Preoperative Prediction of Gangrenous Cholecystitis Using CT and MRI Findings: A Retrospective Observational Study in a Single Emergency Center

Preoperative Prediction of Gangrenous Cholecystitis Using CT and MRI Findings: A Retrospective Observational Study in a Single Emergency Center | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Preoperative Prediction of Gangrenous Cholecystitis Using CT and MRI Findings: A Retrospective Observational Study in a Single Emergency Center Hideya Itagaki, Tomoyuki Endo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7131448/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Gangrenous cholecystitis is a severe form of acute cholecystitis that requires prompt surgical intervention. While ultrasound is often the first-line diagnostic tool, CT and MRI are increasingly utilized for their superior diagnostic accuracy. However, reliable imaging markers for predicting gangrenous cholecystitis remain unclear. Objectives To identify preoperative CT and MRI findings that are predictive of gangrenous cholecystitis in patients with acute cholecystitis. Methods We conducted a retrospective observational study of 119 patients with acute cholecystitis who underwent CT or MRI prior to surgery between January 2020 and March 2025. Patients were divided into two groups: gangrenous cholecystitis and non-gangrenous cholecystitis, based on postoperative histopathology. Clinical characteristics, laboratory data, and imaging findings were compared. Multivariate logistic regression and ROC analysis were performed to identify independent predictors of gangrenous cholecystitis and evaluate diagnostic performance. Results Fifty patients were diagnosed with gangrenous cholecystitis and 69 with non-gangrenous cholecystitis. CT findings significantly associated with gangrenous cholecystitis included gallbladder wall thickening, pericholecystic stranding, pericholecystic fluid, intraluminal bile attenuation ≥ 12.5 HU, gallbladder wall attenuation ≥ 31.5 HU, solution of continuity, and free peritoneal effusion. Multivariate analysis identified intraluminal bile attenuation ≥ 12.5 HU (aOR: 12.80), gallbladder wall attenuation ≥ 31.5 HU (aOR: 5.82), and pericholecystic stranding (aOR: 4.35) as independent predictors. Among biomarkers, neutrophil count (AUC = 0.820), CRP (AUC = 0.782), and D-dimer (AUC = 0.791) demonstrated high diagnostic performance. Conclusions Gallbladder wall and intraluminal bile attenuation values on non-contrast CT and pericholecystic stranding are practical, objective imaging predictors of gangrenous cholecystitis. These findings can facilitate early risk stratification and surgical decision-making in the emergency setting without the need for contrast agents. Gangrenous cholecystitis Acute cholecystitis Computed tomography Magnetic resonance imaging Non-contrast CT Hounsfield unit Risk stratification Figures Figure 1 Figure 2 Introduction Acute cholecystitis is a common clinical condition that typically results from obstruction of the cystic duct or gallbladder neck by gallstones and is one of the most frequent causes of acute abdominal pain in the emergency department (ED)[ 1 , 2 ]. According to the Tokyo Guidelines 2018, ultrasonography is recommended as the first-line diagnostic modality [ 3 ]. However, in Japan, the number of computed tomography (CT) scans performed per 1,000 population has reached 221.5, and the use of CT in the ED is increasing, including for the diagnosis of acute cholecystitis [ 4 , 5 ]. CT is considered to have superior diagnostic performance compared to ultrasonography. A meta-analysis by Guilherme et al. reported a sensitivity of 83.9% and specificity