Frequency-selective non-linear blending for the computed tomography diagnosis of acute gangrenous cholecystitis: Pilot retrospective evaluation R. Schwarz,

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Presentation transcript:

Frequency-selective non-linear blending for the computed tomography diagnosis of acute gangrenous cholecystitis: Pilot retrospective evaluation R. Schwarz, N.M. Bongers, C. Hinterleitner, H. Ditt, K. Nikolaou, J. Fritz, H. Bösmüller, M. Horger European Journal of Radiology Open Volume 5, Pages 114-120 (January 2018) DOI: 10.1016/j.ejro.2018.07.005 Copyright © 2018 The Authors Terms and Conditions

Fig. 1 a–d: 61-year-old male patient referred to CECT for elucidation of acute colicky right abdominal pain. On Fig. 1a linear blending (soft tissue windowing; W 300; C 40) was used showing ill-defined thickened gallbladder wall and pericholecystic fluid. Wall enhancement couldn’t be sufficiently assessed on this image. Fig. 1b reveals multifocal absence or markedly reduced gallbladder wall enhancement (arrowhead) compatible with gangrenous cholecystitis. Note disruption of the gallbladder wall in the fundus region with perforation (arrow). Three slices distal from Fig. 1a- and b, linear blending (c) and frequency-selective non-linear blending (d) show again great differences in the assessment of the gallbladder wall in terms of confines and presence/absence of enhancement. Surgery and subsequent histologic examination confirmed multifocal gallbladder wall necrosis. European Journal of Radiology Open 2018 5, 114-120DOI: (10.1016/j.ejro.2018.07.005) Copyright © 2018 The Authors Terms and Conditions

Fig. 2 a–b: 79-year-old male patient presenting with acute colicky pains in the upper right abdominal quadrant and referred to CECT for diagnosis. Fig. 2a (linear blending -soft tissue windowing; W 350; C 50) shows ill-defined thickened gallbladder wall as well as pericholecystic fluid. Wall enhancement was discontinuous suggesting ischemia. Note improved delineation of the gallbladder wall on Fig. 2b with multiple areas of necrosis (arrowhead) and skip areas with persistent vascularization (arrow) compatible with gangrenous cholecystitis. At surgery and subsequent histologic examination multifocal gallbladder wall necrosis with skip areas was confirmed. There was also focal hemorrhage in the necrotic tissue at histological examination. European Journal of Radiology Open 2018 5, 114-120DOI: (10.1016/j.ejro.2018.07.005) Copyright © 2018 The Authors Terms and Conditions

Fig. 3 a–b: 65-year-old male patient referred to CECT for acute cholecystitis. On Fig. 3a linear blending (soft tissue windowing; W 350; C 50) shows gallbladder wall thinning, but no clear mucosal enhancement. Fig. 3b (frequency-selective non-linear blending) shows discontinuation of gallbladder wall enhancement with almost entire necrosis compatible with gangrenous cholecystitis. There is also some sludge within the gallbladder (arrow). Surgery and subsequent histologic examination confirmed extensive GB-wall necrosis and hemorrhage. European Journal of Radiology Open 2018 5, 114-120DOI: (10.1016/j.ejro.2018.07.005) Copyright © 2018 The Authors Terms and Conditions

Fig. 4 a–b: 78-year-old male patient referred to CECT for acute upper abdominal pain suspected of gastritis. Fig. 4a (linear blending-soft tissue windowing; W 350; C 50) shows slightly thickened GB-wall with minimal enhancement suggesting ischemia (necrosis) and partial wall thinning suggesting large ulcera whereas frequency-selective non-linear blending (Fig. 4b) obviously delineates transmural ischemia (arrows). Surgery and subsequent histologic examination confirmed extensive gallbladder wall necrosis and ulcers. European Journal of Radiology Open 2018 5, 114-120DOI: (10.1016/j.ejro.2018.07.005) Copyright © 2018 The Authors Terms and Conditions