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Acute cholecystitis: diagnostic value of dual-energy CT-derived iodine map and low-keV virtual monoenergetic images

  • Hepatobiliary
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Abstract

Purpose

To compare conventional and dual-energy CT (DECT) for the diagnosis of acute cholecystitis and gangrene.

Methods

Fifty-seven consecutive adult patients with abdominal pain who underwent IV contrast-enhanced abdominal DECT on a dual-layer (dlDECT) or rapid-switching (rsDECT) scanner from September, 2018 to April, 2021 with cholecystectomy and pathology-confirmed cholecystitis were retrospectively reviewed, and compared with 57 consecutive adult patients without cholecystitis from the same interval scanned with DECT. Images were reviewed independently by two abdominal radiologists with 12 and 16 years of experience in two sessions 4 weeks apart, blinded to clinical data. Initially, only blended reconstructions (simulating conventional single-energy CT images) were reviewed (CT). Subsequently, CT and DECT reconstructions including low-keV virtual monoenergetic images and iodine maps were reviewed. Gallbladder fossa hyperemia, pericholecystic fluid, subjective presence of gangrene, heterogeneous wall enhancement, sloughed membranes, intramural air, abscess, overall impression of the presence of acute cholecystitis, and intramural iodine density were assessed.

Results

Gallbladder fossa hyperemia was detected with increased sensitivity on DECT (R1, 61.4%; R2, 75.4%) vs. CT (R1, 22.8%; R2, 15.8%). DECT showed increased sensitivity for gangrene (R1, 24.6%; R2, 38.6%) vs. CT (R1, 5.3%; R2, 14%), heterogeneous wall enhancement (DECT: R1, 33.3%; R2, 63.2% vs. CT: R1, 7%; R2, 31.6%), and cholecystitis (DECT: R1, 86%; R2, 89.5% vs. CT: R1, 77.2%; R2, 70.2%). In addition, DECT was more sensitive for the detection of acute cholecystitis (R1, 86%; R2, 89.5%) vs. CT (R1, 77.2%; R2, 70.2%). Iodine density threshold of 1.2 mg/ml, 0.8 mg/mL, and 0.5 mg/mL showed specificity for gangrenous cholecystitis of 78.26%, 86.96%, and 95.65%, respectively, using the rsDECT platform.

Conclusion

DECT showed improved sensitivity compared to conventional CT for detection of acute cholecystitis. Iodine density measurements may be helpful to diagnose gangrene.

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References

  1. Wertz, J.R., Lopez, J.M., Olson, D. and Thompson, W.M., 2018. Comparing the diagnostic accuracy of ultrasound and CT in evaluating acute cholecystitis. American Journal of Roentgenology, 211(2), pp.W92-W97. https://doi.org/10.2214/AJR.17.18884

    Article  PubMed  Google Scholar 

  2. Bennett, G.L. and Balthazar, E.J., 2003. Ultrasound and CT evaluation of emergent gallbladder pathology. Radiologic Clinics, 41(6), pp.1203–1216. https://www.radiologic.theclinics.com/article/S0033-8389(03)00097-6/abstract

  3. Pinto A, Romano S, Del Vecchio W, et al. (2000) Personal experience in 71 consecutive patients with acute cholecystitis. Radiol Med (Torino) 99:62–67. https://europepmc.org/article/med/10803189

  4. Bennett, G.L. and Balthazar, E.J., 2003. Ultrasound and CT evaluation of emergent gallbladder pathology. Radiologic Clinics, 41(6), pp.1203–1216. https://jamanetwork.com/journals/jamasurgery/article-abstract/566942

  5. Mentzer Jr, R.M., Golden, G.T., Chandler, J.G. and Horsley 3rd, J.S., 1975. A comparative appraisal of emphysematous cholecystitis. American journal of surgery, 129(1), pp.10–15. https://europepmc.org/article/med/174453

  6. Fry, D.E., Cox, R.A. and Harbrecht, P.J., 1981. Gangrene of the gallbladder: a complication of acute cholecystitis. Southern medical journal, 74(6), pp.666–668. https://europepmc.org/article/med/7244741

  7. Cotran, R.S. and Kumar, V., 1989. Robbins pathologic basis of disease. WB Saunders Company. Philadelphia, PA.

    Google Scholar 

  8. Fuks, D., Mouly, C., Robert, B., Hajji, H., Yzet, T. and Regimbeau, J.M., 2012. Acute cholecystitis: preoperative CT can help the surgeon consider conversion from laparoscopic to open cholecystectomy. Radiology, 263(1), pp.128-138. https://doi.org/10.1148/radiol.12110460

    Article  PubMed  Google Scholar 

  9. Baird, D.R., Wilson, J.P., Mason, E.M., Duncan, T.D., Evans, J.S., Luke, J.P., Ruben, D.M. and Lucas, G.W., 1992. An early review of 800 laparoscopic cholecystectomies at a university-affiliated community teaching hospital. The American surgeon, 58(3), pp.206–210. https://europepmc.org/article/med/1532704

  10. Bennett, G.L., Rusinek, H., Lisi, V., Israel, G.M., Krinsky, G.A., Slywotzky, C.M. and Megibow, A., 2002. CT findings in acute gangrenous cholecystitis. American Journal of Roentgenology, 178(2), pp.275–281. https://www.ajronline.org/doi/full/https://doi.org/10.2214/ajr.178.2.1780275

