Maehira Hiromitsu, Itoh Aya, Kawasaki Masayasu, Ogawa Masao, Imagawa Atsuo, Mizumura Naoto, Okumura Satoshi, Kameyama Masao
Department of Surgery, Bell Land General Hospital, Osaka, Japan.
Department of Surgery, Bell Land General Hospital, Osaka, Japan.
Am J Emerg Med. 2016 Dec;34(12):2306-2309. doi: 10.1016/j.ajem.2016.08.033. Epub 2016 Aug 16.
To determine if the increase in transient focal enhancement of the liver adjacent to the gallbladder seen on dynamic computed tomography (CT) is greater in gangrenous cholecystitis than in nongangrenous cholecystitis by determining the CT attenuation value.
We retrospectively reviewed the medical records of 57 patients who underwent emergency cholecystectomy for acute cholecystitis and preoperative dynamic CT scans between March 2011 and April 2016. Based on the pathology findings, patients were assigned to a gangrenous group or a nongangrenous group. The CT attenuation ratio (AR) was defined as the ratio of the maximum CT attenuation value in the region of interest in segment 5 (liver parenchyma adjacent to the gallbladder) and that in the control region of interest in segment 8. The patient characteristics and CT findings were compared between the groups. The appropriate AR of the arterial phase (ARAP) cutoff value for a diagnosis of gangrenous cholecystitis was determined using receiver operating characteristic curve analysis.
The ARAP was significantly higher in the gangrenous group than in the nongangrenous group (P < .001); the area under the receiver operating characteristic curve was 0.849. The ARAP cutoff value of 1.46 had a sensitivity and specificity of 84.6% and 83.9%, respectively (odds ratio, 21.17; 95% confidence interval, 4.90-118.91), and ARAP ≥1.46 was significantly correlated with a diagnosis of gangrenous cholecystitis (P < .001).
The increase in transient focal enhancement of the liver adjacent to the gallbladder during the arterial phase of dynamic CT was greater in gangrenous cholecystitis than in nongangrenous cholecystitis.
通过测定CT衰减值，确定坏疽性胆囊炎患者肝脏邻近胆囊区域在动态计算机断层扫描（CT）上的短暂局灶性强化增加是否比非坏疽性胆囊炎患者更明显。
我们回顾性分析了2011年3月至2016年4月期间因急性胆囊炎接受急诊胆囊切除术并术前行动态CT扫描的57例患者的病历。根据病理结果，将患者分为坏疽组和非坏疽组。CT衰减率（AR）定义为第5段（肝脏邻近胆囊的实质）感兴趣区域的最大CT衰减值与第8段对照感兴趣区域的最大CT衰减值之比。比较两组患者的特征和CT表现。使用受试者工作特征曲线分析确定诊断坏疽性胆囊炎的动脉期合适AR（ARAP）截断值。
坏疽组的ARAP显著高于非坏疽组（P <.001）；受试者工作特征曲线下面积为0.849。ARAP截断值为1.46时，灵敏度和特异度分别为84.6%和83.9%（优势比，21.17；95%置信区间，4.90 - 118.91），且ARAP≥1.46与坏疽性胆囊炎的诊断显著相关（P <.001）。
动态CT动脉期肝脏邻近胆囊区域的短暂局灶性强化增加在坏疽性胆囊炎中比在非坏疽性胆囊炎中更明显。
