Radiology Unit, Buon Consiglio Fatebenefratelli Hospital, 80123 Naples, Italy.
Diagnostic Imaging and Radiotherapy Department, Azienda Ospedaliera Universitaria "Federico II", 80131 Naples, Italy.
Tomography. 2022 Apr 18;8(2):1159-1171. doi: 10.3390/tomography8020095.
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.
急性胆囊炎是最常见的外科病理之一，在右上腹痛急症中应始终考虑到这种疾病。为此，正确诊断的重要性已得到充分描述。然而，已经证明，仅通过临床（疼痛、墨菲氏征）和实验室（白细胞增多）参数的简单组合并不能用于诊断或排除这种情况，除非伴有影像学检查。长期以来，超声检查（US）一直是首选的影像学检查方法，这要归功于其快速、对单纯性急性胆囊炎具有非常高的敏感性和特异性。然而，急性胆囊炎可能会出现一些 US 难以发现的并发症。此外，研究表明，多排螺旋 CT（MDCT）在显示胆囊炎的复杂形式方面具有更高的敏感性和特异性，并且能够进行多平面（MPR）重建，从而更详细地显示并发症。它们已被证明对准确评估血管并发症、胆道解剖结构以及炎症向周围结构（例如结肠炎）的扩展有用。因此，基于我们的经验，对于表现不典型的患者，或对复杂形式高度怀疑的患者，会进行 MDCT 腹部扫描。在本综述中，列出并描述了主要发现，以基于解剖和拓扑标准创建急性并发症的 CT 分类。
