Diagnosis of complications associated with acute cholecystitis using computed tomography and diffusion-weighted imaging with background body signal suppression/T2 image fusion

Abstract

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. IntroductionAcute cholecystitis is an inflammation of the gallbladder caused by gallstones packed in its neck or the cystic duct (1). Perforations of the gallbladder into the liver or the pericholecystic space may lead to the development of liver abscesses or peritonitis, respectively (2-4). In order to effectively manage acute cholecystitis, an accurate diagnosis must be made before the disease worsens (5). Acute cholecystitis is diagnosed based on a combination of signs indicating local and systemic inflammation (6). Local inflammation presents as right upper quadrant pain. Murphy's sign, which is a pain on taking a deep breath in the right upper quadrant when the examiner's finger is on the location of the gallbladder, is considered to be the most useful indicator for the diagnosis of local inflammation in patients with acute cholecystitis (7). Systemic inflammation is confirmed based on the findings of blood tests, with leukocytosis and elevated levels of C-reactive protein (CRP) indicating systemic inflammation (8). To confirm the diagnosis of cholecystitis, diagnostic imaging is useful; computed tomography (CT) scanning typically reveals thickened walls of the gallbladder, pericholecystic inflammation, and the presence of liver abscesses (9).Diffusion-weighted imaging (DWI) utilizes the random movement of water molecules to construct images (10). Based on DWI, diffus...

Gallbladder perforation without cholecystitis in a patient awaiting liver transplantation: a peculiar case report of anaemia in cirrhosis

“…Stones outside the gallbladder documented at the CT scan are considered a direct sign of the perforation [21, 22]. In our patient, gallbladder morphology changed from swelling to scleroatrophic compared to previous CT exams, whereas no thickened walls of gallbladder, signs of interruptions, pericholecystic inflammation or liver abscesses were documented [23, 24].…”

Frequency-selective non-linear blending for the computed tomography diagnosis of acute gangrenous cholecystitis: Pilot retrospective evaluation

“…Some other imaging techniques like MRI and contrast-enhanced ultrasound (CEUS) have been tested with more or less success, but their routine use is limited by their conditioned availability in the emergency setting, higher costs or by being strongly operator-dependent and in the first line by limitations related to the cholecystitis itself (e.g. gas in the wall and bile stones hamper visualization of the gallbladder-wall; acute abdominal pain or incipient biliary peritonitis and paralytic ileus impair adequate ultrasound examination [ 5 , 22 , 23 ].…”

“…While AC can be diagnosed based on typical symptoms and several inflammatory markers, cross-sectional imaging is often used to confirm the diagnosis and diagnose potential mimics. Ultrasound and computed tomography (CT) have been used most frequently, whereas magnetic resonance imaging has not shown relevant advantages in diagnosis [ 1 , 4 , 5 ].…”