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Evaluation of early sonographic predictors of gangrenous cholecystitis: mucosal discontinuity and echogenic pericholecystic fat

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To identify early sonographic features of gangrenous cholecystitis.

Materials and methods

101 patients with acute cholecystitis and a pre-operative sonogram were retrospectively reviewed by three radiologists in this IRB-approved and HIPAA-compliant study. Imaging data were correlated with histologic findings and compared using the Fisher’s exact test or Student t test with p < 0.05 to determine statistical significance.

Results

Forty-eight patients had gangrenous cholecystitis and 53 had non-gangrenous acute cholecystitis. Patients with gangrenous cholecystitis tended to be older (67 ± 17 vs 48 ± 18 years; p = 0.0001), male (ratio of male:female 2:1 vs 0.6:1; p = 0.005), tachycardic (60% vs 28%; p = 0.001), and diabetic (25% vs 8%; p = 0.001). Median time between pre-operative sonogram and surgery was 1 day. On imaging, patients with gangrenous cholecystitis were more likely to have echogenic pericholecystic fat (p = 0.001), mucosal discontinuity (p = 0.010), and frank perforation (p = 0.004), while no statistically significant differences were seen in the presence of sloughed mucosa (p = 0.104), pericholecystic fluid (p = 0.523) or wall striations (p = 0.839). In patients with gangrenous cholecystitis and echogenic pericholecystic fat, a smaller subset had concurrent mucosal discontinuity (57%), and a smaller subset of those had concurrent frank perforation (58%). The positive likelihood ratios for gangrenous cholecystitis with echogenic fat and mucosal discontinuity were 4.6 (95% confidence interval 1.9–11.3) and 14.4 (2.0–106), respectively.

Conclusion

Echogenic pericholecystic fat and mucosal discontinuity are early sonographic findings that may help identify gangrenous cholecystitis prior to late findings of frank perforation.

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Authors and Affiliations

  1. Department of Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA

    Justin R. Tse

  2. Department of Surgery, University of California San Francisco East Bay Surgery Program, 1411 East 31st Street, Oakland, CA, 94602, USA

    Rebecca Gologorsky

  3. Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA

    Luyao Shen, R. Brooke Jeffrey & Aya Kamaya

  4. Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, Room H-2110, Mail Code 5243, Stanford, CA, 94305, USA

    David B. Bingham

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  1. Justin R. Tse
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  2. Rebecca Gologorsky
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  3. Luyao Shen
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  5. R. Brooke Jeffrey
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  6. Aya Kamaya
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Corresponding author

Correspondence to Aya Kamaya.

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Conflict of interest

Dr. Aya Kamaya receives book royalties from Elsevier. The remaining authors do not have any conflicts of interests or competing interests.

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Approved by Stanford University Institutional Review Board.

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Waived (retrospective study) by Stanford University Institutional Review Board. Consent for publication Waived (retrospective study) by Stanford University Institutional Review Board.

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Tse, J.R., Gologorsky, R., Shen, L. et al. Evaluation of early sonographic predictors of gangrenous cholecystitis: mucosal discontinuity and echogenic pericholecystic fat. Abdom Radiol 47, 1061–1070 (2022). https://doi.org/10.1007/s00261-021-03320-4

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  • DOI: https://doi.org/10.1007/s00261-021-03320-4

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