Preoperative diagnosis of gangrenous acute cholecystitis: usefulness of CEUS.

PURPOSE: To evaluate CEUS for the preoperative diagnosis of gangrenous acute cholecystitis. SUBJECTS AND METHODS: This prospective study was approved by our institution's ethical committee. Fifty-six patients who underwent both US and CEUS and were confirmed as presenting with acute cholecystitis at pathology were included. Clinical data, mean time until surgery, macroscopic appearance of the GB, and the presence of gangrene at pathology were noted. Baseline US images and CEUS cine clips were analyzed by two experienced radiologists. Statistical analyses were performed. RESULTS: Gangrenous acute cholecystitis was diagnosed in 23 (41%) patients and uncomplicated acute cholecystitis in 33 (59%). Patients with gangrenous acute cholecystitis were found to be older (p = 0.048). Mean time from CEUS to surgery was found to be shorter in patients presenting with gangrenous acute cholecystitis (p = 0.052). At US, GB short axis ≥4 cm (p = 0.039) and GB wall interruption (p = 0.037) showed a statistically significant association with the diagnosis of gangrenous acute cholecystitis. On CEUS, discontinuous or irregular GB wall enhancement was reported in 19/23 (83%) patients with gangrenous acute cholecystitis and showed association with the presence of gangrene at pathology (p = 0.001). The interobserver agreement for the presence of discontinuous or irregular GB wall enhancement on CEUS images was good. CONCLUSION: Performing CEUS on patients presenting with US findings of acute cholecystitis is relevant, since the presence of a discontinuous or irregular enhancement of the GB wall appears to be correlated with the diagnosis of gangrenous acute cholecystitis.

Liver spontaneous hypoattenuation on CT is an imaging biomarker of the severity of acute pancreatitis.

PURPOSE: The purpose of this study was to evaluate the relationship between liver spontaneous attenuation (LSA) on computed tomography (CT) reflecting the degree of steatosis, and the severity of acute pancreatitis (AP). MATERIALS AND METHODS: All consecutive patients admitted from December 2014 to September 2020 for an episode of AP were retrospectively reviewed. LSA was evaluated on early CT examination and all abdominal CT examinations were reviewed by two abdominal radiologists. Severity of AP was categorized using Atlanta classification and CT severity index. Univariable and multivariable statistical analyses were performed. RESULTS: A total of 467 patients were included. There were 297 men and 170 women, with a mean age of 57 ± 19 (SD) years (range: 18-98 years). Among them, 236 patients (51%) had acute biliary pancreatitis, 134 (29%) had acute alcoholic pancreatitis and 97 (20%) had AP due to other etiologies. A total of 44 (9%) patients had severe AP and 423 (91%) had non severe AP. Median LSA was significantly lower in patients with severe AP (36 Hounsfield units [HU]; interquartile range [IQR]:18; 54) than in patients with non-severe AP (45 HU; IQR: 35; 51) (P < 0.001). In patients with alcoholic AP, median LSA was significantly lower in patients with severe AP (29 HU; IQR: 3; 43) than in those with non-severe AP (42 HU; IQR: 27; 50) (P = 0.022). At multivariable analysis, the third and fourth quartiles of liver spontaneous attenuation values (i.e., < 45 HU/>30 HU and < 30 HU) were independently associated with severe AP (OR, 3.23; 95% CI: 1.33-51.2; P = 0.038 and OR, 8.82; 95% CI: 1.91-69.7; P = 0.014; respectively). CONCLUSION: LSA on CT is associated with clinical severity of AP and may be used as an additional marker of disease severity.

Does IV contrast extravasation on CT in anticoagulant-related rectus sheath and iliopsoas hematoma predict hematoma expansion and patient outcomes?

OBJECTIVE: The purpose of the study was to evaluate if IV contrast extravasation on CT in anticoagulant-related rectus sheath and iliopsoas hematoma predict hematoma expansion and patient outcomes. MATERIALS AND METHODS: All patients presented with anticoagulation-related spontaneous IP hematoma or RS hematoma and who underwent contrast-enhanced CT exploration, with injection of a contrast material, from January 2012 to January 2015 in our institution were included in this study. Considering the retrospective nature of our study, our institutional review board judged our study to be exempted from ethical approval and no patient consent was required. Computed tomography (CT) images were retrospectively analyzed blindly of the evolution and treatment of hematomas. The type of muscle involved; the presence of contrast extravasation after contrast injection; the volume of the hematoma, as well as, clinical and biological results (hemoglobin value g/dL); and for each patient, the type of anticoagulation used, patient's treatment and outcomes were noted. The analyses were conducted using R 3.1.0. All statistical tests were 2-sided, and probability values <0.05 were regarded as significant. RESULTS: Sixty-eight patients were reviewed. Among 68 patients, 44 (65%) patients presented spontaneous IP hematoma and 24/68 (35%) a RS hematoma. There were 37 men (54%) and 31 (46%) women, ranging from 39 to 93 years with a median age of 75 years. Hemodynamic instability was statistically associated with IP hematomas and large volume of hematoma (p < 0.001). Only 15 patients had follow-up CT, 10 without and with IV contrast, 2 with IV contrast only, and 3 without contrast. Follow-up CT was performed from J0 to J8. Detection of contrast extravasation did not appear related to hemodynamically instability (p = 0.35), to a neurological deficit (p = 1), or to the increase in the volume of the hematoma on follow-up CT (p = 0.81). The different types of anticoagulant were not related to muscular type more than the other (p = 0.9). Among anticoagulant therapy, only vitamin K antagonist therapy was statistically associated with surgery (p = 0.04). CONCLUSION: CT extravasation of contrast material in IP and RS hematoma does not appear to be related with clinical criteria of severity, and therefore should not be solely considered as a radiological decision criteria.