in differentiating gallbladder cancer from acute and xanthogranulomatous cholecystitis. Clin Imaging 2018; 50:223-228. [PMID: 29679780 DOI: 10.1016/j.clinimag.2018.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 04/05/2018] [Accepted: 04/11/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine the diagnostic accuracy of multi-detector CT (MDCT) for differentiating gallbladder cancer from acute and xanthogranulomatous cholecystitis using previously described imaging features. METHODS In this IRB approved HIPAA-compliant retrospective cohort study, contrast-enhanced MDCT of histologically confirmed acute cholecystitis (n = 17), xanthogranulomatous cholecystitis (n = 25), and gallbladder cancer (n = 18) were reviewed independently by three abdominal radiologists blinded to outcome. The primary outcome was the diagnostic accuracy of MDCT for the differentiation of gallbladder cancer from cholecystitis (acute and xanthogranulomatous) using various imaging parameters. Kappa (κ) statistics and two-way mixed-model single-measure intra-class correlation statistics (ICC) were calculated for each imaging feature and the final radiologic diagnosis. RESULTS Inter-rater agreement was moderate to substantial (κ = 0.43-0.70), sensitivity 0.67-0.78, specificity 0.22-0.33 and the positive likelihood ratio was 4.28-8.56 for the differentiation of gallbladder cancer from benign gallbladder pathology. Only three imaging findings: disrupted gallbladder mucosa (κ = 0.68), intraluminal gallstones (κ = 0.66), and gallbladder wall thickness (ICC = 0.63) had substantial inter-rater agreement. The following had slight or no agreement: intramural hypoattenuating nodules (κ = 0.17), transient hepatic attenuation differences (κ = 0.14), gallbladder wall calcification (κ = -0.01), gallbladder wall enhancement (κ = 0.18), and omental or mesenteric invasion (κ = 0.08). In the final multivariate model, the following were significant predictors useful in making or excluding diagnosis of gallbladder cancer: focal gallbladder wall thickening (p = 0.003, OR: 13.09 [95% CI: 2.40-71.48]), pericholecystic "fat stranding" (p = 0.018, OR: 0.10 [95% CI: 0.01-0.66]), and maximum short axis lymph node diameter (p = 0.043, OR: 1.18 [95% CI: 1.00-1.38]). CONCLUSION MDCT has moderate sensitivity, poor specificity, and moderate-to-substantial inter-rater repeatability for the differentiation of gallbladder cancer from acute and xanthogranulomatous cholecystitis.
Collapse
Affiliation(s)
- Ashish P Wasnik
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States.
| | - Mathew S Davenport
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States
| | - Ravi K Kaza
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States
| | - William J Weadock
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States
| | - Aaron Udager
- Department of Pathology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States
| | - Nahid Keshavarzi
- Michigan Institute of Clinical & Health Research (MICHR), University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States
| | - Bin Nan
- Department of Statistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, United States
| | - Katherine E Maturen
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States
| |
Collapse
|
39
|
Schiappacasse G, Soffia P, Silva C, Villacrés F. Computed tomography imaging of complications of acute cholecystitis. Indian J Radiol Imaging 2018; 28:195-199. [PMID: 30050243 PMCID: PMC6038218 DOI: 10.4103/ijri.ijri_316_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Acute cholecystitis (AC) is a frequent complication of biliary cholelithiasis. Although ultrasound is the first diagnostic imaging procedure, frequently the initial imaging modality is computed tomography (CT). Therefore, familiarization of CT findings in AC and potential related complications are extremely important. This pictorial essay reviews a broad spectrum of complications related to AC and its key findings in CT.
