CT findings of mild forms or early manifestations of acute cholecystitis



      The objective of this study was to determine the most predictive CT feature of the mild forms or early manifestations of acute cholecystitis.

      Materials and Methods

      Two radiologists analyzed CT of 34 patients with mild or early acute cholecystitis and 34 control patients for pericholecystic increased attenuation on the arterial phase, indistinctness of the interface between the gallbladder (GB) and the liver, enhancement of the GB wall, and increased attenuation of the GB bile.


      There were significant differences in the mean values for each CT feature but increased attenuation of the GB bile between patients and control group (P<.05). The most significant predictor of mild or early acute cholecystitis on CT was the presence of pericholecystic increased attenuation on the arterial phase (sensitivity, 82.4%), followed by indistinctness of the interface between the GB and liver (sensitivity, 38.0%), which were identified by both observers with good agreement (κ=0.735 and κ=0.687).


      The pericholecystic increased attenuation on arterial phase CT was the most significant predictor of mild forms or early manifestations of acute cholecystitis.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • deDombal FT
        in: deDombal FT Diagnosis of acute abdominal pain. 2nd ed. Churchill Livingston, New York1991: 1-10
        • Rumack CM
        • Wilson SR
        • Charboneau JW
        Diagnostic ultrasound. 2nd ed. Mosby, St Louis, MO1998: 175-200
        • Mindelzun RE
        • Jeffrey RB
        The acute abdomen: current CT imaging technique.
        Semin Ultrasound CT MR. 1999; 20: 63-67
        • Marincek B
        Nontraumatic abdominal emergencies. Acute abdominal pain: diagnostic strategies.
        Eur Radiol. 2002; 12: 2136-2150
        • Rosen MP
        • Siewert B
        • Sands DZ
        • Bromberg R
        • Edlow J
        • Raptopoulos V
        Value of abdominal CT in the emergency department for patients with abdominal pain.
        Eur Radiol. 2003; 13: 418-424
        • Leschka S
        • Alkadhi H
        • Wildermuth S
        • Marincek B
        Multi-detector computed tomography of acute abdomen.
        Eur Radiol. 2005; 15: 2435-2447
        • Paulson EK
        • Jaffe TA
        • Thomas J
        • Harris JP
        • Nelson RC
        MDCT of patients with acute abdominal pain: a new perspective using coronal reformations from submillimeter isotropic voxels.
        AJR Am J Roentgenol. 2004; 183: 899-906
        • Fidler J
        • Paulson EK
        • Layfield L
        CT evaluation of acute cholecystitis: findings and usefulness in diagnosis.
        AJR Am J Roentgenol. 1996; 166: 1085-1088
        • Paulson EK
        Acute cholecystitis: CT findings.
        Semin Ultrasound CT MR. 2000; 21: 56-63
        • Kane RA
        • Costello P
        • Duszlak E
        Computed tomography in acute cholecystitis: new observations.
        AJR Am J Roentgenol. 1983; 141: 697-701
        • Blankeberg F
        • Wirth R
        • Jeffrey Jr, RB
        • Mindelzun R
        • Francis I
        Computed tomography as an adjunct to ultrasound in the diagnosis of acute acalculous cholecystitis.
        Gastrointest Radiol. 1991; 16: 149-153
        • Al-Azawi D
        • Mc Mahon D
        • Rajpal PK
        The diagnosis of acute cholecystitis in patients undergoing early laparoscopic cholecystectomy in a community hospital.
        Surg Laparosc Endosc Percutan Tech. 2007; 17: 19-21
        • Cameron K
        • Chadwick C
        • Phillips J
        • Johnson AG
        Management of acute cholecystitis in UK; time for change.
        Postgrad Med J. 2004; 80: 292-294
        • Trowbridge RL
        • Rutkowski NK
        • Shojania KG
        Does this patient have acute cholecystitis?.
        JAMA. 2003; 289: 80-86
        • Vracko J
        • Markovic S
        • Wiechel KL
        Conservative treatment versus endoscopic sphincterotomy in the initial management of acute cholecystitis in elderly patients at high surgical risk.
        Endoscopy. 2006; 38: 773-778
        • Landis JR
        • Koch GG
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Yamashita K
        • Jin MJ
        • Hirose Y
        • Morikawa M
        • Sumioka H
        • Ito K
        • et al.
        CT finding of transient focal increased attenuation of the liver adjacent to the gallbladder in acute cholecystitis.
        AJR Am J Roentgenol. 1995; 164: 343-346
        • Ito K
        • Awaya H
        • Mitchell DG
        • Honjo K
        • Fujita T
        • Uchisako H
        • et al.
        Gallbladder disease: appearance of associated transient increased attenuation in the liver at biphasic, contrast-enhanced dynamic CT.
        Radiology. 1997; 204: 723-728
        • Francis IR
        • Cohan RH
        • McNulty NJ
        • Platt JF
        • Korobkin M
        • Gebremariam A
        • et al.
        Multidetector CT of the liver and hepatic neoplasms: effect of multiphasic imaging on tumor conspicuity and vascular enhancement.
        AJR Am J Roentgenol. 2003; 180: 1217-1224
        • Kim MJ
        • Choi JY
        • Lim JS
        • Kim JY
        • Kim JH
        • Oh YT
        • et al.
        Optimal scan window for detection of hypervascular hepatocellular carcinomas during MDCT examination.
        AJR Am J Roentgenol. 2006; 187: 198-206
        • Van Breda Vriesman AC
        • Engelbrech MR
        • Smithuis RH
        • Puylaert JB
        Diffuse gallbladder wall thickening: differential diagnosis.
        AJR Am J Roentgenol. 2007; 188: 495-501
        • Kimura Y
        • Takada T
        • Kawarada Y
        • Nimura Y
        • Hirata K
        • Sekimoto M
        • et al.
        Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo guidelines.
        J Hepatobiliary Pancreat Surg. 2007; 14: 15-26
        • Gabata T
        • Matsui O
        • Kadoya M
        • Ueda K
        • Kawamori Y
        • Yoshikawa J
        • et al.
        Aberrant gastric venous drainage in a focal spared area of segment IV in fatty liver: demonstrated with color Doppler sonography.
        Radiology. 1997; 203: 461-463