Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel.
Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel.
Eur J Radiol. 2024 Jul;176:111498. doi: 10.1016/j.ejrad.2024.111498. Epub 2024 May 7.
Low mono-energetic CT has been shown to improve visualization of acute abdominal inflammatory processes. We aimed to determine its utility in patients with acute cholecystitis and potential added value in clinical decision making.
Sixty-seven consecutive patients with radiological signs of cholecystitis on contrast-enhanced dual-layer CT imaging were retrospectively identified over a four-year period (2/17-8/21). A ranked Likert scale was created for imaging findings present in acute cholecystitis, including gallbladder mucosal integrity and enhancement and pericholecystic liver parenchymal enhancement. These rankings were correlated with laboratory data, followed by sensitivity, specificity, and odds-ratios calculations.
Mucosal integrity and pericholecystic liver enhancement were better seen on low-energetic images by unanimous consensus. Presence of pericholecystic liver enhancement and poorer mucosal wall integrity correlated with positive bile cultures (sensitivity: 93.8 % and 96.9 %, specificity: 37.5 and 50.0 %; odds-ratio: 9.0[1.1-68.1 95 %CI] and 31.0 [2.7-350.7 95 %CI], p = 0.017 and p ≤ 0.001) in patients undergoing cholecystostomy (n = 40/67). Moreover, binary regression modeling showed that the strongest predictor variable for bile culture positivity was the score for pericholecystic liver enhancement (Exp(B) = 0.6, P = 0.022). By contrast, other laboratory markers and other imaging findings (such as GB wall thickness) showed lower sensitivities (76-82 %), specificities (16-21 %) and odds ratios (0.2-4.4) for the prediction of infected bile.
Pericholecystic liver enhancement and gallbladder wall integrity are better visualized on low-DECT images. These findings also potentially predict bile culture positivity in patients with cholecystitis, which may influence clinical management including the need for intervention.
低单能量 CT 已被证明可改善急性腹部炎症过程的可视化效果。我们旨在确定其在急性胆囊炎患者中的应用价值及其在临床决策中的潜在附加价值。
在四年期间（2017 年 2 月至 2021 年 8 月），回顾性地在对比增强双层 CT 成像上发现有胆囊炎放射学征象的 67 例连续患者。为急性胆囊炎的影像学表现创建了一个排序李克特量表，包括胆囊黏膜完整性和增强以及胆囊周围肝实质增强。这些评分与实验室数据相关，随后进行了敏感性、特异性和优势比计算。
一致认为低能量图像能更好地显示黏膜完整性和胆囊周围肝增强。存在胆囊周围肝增强和较差的黏膜壁完整性与胆汁培养阳性相关（敏感性：93.8%和 96.9%，特异性：37.5%和 50.0%；优势比：9.0[1.1-68.1 95%置信区间]和 31.0 [2.7-350.7 95%置信区间]，p=0.017 和 p≤0.001），在接受胆囊造口术的患者（n=40/67）中。此外，二元回归模型显示，预测胆汁培养阳性的最强预测变量是胆囊周围肝增强评分（Exp(B)=0.6，P=0.022）。相比之下，其他实验室标志物和其他影像学表现（如胆囊壁厚度）对预测感染性胆汁的敏感性（76-82%）、特异性（16-21%）和优势比（0.2-4.4）较低。
低 DECT 图像上胆囊周围肝增强和胆囊壁完整性显示更佳。这些发现还可能预测胆囊炎患者胆汁培养阳性，这可能影响临床管理，包括干预的需要。