of 94% for CT in diagnosing acute cholecystitis [ 6 – 8 ]. In particular, for complicated cholecystitis such as gangrenous cholecystitis, CT has demonstrated greater diagnostic utility than ultrasound. Notably, the positive likelihood ratio (LR+) of CT for gangrenous cholecystitis is reported to be as high as 7.8, while that of ultrasound remains around 1.0 [ 9 ]. Therefore, CT is considered useful not only for diagnosis but also for determining the need for emergency surgery. Magnetic resonance imaging (MRI) also provides excellent contrast resolution and is effective in delineating gallbladder distention, wall thickening, and pericholecystic inflammation[ 10 ]. In particular, pericholecystic high signal intensity on T2-weighted images is known to have high diagnostic accuracy for acute cholecystitis, with a reported sensitivity of 91% and specificity of 79% [ 10 ]. In the ED setting, timely and accurate assessment of disease severity and determination of treatment strategies are essential. Among various forms of complicated cholecystitis, gangrenous cholecystitis requires especially prompt recognition and intervention to improve outcomes. Therefore, enhancing the diagnostic accuracy of preoperative imaging is crucial. This study aimed to identify imaging features on preoperative CT and MRI that are predictive of gangrenous cholecystitis, to facilitate early risk stratification and clinical decision-making in the emergency setting. Materials and Methods Study design This was a single-center retrospective observational study conducted at Tohoku Medical and Pharmaceutical University Hospital. Patients diagnosed with acute cholecystitis between January 2020 and March 2025 were included. Selection of participants Inclusion criteria comprised patients aged 18 years or older who visited the ED and were diagnosed with acute cholecystitis, underwent CT or MRI imaging, and received surgical treatment. Exclusion criteria were: age under 18, pregnancy, presence of malignancy, hepatic or renal failure requiring dialysis, concomitant gallstone pancreatitis or cholangitis, and shock vital signs. The Institutional Review Board of Tohoku Medical and Pharmaceutical University granted ethical approval for this study (Approval No. 2025-2-008-0000). The requirement for informed consent was waived due to the study's retrospective nature. Protocol and measurements Patients were divided into two groups based on postoperative pathological diagnosis: the gangrenous cholecystitis group and the non-gangrenous cholecystitis group. T Clinical and laboratory data at presentation included: sex, age, height, weight, vital signs (blood pressure [BP], pulse rate [PR], respiratory rate [RR], body temperature [BT]), symptoms (abdominal pain, nausea, vomiting), blood tests (white blood cell count [WBC], neutrophils, lymphocytes, red blood cell count [RBC], platelets [Plat], activated partial thromboplastin time [APTT], prothrombin time [PT], D-dimer), biochemistry (total protein [TP], albumin [Alb], aspartate aminotransferase [AST], alanine aminotransferase [ALT], alkaline phosphatase [ALP], gamma-glutamyl transpeptidase [γGT], C-reactive protein [CRP], procalcitonin [PCT]), imaging (CT and MRI), hospital stay, surgery, and outcomes (discharge or death). The CT findings evaluated were based on previous literature. They included: gallbladder stone, gallbladder wall thickening, pericholecystic stranding, gallbladder distension (length ≥ 8 cm and width ≥ 4 cm), pericholecystic fluid collections, rim sign, gallbladder wall attenuation ≥ 31.5 Hounsfield units, intraluminal gallbladder attenuation ≥ 12.5 Hounsfield units, peri-vesicular abscess, solution