Collapse
Affiliation(s)
- Giancarlo Schiappacasse
- Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Radiology Department, Hospital Padre Hurtado, Santiago de Chile
| | - Pablo Soffia
- Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Radiology Department, Hospital Padre Hurtado, Santiago de Chile
| | - Claudio Silva
- Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Radiology Department, Hospital Padre Hurtado, Santiago de Chile
| | - Fabian Villacrés
- Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Radiology Department, Hospital Padre Hurtado, Santiago de Chile
| |
Collapse
|
40
|
Ratanaprasatporn L, Uyeda JW, Wortman JR, Richardson I, Sodickson AD. Multimodality Imaging, including Dual-Energy CT, in the Evaluation of Gallbladder Disease. Radiographics 2018; 38:75-89. [DOI: 10.1148/rg.2018170076] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Lisa Ratanaprasatporn
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Jennifer W. Uyeda
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Jeremy R. Wortman
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Ian Richardson
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Aaron D. Sodickson
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| |
Collapse
|
41
|
Tomizawa M, Shinozaki F, Tanaka S, Sunaoshi T, Kano D, Sugiyama E, Shite M, Haga R, Fukamizu Y, Fujita T, Kagayama S, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, Yamamoto S, Ishige N. Diagnosis of complications associated with acute cholecystitis using computed tomography and diffusion-weighted imaging with background body signal suppression/T2 image fusion. Exp Ther Med 2017; 14:743-747. [PMID: 28672993 DOI: 10.3892/etm.2017.4567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 03/17/2017] [Indexed: 12/22/2022] Open
Abstract
In a clinical setting, it is important to diagnose complications of acute cholecystitis accurately. Diffusion-weighted whole body imaging with background body signal suppression/T2-weighted image fusion (DWIBS/T2) provides high signal intensity with a strong contrast against surrounding tissues in anatomical settings. In the present study, patients who were being treated for acute cholecystitis and underwent DWIBS/T2 in the National Hospital Organization Shimoshizu Hospital between December 2012 and August 2015 were enrolled. A total of 10 men and 4 women underwent DWIBS/T2. Records, including DWIBS/T2 and computed tomography (CT) imaging, were retrospectively analyzed for patients with acute cholecystitis. CT images revealed thickened gallbladder walls in patients with acute cholecystitis, and high signal intensity was observed in DWIBS/T2 images for the thickened gallbladder wall. Inflammation of the pericholecystic space and the liver resulted in high intensity signals with DWIBS/T2 imaging, whereas CT imaging revealed a low-density area in the cholecystic space. Plain CT scanning identified a low-density area in the liver, which became more obvious with contrast-enhanced CT. DWIBS/T2 imaging showed the inflammation of the liver and pericholesyctic space as an area of high signal intensity. Detectability of inflammation of the pericholecystic space and the liver was the same for DWIBS/T2 and CT, which suggests that DWIBS/T2 has the same sensitivity as CT scanning for the diagnosis of complicated acute cholecystitis. However, the strong contrast shown by DWIBS/T2 allows for easier evaluation of acute cholecystitis than CT scanning.
Collapse
Affiliation(s)
- Minoru Tomizawa
- Department of Gastroenterology, National Hospital Organization, Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Fuminobu Shinozaki
- Department of Radiology, National Hospital Organization, Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Satomi Tanaka
- Department of Radiology, National Hospital Organization, Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Takafumi Sunaoshi
- Department of Radiology, National Hospital Organization, Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Daisuke Kano
- Department of Radiology, National Hospital Organization, Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Eriko Sugiyama
- Department of Radiology, National Hospital Organization, Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Misaki Shite
- Department of Radiology, National Hospital Organization, Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Ryouta Haga
- Department of Radiology, National Hospital Organization, Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Yoshiya Fukamizu
- Department of Radiology, National Hospital Organization, Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Toshiyuki Fujita
- Department of Radiology, National Hospital Organization, Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Satoshi Kagayama
- Department of Radiology, National Hospital Organization, Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Rumiko Hasegawa
- Department of Surgery, National Hospital Organization, Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Yoshinori Shirai
- Department of Surgery, National Hospital Organization, Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Yasufumi Motoyoshi
- Department of Neurology, National Hospital Organization, Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Takao Sugiyama
- Department of Rheumatology, National Hospital Organization, Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Shigenori Yamamoto
- Department of Pediatrics, National Hospital Organization, Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Naoki Ishige
- Department of Neurosurgery, National Hospital Organization, Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| |
Collapse
|
42
|
Aparici CM, Win AZ. Acute Calculous Cholecystitis Missed on Computed Tomography and Ultrasound but Diagnosed with Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography. J Clin Imaging Sci 2016; 6:31. [PMID: 27625897 PMCID: PMC4995848 DOI: 10.4103/2156-7514.188474] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 07/12/2016] [Indexed: 01/01/2023] Open
Abstract
We present a case of a 69-year-old patient who underwent ascending aortic aneurysm repair with aortic valve replacement. On postsurgical day 12, he developed leukocytosis and low-grade fevers. The chest computed tomography (CT) showed a periaortic hematoma which represents a postsurgical change from aortic aneurysm repair, and a small pericardial effusion. The abdominal ultrasound showed cholelithiasis without any sign of cholecystitis. Finally, a fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT examination was ordered to find the cause of fever of unknown origin, and it showed increased FDG uptake in the gallbladder wall, with no uptake in the lumen. FDG-PET/CT can diagnose acute cholecystitis in patients with nonspecific clinical symptoms and laboratory results.
