Differentiation of acute cholecystitis from chronic cholecystitis

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.

[Retracted] Value of Multislice Spiral CT in Differential Diagnosis of Thick‐Wall Gallbladder Carcinoma and Chronic Cholecystitis

“…TWGC is a malignant lesion, and cancer cells in patients can easily penetrate through the muscularum to the serosa, thus invading the adipose tissue and adjacent liver tissue in the gallbladder fossa, resulting in blurred gallbladder outline [ 8 ]. However, chronic cholecystitis is a benign disease with limitations on surrounding liver infiltration, so the hepatobiliary interface of most patients still exists and the gallbladder is clearly defined [ 13 ]. Bile duct dilation is an indirect sign of gallbladder cancer, which is triggered by bile duct compression, tumor invasion of the common bile duct, and tumor spread through the bile duct [ 14 ].…”

The patterns and changes of general surgical presentations during the first wave COVID-19 pandemic at a metropolitan Sydney hospital

“…11 An American study reported a different experience with CT use demonstrating a significant decrease in CT abdomen and pelvis (33.6% vs. 31.1%), but increase in US abdomen (15.7% vs. 20.3%) during the pandemic period, except for an increase in CT chest. 12,13 Whilst reductions in presentations account for this change, Houshyar attributes this as multifactorial relating to regional differences in disease prevalence, magnitude and scope of social distancing mandates, variable adoption of these measures by members of the public, and existing image ordering practices and resources. 14 Despite the absence of reported cases of COVID-19, the general surgical unit did not identify any clinically significant differences in biochemical parameters, operative management, or major clinical outcomes between both groups.…”

Effectiveness of ultrasound screening in right upper quadrant pain: A comparative study in a basic emergency service

“…In the category of “Pericholecystic Fluid or Hazy Wall Delineation,” we used the older concept in ultrasonography of “hazy wall definition” 32 or “pericholecystic haziness,” 33 which is more evident on older sonography equipment like the one used in the BES.…”