of continuity, parietal pneumatosis, and free peritoneal effusion. MRI findings included the presence of pericholecystic high-signal-intensity. Attenuation measurements were performed according to the method by Sureka et al. Gallbladder wall attenuation was measured using pixel-based Region of Interests, and intraluminal bile attenuation was calculated based on surface area. Three measurements were taken for each parameter and averaged [ 11 ]. Statistical analysis Statistical analyses were performed using Stata/MP 18.0 (StataCorp, College Station, TX, USA). Continuous variables were expressed as medians (interquartile ranges), and categorical variables as frequencies and percentages. Mann-Whitney U test was used for continuous variables, and Pearson's chi-square test for categorical data. A P-value of < 0.05 was considered statistically significant. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic performance of various parameters. Variables significant in univariate analysis were entered into multivariate logistic regression analysis to identify independent predictors of gangrenous cholecystitis, adjusting for confounders such as age, sex, heart rate, body temperature, Charlson Comorbidity Index (CCI), WBC, CRP, and D-dimer. Results Of 160 patients diagnosed with acute cholecystitis during the study period, 119 were included after applying exclusion criteria. Among them, 50 were diagnosed with gangrenous cholecystitis and 69 with non-gangrenous cholecystitis. Clinical characteristics of the two groups are detailed in Table 1 The median age of all patients was 71 years, with the gangrenous group being older (75 vs 67 years, P = 0.007). Male predominance was observed overall (64.7%), and this trend was more pronounced in the gangrenous group (78% vs 55%, P = 0.01). CCI was significantly higher in the gangrenous group (3 [ 2 – 5 ] vs. 2 [ 1 – 4 ], P = 0.004). Vital signs comparison showed significantly lower heart rates (79 [67–92] vs. 90.5 [76–106] bpm, P = 0.002) and body temperatures (37.0 [36.0–37.0] °C vs. 37.0 [37.0–38.0] °C, P < 0.001) in the gangrenous group. No significant differences were found in blood pressure or respiratory rate. In terms of biomarkers, the gangrenous group had significantly higher WBC, neutrophils, D-dimer, and CRP (all P < 0.001), and lower albumin (P = 0.004). APTT and PT-INR were also prolonged in the gangrenous group (P = 0.027 and 0.024, respectively). No significant differences were found for lymphocytes, RBC, platelets, total protein, liver enzymes, or PCT. There were no significant differences in blood or bile culture positivity. However, hospital stay was longer in the gangrenous group (6 [ 5 – 10 ] vs 5 [ 4 – 6 ] days, P < 0.001), while mortality rates did not differ significantly (P = 0.240). Table 1 Baseline clinical, physical, and laboratory parameters in patients with gangrenous and non-gangrenous cholecystitis Parameters Cholecystitis (N = 119) Gangrenous cholecystitis (N = 50) Non-Gangrenous cholecystitis (N = 69) P values Clinical feature Age (years) 71 (51–81) 75 (60–83) 67 (49–78) 0.007 Sex, male, No. (%) 77 (64.7%) 39 (78%) 38 (55%) 0.010 BW (kg) 69 (57–80) 69 (57–81) 69 (57–77) 0.692 Height (cm) 161.5 (155–168) 163.5 (158–170) 160 (153.5–168) 0.074 BMI (kg/m2) 26 (23–29) 26 (23–29) 26 (23.5–29) 0.549 Charlson Comorbidity Index, median (IQR) 3 (1–5) 3 (2–5) 2 (1–4) 0.004 Time from onset to surgery, No. (%) 0.167 -24hr 57 (47.9%) 18 (36%) 39 (56.5%) 24-48hr 20 (16.8%) 10 (20%) 10 (14.5%) 48-72hr 18 (15.1%) 9 (18%) 9 (13%) 72hr- 24 (20.2%) 13 (26%) 11 (15.9%) Chief complaint Nausea, n/N. (%) 29/119 (24.37) 5/50 (10) 24/69 (34.78) 0.002 Pain, n/N. (%) 113/119 (94.96) 47/50 (94) 66/69 (95.65) 0.684 Physical findings Systolic blood pressure (mmHg) 143 (127–162) 142 (122–161) 146 (132–162) 0.26 Diastolic blood pressure (mmHg) 86 (76–98) 84.5 (73–96) 87 (77–98) 0.429 Heart rate (/min) 83 (69–98) 90.5 (76–106) 79 (67–92) 0.002 Respiratory rate (cycles/min) 20 (18–24) 20 (18–24) 20 (17.5–24) 0.117 Body temperature (℃) 37.0 (36.0–38.0) 37.0 (37.0–38.0) 37.0 (36.0–37.0) < 0.001 Biomarker White blood cell count (x1000/µL) 10.5 (7.5–13.5) 12.05 (9.7–15.4) 9.2 (7.20–11.8) < 0.001 Neutrophil count (x1000/µL) 8.82 (5.52–11.37) 11.02 (9.46–15.98) 7.09 (4.93–9.60) < 0.001 Lymphocyte count (x1000/µL) 0.90 (0.64–1.45) 0.85 (0.62–1.11) 0.92 (0.68–1.70) 0.196 Red Blood Cell (x10^4/µL) 430 (400–480) 430 (400–490) 440 (400–480) 0.918 Platelet count (x1000/µL) 212 (160–269) 217 (158–269) 211 (169–267) 0.884 Activated Partial Thromboplastin Time (sec) 34.0 (29.0–37.8) 35.1 (31.3–41.2) 31.8 (28.2–37.0) 0.027 Prothrombin time-International Normalized Ratio 1.0 (1.0–1.1) 1.0 (1.0–1.2) 1.0 (1.0–1.1) 0.024 D-dimer (µg/mL) 1.2 (0.8–3.3) 2.4 (1.6–5.1) 0.9 (0.7–1.5) < 0.001 Total protein (g/dL) 7.0 (6.6–7.6) 7.0 (6.5–7.5) 7.2 (6.6–7.7) 0.134 Albumin(g/dL) 4.0 (3.5–4.3) 3.8 (3.3–4.2) 4.1 (3.9–4.5) 0.004 Aspartate aminotransferase (U/L) 27.0 (19.0–41.0) 27.0 (20.0–37.0) 26.0 (19.0–45.0) 0.569 Alanine Aminotransferase (U/L) 29.0 (19.0–49.0) 26.0 (20.0–47.0) 31.0 (19.0–51.0) 0.732 Alkaline phosphatase (U/L) 89.0 (69.0–114.0) 87.0 (68.0–114.0) 92.5 (70.5–113.5) 0.598 γ-glutamyl transpeptidase (U/L) 49.0 (25.0–117.0) 47.5 (28.0–110.0) 49.0 (25.0–118.0) 0.821 C-reactive protein (mg/L) 1.50 (0.20–11.50) 8.20 (1.70–20.00) 0.40 (0.10–2.20) < 0.001 Procalcitonin (ng/mL) 0.20 (0.10–0.90) 0.30 (0.10–1.80) 0.10 (0.00–0.40) 0.060 Outcome Positive blood culture, n/N. (%) 11/40(27.5%) 6/25 (24.0%) 5/15 (33.3%) 0.527 Positive bile culture, n/N. (%) 35/73(47.95%) 16/34(47.06%) 19/39(48.72%) 0.882 Length of hospital stay (days) 5 (4–7) 6 (5–10) 5 (4–6) < 0.001 Death, No. (%) 1 (0.84%) 1 (2%) 0 (0%) 0.240 Legend: All categorical variables are shown as n/N (%), where N denotes the number of patients with available data. Continuous variables are expressed as median (interquartile range). The total number of patients is 119, but the denominator may vary due to missing data. Abbreviations: BMI, body mass index; BW, body weight; IQR, interquartile range. CT and MRI imaging findings are presented in Table 2 . The gangrenous group had significantly higher frequencies of gallbladder wall thickening (84% vs 66.7%, P = 0.033), pericholecystic stranding (86% vs 47.8%, P < 0.001), pericholecystic fluid collections (42% vs 18.8%, P = 0.006), gallbladder wall attenuation ≥ 31.5 HU (30% vs 10.1%, P = 0.006), intraluminal bile attenuation ≥ 12.5 HU (64% vs 24.6%, P < 0.001), solution of continuity (18.7% vs 5.8%, P = 0.028), and free peritoneal effusion (18.0% vs 4.3%, P = 0.015). No significant differences were observed for gallbladder stones, distension, rim sign, peri-vesicular abscess, parietal pneumatosis, or pericholecystic high signal. Table 2 Radiological findings on CT and MRI in patients with gangrenous and non-gangrenous cholecystitis Parameters Cholecystitis (N = 119) Gangrenous cholecystitis (N = 50) Non-Gangrenous cholecystitis (N = 69) P values CT Gallbladder stone, n/N. (%) 89/119(74.8%) 38/50(76%) 51/69(73.9%) 0.796 Gallbladder wall thickening, n/N. (%) 88/119(73.9%) 42/50(84%) 46/69(66.7%) 0.033 Pericholecystic stranding or Pericholecystic fat infiltration, n/N. (%) 76/119(63.8%) 4/50(86%) 33/69(47.8%) < 0.001 Gallbladder distension measuring 8 cm in length and 4 cm in width, n/N. (%) 99/119(83.2%) 45/50(90%) 54/69(78.3%) 