Omiya K, Hiramatsu K, Kato T, Shibata Y, Yoshihara M, Aoba T, Arimoto A, Ito A
Department of General Surgery, Toyohashi Municipal Hospital, 50 Hakken-Nishi, Aotake-cho,, Toyohashi City, Aichi Prefecture, 440-8570, Japan.
BJS Open. 2020 Sep 7;4(6):1137-45. doi: 10.1002/bjs5.50344.
Severe inflammation with necrosis and fibrosis of the gallbladder in acute cholecystitis increases operative difficulty during laparoscopic cholecystectomy. This study aimed to assess the use of preoperative MRI in predicting pathological changes of the gallbladder associated with surgical difficulty.
Patients who underwent both preoperative MRI and early cholecystectomy for acute cholecystitis between 2012 and 2018 were identified retrospectively. On the basis of the layered pattern of the gallbladder wall on MRI, patients were classified into three groups: high signal intensity (HSI), intermediate signal intensity (ISI), and low signal intensity (LSI). The endpoint was the presence of pathological changes of the gallbladder associated with surgical difficulty, such as necrosis, abscess formation and fibrosis.
Of 229 eligible patients, pathological changes associated with surgical difficulty were found in 17 (27 per cent) of 62 patients in the HSI group, 84 (85 per cent) of 99 patients in the ISI group, and 66 (97 per cent) of 68 patients in the LSI group (P < 0·001). For detecting these changes, intermediate to low signal intensity of the gallbladder wall had a sensitivity of 90 (95 per cent c.i. 84 to 94) per cent, specificity of 73 (60 to 83) per cent and accuracy of 85 (80 to 90) per cent.
Preoperative MRI predicted pathological changes associated with surgical difficulty during laparoscopic cholecystectomy for acute cholecystitis.
急性胆囊炎时胆囊的严重炎症伴坏死和纤维化会增加腹腔镜胆囊切除术的手术难度。本研究旨在评估术前磁共振成像（MRI）在预测与手术难度相关的胆囊病理变化中的应用。
回顾性纳入2012年至2018年间接受术前MRI检查并因急性胆囊炎接受早期胆囊切除术的患者。根据MRI上胆囊壁的分层模式，将患者分为三组：高信号强度（HSI）组、中等信号强度（ISI）组和低信号强度（LSI）组。观察终点为与手术难度相关的胆囊病理变化，如坏死、脓肿形成和纤维化。
在229例符合条件的患者中，HSI组62例患者中有17例（27%）出现与手术难度相关的病理变化，ISI组99例患者中有84例（85%），LSI组68例患者中有66例（97%）（P<0.001）。对于检测这些变化，胆囊壁中等至低信号强度的敏感度为90%（95%置信区间84%至94%），特异度为73%（60%至83%），准确度为85%（80%至90%）。
术前MRI可预测急性胆囊炎腹腔镜胆囊切除术中与手术难度相关的病理变化。