Collapse
Affiliation(s)
- Carina Mari Aparici
- Department of Radiology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Aung Zaw Win
- Department of Radiology, San Francisco VA Medical Center, San Francisco, CA 94121, USA
| |
Collapse
|
43
|
Kim KH, Kim SJ, Lee SC, Lee SK. Risk assessment scales and predictors for simple versus severe cholecystitis in performing laparoscopic cholecystectomy. Asian J Surg 2016; 40:367-374. [PMID: 26922627 DOI: 10.1016/j.asjsur.2015.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/03/2015] [Accepted: 12/21/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Because acute cholecystitis has a different prognosis according to the degree of inflammation, early detection and prompt operation of severe cholecystitis are critical to the success of treatment. However, computed tomography (CT) has a low discriminative value for differentiating between simple and severe cholecystitis. Therefore, to enhance the diagnostic accuracy of CT scan, the imaging studies should be supplemented by preoperative clinical variables. METHODS Patients undergoing laparoscopic cholecystectomy for simple and severe cholecystitis between 2007 and 2014 were compared. Severe cholecystitis included hemorrhagic, gangrenous, emphysematous, xanthogranulomatous, and perforated cholecystitis. Prediction models for severe cholecystitis were developed based on multivariate analyses of preoperative clinical and radiologic variables. RESULTS Independent factors related with severe cholecystitis were age ≥65 years, male gender, body mass index (BMI) ≥25, serum leukocyte count ≥10,000/mm3, serum neutrophil fraction ≥80%, serum platelet count ≥20,000/mm3, serum alanine transaminase (ALT) level ≥40 IU/L, admission via the emergency department, and radiologic features of gallbladder wall thickening ≥4 mm, and presence of pericholecystic fluid collection (p < 0.05). A standard risk assessment scale (range: 0-77) for severe cholecystitis was developed based on the individual hazard rate of these variables. Patients scoring ≥28 on the risk assessment scale showed an 8.6 higher odds of severe cholecystitis than those scoring <28 (p < 0.01). CONCLUSION Standard and quick-and-easy predictive models for severe cholecystitis have been developed based on preoperative radiological and clinical variables, which is expected to help improve surgical outcome of patients with cholecystitis.
Collapse
Affiliation(s)
- Kee-Hwan Kim
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Say-June Kim
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Sang Chul Lee
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Sang Kuon Lee
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea.
| |
Collapse
|
44
|
Cystic Duct Enhancement: A Useful CT Finding in the Diagnosis of Acute Cholecystitis Without Visible Impacted Gallstones. AJR Am J Roentgenol 2016; 205:991-8. [PMID: 26496546 DOI: 10.2214/ajr.15.14403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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. MATERIALS AND 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). CONCLUSION 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.