0.091 Pericholecystic fluid collections, n/N. (%) 34/119(28.5%) 21/50(42%) 13/69(18.8%) 0.006 Rim sign, n/N. (%) 80/95(84.2%) 31/37(83.8%) 49/58(84.5%) 0.927 Gallbladder wall attenuation ≥ 31.5 Hounsfield units, n/N. (%) 22/119(18.5%) 15/50(30%) 7/69(10.1%) 0.006 Gallbladder attenuation ≥ 12.5 Hounsfield units, n/N. (%) 49/119(41.2%) 32/50(64%) 17/69(24.6%) < 0.001 Peri-vesicular abscess, n/N. (%) 1/119(0.84%) 1/50(2%) 0/69(0%) 0.238 Solution of continuity, n/N. (%) 13/117(11.1%) 9/48(18.7%) 4/69(5.8%) 0.028 Parietal pneumatosis, n/N. (%) 1/119(0.84%) 1/50(2%) 0/69(0%) 0.238 Free peritoneal effusion, n/N. (%) 12/119(10.1%) 9/50(18.0%) 3/69(4.3%) 0.015 MRI Pericholecystic high signal, n/N. (%) 67/71(93.8%) 28/29(96.5%) 39/42(92.8%) 0.507 Legend: All values are expressed as n/N (%), where N denotes the number of patients with available data for each variable. Although the total number of patients is 119, the denominator may vary due to missing data. ROC curve analysis of biomarkers and clinical parameters is summarized in Table 3 . The best discriminator for gangrenous cholecystitis was neutrophil count (AUC = 0.8204), followed by CRP (AUC = 0.7823) and D-dimer (AUC = 0.7909). Clinical features like heart rate, temperature, CCI, and age had moderate predictive value. Table 3 Discriminative Ability of Clinical and Laboratory Parameters for Predicting Gangrenous Cholecystitis Based on ROC Curve Analysis Variable ROC AUC value 95% Cl Clinical feature and Physical findings Age 0.6464 0.5471–0.7456 Charlson Comorbidity Index 0.6536 0.5568–0.7503 Heart rate (/min) 0.6699 0.5705–0.7691 Body temperature (℃) 0.6675 0.5742–0.7608 Laboratory biomarkers White blood cell count (x1000/µL) 0.6871 0.5897–0.7844 Neutrophil count (x1000/µL) 0.8204 0.7133–0.9273 Activated Partial Thromboplastin Time (sec) 0.6291 0.5182-0.7400 Prothrombin time-International Normalized Ratio 0.6300 0.5225–0.7374 D-dimer (µg/mL) 0.7909 0.7045–0.8773 Albumin(g/dL) 0.3407 0.2370–0.4443 Alkaline phosphatase (U/L) 0.4713 0.3636–0.5790 γ-glutamyl transpeptidase (U/L) 0.4878 0.3828–0.5928 C-reactive protein (mg/L) 0.7823 0.6970–0.8675 Procalcitonin (ng/mL) 0.6413 0.4976-07848 Legend: This table presents the area under the receiver operating characteristic (ROC) curve (AUC) and corresponding 95% confidence intervals (CIs) for clinical features, physical findings, and biomarkers used to discriminate gangrenous from non-gangrenous cholecystitis. AUC values closer to 1.0 indicate higher discriminative power. Parameters include demographic data, vital signs, and biomarkers related to inflammation or coagulation. AUC, area under the curve; CI, confidence interval; ROC, receiver operating characteristic; INR, international normalized ratio. Diagnostic accuracy of CT and MRI findings is detailed in Table 4 . Pericholecystic stranding had the highest utility (AUC = 0.70, sensitivity 56.6%, specificity 83.7%, OR 6.70), followed by intraluminal bile attenuation ≥ 12.5 HU (AUC = 0.70, OR 5.44) and free peritoneal effusion (AUC = 0.68, OR 4.83). Gallbladder wall attenuation ≥ 31.5 HU, solution of continuity, and fluid collections showed moderate performance (AUC 0.64–0.66). The rim sign and gallstones had low AUCs (~ 0.5). Abscess and pneumatosis had high sensitivity but low prevalence. Table 4 Diagnostic Accuracy of Imaging Findings for Identifying Gangrenous Cholecystitis Imaging finding (Variable) Sensitivity (%) Specificity (%) PPV (%) NPV (%) LR+ LR– ROC AUC Odds Ratio Pericholecystic stranding 56.6 83.7 86.0 52.2 3.48 0.52 0.70 6.70 Gallbladder attenuation ≥ 12.5 Hounsfield units 63.5 74.3 64.0 75.4 2.54 0.47 0.70 5.44 Free peritoneal effusion 75.0 61.7 18.0 95.7 