Use of Gallbladder Width Measurement by Computed Tomography in the Diagnosis of Acute Cholecystitis

Abstract

This study aimed to evaluate the diagnostic value of gallbladder width measurement with computed tomography (CT) in patients with acute cholecystitis. This retrospective case−control study was conducted between March 2016 and March 2020 at a tertiary emergency department. Of 310 patients, 254 patients with acute cholecystitis confirmed by surgery were compared with 254 patients diagnosed with other diseases (controls). In the acute cholecystitis group, the number of older patients with underlying illnesses was much higher (64% of men). Upon CT, the median (interquartile range [IQR]) gallbladder width was significantly longer in patients with acute cholecystitis (2.26 [1.82−2.78] cm vs. 3.73 [3.32−4.16] cm, p < 0.001). The optimal cut-off value of gallbladder width for differentiating acute cholecystitis was 3.12 cm, showing a sensitivity of 88% and specificity of 86%. In a multivariable analysis using a logistic regression model for diagnosing acute cholecystitis with CT findings (gallbladder width, length, stone, wall thickening, and pericholecystic fluid), a gallbladder width of ≥3.12 cm was significantly meaningful, even when adjusting for other variables (odds ratio 37.9; p < 0.001). Therefore, an increase in gallbladder width (≥3.12 cm) measured with CT can be a simple and sensitive diagnostic sign of acute cholecystitis, supporting the underlying pathophysiology of bile outflow obstruction.

Keywords: CT; acute cholecystitis; computed tomography; diagnosis; gallbladder.

Figure 1

Patient populations with acute cholecystitis. Abbreviations: ED, emergency department; CT, computed tomography; PTGBD, percutaneous transhepatic gallbladder biliary drainage.

Figure 2

Abdominal computed tomography (CT) findings of acute cholecystitis in a 71-year-old with leukocytosis and right upper quadrant pain ((A) axial scan, (B) sagittal scan). Abdominal CT results showing gallbladder (GB) distension (double arrow; GB width, 3.36 cm and GB length, 9.34 cm) with impacted GB stone (black triangle). It demonstrates fat infiltration (white arrow) and pericholecystic fluid collection (white triangle).

Figure 3

Box plot of acute cholecystitis and control group by gallbladder (GB) width (A) and length (B).

Figure 4

(A) The ROC curve for univariable logistic regression analysis of the association between GB width and acute cholecystitis, (B) ROC curve for univariable logistic regression analysis of the association between GB length and acute cholecystitis. (Abbreviations: GB, gallbladder; ROC, receiver operating characteristic; AUC, area under the curve.)