Collapse
|
45
|
Wang A, Shanbhogue AK, Dunst D, Hajdu CH, Rosenkrantz AB. Utility of diffusion-weighted MRI for differentiating acute from chronic cholecystitis. J Magn Reson Imaging 2015; 44:89-97. [PMID: 26691912 DOI: 10.1002/jmri.25128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/01/2015] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To assess the use of diffusion-weighted imaging (DWI) for differentiating acute from chronic cholecystitis, in comparison with conventional magnetic resonance imaging (MRI) features. MATERIALS AND METHODS Liver MRI including DWI (b-values 0/500/1000s/mm(2) ) was performed at 1.5T ≤30 days before cholecystectomy in 83 patients with abdominal pain. Two radiologists assessed cases for conventional (gallstones, wall thickening, pericholecystic fluid, pericholecystic fat changes, gallbladder distension, pericholecystic liver enhancement, mural T2 -hyperintensity, mural hyperenhancement, mural striations, abscess, intraluminal membranes, and mural defect) and DWI (increased mural signal on high b-value images, visually low apparent diffusion coefficient [ADC], and ADC values) features. RESULTS Acute cholecystitis was present in 43%; chronic cholecystitis was present in 57%. Nine of 12 conventional features were more frequent in acute cholecystitis for both readers (P ≤ 0.003). Increased mural signal on high b-value images was more frequent (P < 0.001) in acute than chronic cholecystitis for R1 (92% vs. 32%) and R2 (83% vs. 30%). Sensitivity and specificity of increased signal on high b-value images were: R1, 92%/68%; R2, 83%/70%. Visually low ADC was more frequent in acute cholecystitis for R2 (P < 0.001) but not R1 (P = 0.406); ADC values were not different between groups for either reader (P = 0.104-0.139). Among conventional and DWI features, only increased signal on high b-value DWI was independently associated with acute cholecystitis for both readers (P = 0.006-0.012). CONCLUSION Visually increased mural signal on high b-value DWI was highly sensitive and moderately specific for acute cholecystitis, being an independent predictor relative to conventional features for both readers. Although requiring larger studies, DWI (particularly the high b-value images) may have additive value relative to conventional MRI-suspected acute cholecystitis. J. Magn. Reson. Imaging 2016;44:89-97.
Collapse
Affiliation(s)
- Annie Wang
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Alampady K Shanbhogue
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Diane Dunst
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Cristina H Hajdu
- Department of Pathology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Andrew B Rosenkrantz
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| |
Collapse
|
46
|
|
47
|
Katabathina VS, Zafar AM, Suri R. Clinical Presentation, Imaging, and Management of Acute Cholecystitis. Tech Vasc Interv Radiol 2015; 18:256-65. [PMID: 26615166 DOI: 10.1053/j.tvir.2015.07.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acute cholecystitis (AC) is a life-threatening emergency that commonly occurs as a complication of gallstones. Severe right upper quadrant pain, abdominal guarding, fever, and a positive Murphy's sign with an elevated white blood cell count are the classical clinical manifestations of AC. Although ultrasonography is typically the initial diagnostic examination in patients with suspected AC, computed tomography and magnetic resonance imaging are commonly performed to identify complications; cholescintigraphy is recommended in patients with equivocal findings on the other imaging modalities, as this technique has the highest diagnostic accuracy in the diagnosis of AC. Imaging studies are also helpful in the timely detection of complications associated with AC. Although laparoscopic cholecystectomy is considered the gold-standard treatment for AC, percutaneous gallbladder drainage with or without cholecystostomy tube placement is a safe, effective management technique for surgically high-risk patients with multiple medical conditions. This treatment can be used as either a bridging therapy, with elective cholecystectomy performed at a later time after improvement of the patient's condition, or as definitive treatment in surgically unfit patients. Radiologists play a pivotal role in the initial diagnosis and management of patients with AC.