1.96 0.41 0.68 4.83 Gallbladder wall attenuation ≥ 31.5 Hounsfield units 68.2 63.9 30.0 89.9 1.89 0.50 0.66 3.80 Solution of continuity 69.2 62.5 18.8 94.2 1.85 0.49 0.66 3.75 Pericholecystic fluid collections 61.8 65.9 42.0 81.2 1.81 0.58 0.64 3.12 Gallbladder wall thickening 47.7 74.2 84.0 33.3 1.85 0.70 0.61 2.62 Gallbladder distension 45.5 75.0 90.0 21.7 1.82 0.73 0.60 2.50 Pericholecystic high signal 41.8 75.0 96.6 7.1 1.67 0.78 0.58 2.15 Gallbladder stone 42.7 60.0 76.0 26.1 1.07 0.96 0.51 1.12 Rim sign 38.8 60.0 83.8 15.5 0.97 1.02 0.49 0.95 Peri-vesicular abscess 100.0 58.5 2.0 100.0 2.41 0.00 0.79 Not estimable Parietal pneumatosis 100.0 58.5 2.0 100.0 2.41 0.00 0.79 Not estimable Legend: Diagnostic performance of CT and MRI findings in identifying gangrenous cholecystitis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios (LR), area under the ROC curve (AUC), and odds ratios (OR) were calculated for each finding. "Not estimable" indicates values that could not be calculated due to 0 false negatives or low event numbers. A forest plot of positive likelihood ratios (+ LR) for each imaging feature is shown in Fig. 2 . Results of univariate and multivariate logistic regression analyses are presented in Table 5 . Univariate analysis identified pericholecystic stranding (OR: 6.70), intraluminal bile attenuation ≥ 12.5 HU (OR: 5.44), free peritoneal effusion (OR: 4.83), gallbladder wall attenuation ≥ 31.5 HU (OR: 3.80), and solution of continuity (OR: 3.75) as significant. Multivariate analysis (adjusting for clinical confounders) identified intraluminal bile attenuation ≥ 12.5 HU (aOR: 12.80), gallbladder wall attenuation ≥ 31.5 HU (aOR: 5.82), and pericholecystic stranding (aOR: 4.35) as independent predictors. Free peritoneal effusion and solution of continuity were not significant after adjustment. Table 5 Association Between Imaging Findings and Gangrenous Cholecystitis: Results of Univariate and Multivariate Logistic Regression Analyses Imaging finding OR (95% CI) P-value aOR (95% CI)* P-value Pericholecystic stranding 6.701 (2.649–16.951) < 0.001 4.346 (1.279–14.771) 0.019 Gallbladder attenuation ≥ 12.5 Hounsfield units 5.437 (2.453–12.051) < 0.001 12.80 (3.77–43.46) < 0.001 Free peritoneal effusion 4.829 (1.235–18.882) 0.024 4.87 (0.8389–28.276) 0.078 Gallbladder wall attenuation ≥ 31.5 Hounsfield units 3.795 (1.412–10.197) 0.008 5.82 (1.5160–22.344) 0.01 Solution of continuity 3.750 (1.082–12.996) 0.037 0.99 (0.1956–5.104) 0.999 Legend: Univariate and multivariate logistic regression analyses were performed to assess the association between imaging findings and the presence of gangrenous cholecystitis. The multivariate model was adjusted for potential confounding factors, including age, sex, heart rate (HR), body temperature (BT), Charlson Comorbidity Index (CCI), white blood cell count (WBC), C-reactive protein (CRP), and D-dimer (DD). OR = odds ratio; CI = confidence interval; aOR = adjusted odds ratio. Discussion In this study, we directly compared preoperative CT and MRI findings with postoperative pathological diagnoses in patients with acute cholecystitis to identify imaging features predictive of gangrenous cholecystitis. Notably, a gallbladder intraluminal CT value ≥ 12.5 HU, a gallbladder wall CT value ≥ 31.5 HU, and pericholecystic fat stranding were all found to be independent predictive factors in multivariate analysis. Previous studies have reported various imaging features associated with gangrenous cholecystitis, including perfusion defects of the gallbladder wall, pericholecystic stranding, CT attenuation values of the wall > 31.5 HU and bile > 12.5 HU, irregular or discontinuous