Radiology: Volume 263 Number 1-April 2012
David Fuks, MD Charlotte Mouly, MD Brice Robert, MD Hassene Hajji, MD ThierryYzet, MD, PhD Jean-Marc Regimbeau, MD, PhD
Materials and Methods: The study protocol was approved by the local institutional review board, and written informed consent was provided by all patients at enrollment. From 2008 to 2010, all pa- tients admitted to a university medical center with acute calculous cholecystitis and for whom a preoperative contrast material-enhan ced CT study was available were pro- spectively included. Cholecystecto my was always initiated laparoscopicall y. To identify risk factors for conversion specifically related to acute cholecystitis, CT studies were analyzed according to predefined criteria by two radiologists who were blinded to the patient's conversion status. Associations between conversion and radiologic findings were assessed by using univariate and multivariate logistic models.
Purpose: To establish whether preoperative computed tomographic (CT) findings in patients with acute cholecystitis were as- sociated with conversion from laparoscopic to open cho- lecystectomy in patients with calculous acute cholecystitis.
Results: A total of 108 patients were analyzed (61 men, 47 women; median age, 58 years; age range, 17-88 years). Conversion occurred in 24 (22%) cases. On preoperative CT images, the absence of gallbladder wall enhancement was associated with the presence of gangrenous acute chole- cystitis (sensitivity, 73%). The absence of gallbladder wall enhancement (58% and 40% for conversion and noncon-versio n, respectively; P = .02) and the presence of a gallstone in the gallbladder infundibulum (78% and 22% for conversion and nonconversion , respectively; P = .04) were associated with acute cholecystitis-re lated conversion in a multivariate analysis. Interobserver agreement for CT study interpretation was very good (median K value, 0.92; range, 0.76-1.00).
Conclusion: The absence of gallbladder wall enhanceme nt (associated with the presence of gangrenous acute cholecystiti s) and the presence of a gallstone in the gallbladder infundibu- lum are associated with conversion from laparoscopi c to open cholecystectomy.