  11. Singh, A.K. and Sagar, P., 2005. Gangrenous cholecystitis: prediction with CT imaging. Abdominal imaging, 30(2), pp.218-221. https://doi.org/10.1007/s00261-004-0217-0

    Article  CAS  PubMed  Google Scholar 

  12. Nguyen, L., Fagan, S.P., Lee, T.C., Aoki, N., Itani, K.M., Berger, D.H. and Awad, S.S., 2004. Use of a predictive equation for diagnosis of acute gangrenous cholecystitis. The American journal of surgery, 188(5), pp.463–466. https://www.sciencedirect.com/science/article/abs/pii/S0002961004003459

  13. Teefey, S.A., Dahiya, N., Middleton, W.D., Bajaj, S., Dahiya, N., Ylagan, L. and Hildebolt, C.F., 2013. Acute cholecystitis: do sonographic findings and WBC count predict gangrenous changes? American Journal of Roentgenology, 200(2), pp.363-369. https://doi.org/10.2214/AJR.12.8956

    Article  PubMed  Google Scholar 

  14. Kiviluoto T, Siren J, Luukkonen P, et al. Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet 1998; 351:321–325. https://www.sciencedirect.com/science/article/abs/pii/S014067369708447X

  15. Chang, W.C., Sun, Y., Wu, E.H., Kim, S.Y., Wang, Z.J., Huang, G.S. and Yeh, B.M., 2016. CT findings for detecting the presence of gangrenous ischemia in cholecystitis. American Journal of Roentgenology, 207(2), pp.302-309. https://doi.org/10.2214/AJR.15.15658

    Article  PubMed  Google Scholar 

  16. Murphy KP, Darras KE, Nicolaou S, McLaughlin PD. 2016 Oct. Emergency abdominal applications of DECT. Current Radiology Reports. 1;4(10):54. https://www.researchgate.net/publication/306308602_Emergency_Abdominal_Applications_of_DECT

  17. Fitzgibbons RJ, Tseng A, Wang H, Ryberg A, Nguyen N, Sims KL. 1996 Dec. Acute cholecystitis. Surgical endoscopy. 10(12):1180–4. https://pubmed.ncbi.nlm.nih.gov/8939838/

  18. Jacobsen, M.C., Schellingerhout, D., Wood, C.A., Tamm, E.P., Godoy, M.C., Sun, J. and Cody, D.D., 2018. Intermanufacturer comparison of dual-energy CT iodine quantification and monochromatic attenuation: a phantom study. Radiology, 287(1), pp.224-234. https://doi.org/10.1148/radiol.2017170896

    Article  PubMed  Google Scholar 

  19. Landis JR, Koch GG. 1977. The measurement of observer agreement for categorical data. Biometrics, 33 (1), pp. 159-174

    Article  CAS  Google Scholar 

  20. Fidler, J., Paulson, E.K. and Layfield, L., 1996. CT evaluation of acute cholecystitis: findings and usefulness in diagnosis. AJR. American journal of roentgenology, 166(5), pp.1085-1088. https://doi.org/10.2214/ajr.166.5.8615248

    Article  CAS  PubMed  Google Scholar 

  21. Kane RA, Costello P, Duszlak E. Computed tomography in acute cholecystitis: new observations. AJR 1983; 141:697–701. https://doi.org/10.2214/ajr.141.4.697

    Article  CAS  PubMed  Google Scholar 

  22. Yamashita, K., Jin, M.J., Hirose, Y., Morikawa, M., Sumioka, H., Itoh, K. and Konish, J., 1995. CT finding of transient focal increased attenuation of the liver adjacent to the gallbladder in acute cholecystitis. AJR. American journal of roentgenology, 164(2), pp.343-346. https://doi.org/10.2214/ajr.164.2.7839966

    Article  CAS  PubMed  Google Scholar 

  23. Bennett, G.L., 2015. Evaluating patients with right upper quadrant pain. Radiologic Clinics, 53(6), pp.1093–1130.https://www.radiologic.theclinics.com/article/S0033-8389(15)00132-3/abstract

  24. Wu, C.H., Chen, C.C., Wang, C.J., Wong, Y.C., Wang, L.J., Huang, C.C., Lo, W.C. and Chen, H.W., 2011. Discrimination of gangrenous from uncomplicated acute cholecystitis: accuracy of CT findings. Abdominal imaging, 36(2), pp.174-178. https://doi.org/10.1007/s00261-010-9612-x

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Boston Medical Center, Boston, MA, USA

    Fahimul Huda, Christina A. LeBedis, Stephan W. Anderson & Avneesh Gupta

  2. Department of Radiation Oncology, Boston University School of Medicine, Boston, MA, USA

    Muhammad M. Qureshi

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  1. Fahimul Huda
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  2. Christina A. LeBedis
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Correspondence to Fahimul Huda.

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This research study was conducted retrospectively from data obtained for clinical purposes. We consulted extensively with the IRB of Boston University Medical Center who determined that our study did not need ethical approval. An IRB official waiver of ethical approval was granted from the IRB of Boston University Medical Center (IRB Number: H-39858).

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Huda, F., LeBedis, C.A., Qureshi, M.M. et al. Acute cholecystitis: diagnostic value of dual-energy CT-derived iodine map and low-keV virtual monoenergetic images. Abdom Radiol 46, 5125–5133 (2021). https://doi.org/10.1007/s00261-021-03202-9

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