Collapse
Affiliation(s)
- Venkata S Katabathina
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Abdul M Zafar
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Rajeev Suri
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
| |
Collapse
|
48
|
Hwang H, Marsh I, Doyle J. Does ultrasonography accurately diagnose acute cholecystitis? Improving diagnostic accuracy based on a review at a regional hospital. Can J Surg 2014; 57:162-8. [PMID: 24869607 DOI: 10.1503/cjs.027312] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Acute cholecystitis is one of the most common diseases requiring emergency surgery. Ultrasonography is an accurate test for cholelithiasis but has a high false-negative rate for acute cholecystitis. The Murphy sign and laboratory tests performed independently are also not particularly accurate. This study was designed to review the accuracy of ultrasonography for diagnosing acute cholecystitis in a regional hospital. METHODS We studied all emergency cholecystectomies performed over a 1-year period. All imaging studies were reviewed by a single radiologist, and all pathology was reviewed by a single pathologist. The reviewers were blinded to each other's results. RESULTS A total of 107 patients required an emergency cholecystectomy in the study period; 83 of them underwent ultrasonography. Interradiologist agreement was 92% for ultrasonography. For cholelithiasis, ultrasonography had 100% sensitivity, 18% specificity, 81% positive predictive value (PPV) and 100% negative predictive value (NPV). For acute cholecystitis, it had 54% sensitivity, 81% specificity, 85% PPV and 47% NPV. All patients had chronic cholecystitis and 67% had acute cholecystitis on histology. When combined with positive Murphy sign and elevated neutrophil count, an ultrasound showing cholelithiasis or acute cholecystitis yielded a sensitivity of 74%, specificity of 62%, PPV of 80% and NPV of 53% for the diagnosis of acute cholecystitis. CONCLUSION Ultrasonography alone has a high rate of false-negative studies for acute cholecystitis. However, a higher rate of accurate diagnosis can be achieved using a triad of positive Murphy sign, elevated neutrophil count and an ultrasound showing cholelithiasis or cholecystitis.
Collapse
Affiliation(s)
- Hamish Hwang
- The Vernon Jubilee Hospital, Vernon, BC, and the Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - Ian Marsh
- The Vernon Jubilee Hospital, Vernon, BC
| | - Jason Doyle
- The Vernon Jubilee Hospital, Vernon, BC, and the Faculty of Medicine, University of British Columbia, Vancouver, BC
| |
Collapse
|
49
|
ACR appropriateness criteria right upper quadrant pain. J Am Coll Radiol 2014; 11:316-22. [PMID: 24485592 DOI: 10.1016/j.jacr.2013.11.017] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 11/22/2013] [Indexed: 01/06/2023]
Abstract
Acute right upper quadrant pain is a common presenting symptom in patients with acute cholecystitis. When acute cholecystitis is suspected in patients with right upper quadrant pain, in most clinical scenarios, the initial imaging modality of choice is ultrasound. Although cholescintigraphy has been shown to have slightly higher sensitivity and specificity for diagnosis, ultrasound is preferred as the initial study for a variety of reasons, including greater availability, shorter examination time, lack of ionizing radiation, morphologic evaluation, confirmation of the presence or absence of gallstones, evaluation of bile ducts, and identification or exclusion of alternative diagnoses. CT or MRI may be helpful in equivocal cases and may identify complications of acute cholecystitis. When ultrasound findings are inconclusive, MRI is the preferred imaging test in pregnant patients who present with right upper quadrant pain. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
Collapse
|
50
|
Hicks N. Haemorrhagic cholecystitis: an unusual cause of upper gastrointestinal bleeding. BMJ Case Rep 2014; 2014:bcr-2013-202437. [PMID: 24443336 DOI: 10.1136/bcr-2013-202437] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Haemorrhagic cholecystitis is a rare cause of upper gastrointestinal bleeding and is a difficult diagnosis to make. This case report describes an orthopaedic patient, who developed deranged liver function tests and anaemia after a hemiarthroplasty of the hip. The patient had upper abdominal pain and black stools which clinically appeared to be melaena. An ultrasound scan of the abdomen was inconclusive, and therefore a CT was performed and the potential diagnosis of haemorrhagic cholecystitis was raised. An endoscopic evaluation of the upper gastrointestinal tract showed no evidence of other causes of upper gastrointestinal bleeding. Following an emergency laparotomy and cholecystectomy, she recovered well. This report aims to increase awareness about the uncommon condition of haemorrhagic cholecystitis, and to educate regarding clinical and radiological signs which lead to this diagnosis.
Collapse
Affiliation(s)
- Natalie Hicks
- Department of Urology, James Paget University Hosptial, Great Yarmouth, Norfolk, UK
| |
Collapse
|