Dual-energy CT in acute cholecystitis- features predicting culture-positive bile and outcome

Adam Nevo; S Nahum Goldberg; Gili Dar; Marron Daud; Shiran Levy; Jacob Sosna; Naama Lev-Cohain

doi:10.1016/j.ejrad.2024.111498

Dual-energy CT in acute cholecystitis- features predicting culture-positive bile and outcome

Eur J Radiol. 2024 May 7:176:111498. doi: 10.1016/j.ejrad.2024.111498. Online ahead of print.

Authors

Adam Nevo¹, S Nahum Goldberg¹, Gili Dar¹, Marron Daud¹, Shiran Levy¹, Jacob Sosna¹, Naama Lev-Cohain²

Affiliations

¹ Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel.
² Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel. Electronic address: naamal@hadassah.org.il.

PMID: 38728876
DOI: 10.1016/j.ejrad.2024.111498

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Abdominal imaging; Cholecystitis; Dual-energy CT; Gall bladder; Mucosal integrity; Peri-cholecystic liver enhancement.