Chang et al identified changes in computed tomography (CT) images from patients with gangrenous cholecystitis. These can help identify patients who may benefit from urgent cholecystectomy. The authors are from Tri-Service General Hospital and National Defense Medical Center in Taipei, Chang Gung University, University of California in San Francisco and University of Ulsan in Seoul.
CT changes associated with gangrenous cholecystitis:
(1) gallbladder diameter in cm
(2) mural striation (alternating layers of low and high attenuation in a thickened wall)
(3) mural enhancement with contrast
Parameter
Finding
Points
gallbladder diameter
<= 4 cm
0
> 4 cm (distended)
1
mural striations
absent
0
present
1
mural enhancement
normal or increased
0
decreased
1
where:
• The odds ratios on multivariate analysis were 3.6 for decreased mural enhancement, 9.6 for distention and 11.4 for mural striations.
total number of CT changes present =
= SUM(points for all 3 findings)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 3
• The greater the number of risk factors the greater the risk for gangrenous cholecystitis.
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