mucosal enhancement, the rim sign, and gallbladder distension [ 2 , 11 – 15 ]. However, most of these studies relied on descriptive analysis or univariate comparisons and did not perform multivariate analyses to adjust for potential confounders. Our study is methodologically rigorous in that all included patients underwent preoperative CT, and the presence or absence of gangrenous cholecystitis was definitively diagnosed via postoperative histopathology. In terms of sample size, our study represents one of the most extensive single-center investigations of this topic to date. Moreover, to our knowledge, this is the first study to comprehensively analyze previously reported imaging findings using multivariate logistic regression, thereby identifying independent and clinically useful predictors of gangrenous cholecystitis. Gangrenous cholecystitis is a severe form of acute cholecystitis that occurs in approximately 10–30% of cases and can lead to serious complications such as gallbladder perforation, peritonitis, and septic shock [ 16 , 17 ]. Therefore, accurate preoperative risk prediction is critical for timely intervention and appropriate surgical decision-making. The imaging markers identified in this study are all objective, quantifiable, and measurable without the use of contrast agents, making them particularly practical in emergency settings. These findings may support rapid and accurate risk stratification in resource-limited situations such as emergency departments and overnight shifts. Limitations This study has several limitations. First, it was a retrospective observational study conducted at a single center, which may introduce selection bias and unmeasured confounding. Furthermore, the results are based on a specific institutional setting, limiting their external generalizability. Prospective, multicenter studies are warranted to validate our findings. Second, although multiple physicians performed image interpretation, inter-reader variability is unavoidable, and subjectivity in evaluating certain imaging features may have affected the results. We did not assess inter-observer agreement, which should be addressed in future research. Third, the relatively limited sample size may have restricted the statistical power to detect associations with less frequent findings, such as parietal pneumatosis or peri-vesicular abscesses. Larger studies are needed to validate the clinical relevance of these rarer imaging features. Fourth, MRI was not performed in all patients and was selectively applied to a subset of cases. Therefore, there is a potential for selection bias in the analysis of MRI findings, and caution is required in generalizing those results. Future Directions While this study identified key imaging predictors of gangrenous cholecystitis in patients with acute cholecystitis, external validation is necessary. Multicenter prospective studies should aim to determine whether the cutoff values for gallbladder intraluminal and wall CT attenuation observed in this study are reproducible across institutions and imaging protocols. Conclusions This study demonstrated that a gallbladder intraluminal CT value ≥ 12.5 HU, a gallbladder wall CT value ≥ 31.5 HU, and pericholecystic fat stranding are independent predictive imaging markers of gangrenous cholecystitis. These findings, which are quantifiable, objective, and assessable without contrast, may enhance early risk stratification and surgical decision-making in patients with acute cholecystitis. Abbreviations CT Computed Tomography MRI Magnetic Resonance Imaging HU Hounsfield Unit AUC Area Under the Curve OR Odds Ratio aOR Adjusted Odds Ratio CI Confidence Interval CCI Charlson Comorbidity Index CRP C-Reactive Protein WBC White Blood Cell count PT Prothrombin Time APTT Activated Partial Thromboplastin Time TP Total Protein Alb Albumin AST Aspartate Aminotransferase ALT Alanine Aminotransferase ALP Alkaline Phosphatase γGT Gamma-Glutamyl Transpeptidase PCT Procalcitonin SD Standard Deviation IQR Interquartile Range Declarations Author Contributions HI conceptualized and designed the study. HI performed the literature search and data extraction. HI and TE contributed to data interpretation and manuscript revision. All authors reviewed and approved the final manuscript. Funding This research received no external funding. Conflicts of Interest The authors declare that they have no conflicts of interest. Ethics Approval and Consent to Participate Not applicable. This study is a systematic review of previously published case reports and does not involve any new human or animal data. Consent to Publish declaration Not applicable. References Kimura Y, et al. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14(1):15–26. Erlichman DB, et al. Diagnostic significance of the CT rim sign in cases of gangrenous cholecystitis. Clin Imaging. 2021;73:53–6. Yokoe M, et al. Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25(1):41–54. Koyama T, et al. Patterns of CT use in Japan, 2014: A nationwide cross-sectional study. Eur J Radiol. 2017;97:96–100. Park YS et al. Use of Gallbladder Width Measurement by Computed Tomography in the Diagnosis of Acute Cholecystitis. Diagnostics (Basel), 2022. 12(3). Wertz JR, et al. Comparing the Diagnostic Accuracy of Ultrasound and CT in Evaluating Acute Cholecystitis. AJR Am J Roentgenol. 2018;211(2):W92–7. Khafaji MA, et al. Accuracy of Ultrasound and Computed Tomography in Diagnosing Acute Cholecystitis Patients in a Tertiary Care Center in Saudi Arabia. Cureus. 2023;15(9):e44934. de Oliveira GS, et al. Computed tomography versus ultrasound for the diagnosis of acute cholecystitis: a systematic review and meta-analysis. Eur Radiol. 2024;34(11):6967–79. Martellotto S, Dohan A, Pocard M. Evaluation of the CT Scan as the First Examination for the Diagnosis and Therapeutic Strategy for Acute Cholecystitis. World J Surg. 2020;44(6):1779–89. Regan F, et al. The diagnostic utility of HASTE MRI in the evaluation of acute cholecystitis. Half-Fourier acquisition single-shot turbo SE. J Comput Assist Tomogr. 1998;22(4):638–42. Sureka B, et al. Combined hyperdense gallbladder wall-lumen sign: new computed tomography sign in acute gangrenous cholecystitis. Pol J Radiol. 2020;85:e183–7. Wu CH, et al. Discrimination of gangrenous from uncomplicated acute cholecystitis: accuracy of CT findings. Abdom Imaging. 2011;36(2):174–8. Singh AK, Sagar P. Gangrenous cholecystitis: prediction with CT imaging. Abdom Imaging. 2005;30(2):218–21. Chang WC, et al. CT Findings for Detecting the Presence of Gangrenous Ischemia in Cholecystitis. AJR Am J Roentgenol. 2016;207(2):302–9. Bennett GL, et al. CT findings in acute gangrenous cholecystitis. AJR Am J Roentgenol. 2002;178(2):275–81. Aydin C, et al. Prognostic parameters for the prediction of acute gangrenous cholecystitis. J Hepatobiliary Pancreat Surg. 2006;13(2):155–9. Weiss CA 3rd, Lakshman TV, Schwartz RW. Current diagnosis and treatment of cholecystitis. Curr Surg. 2002;59(1):51–4. Additional Declarations No competing interests reported. Supplementary Files Table1.xlsx Table2.xlsx Table3.xlsx Table4.xlsx Table5.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7131448","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":503872292,"identity":"650c0dec-5361-4dbf-b564-832c3ca2958e","order_by":0,"name":"Hideya Itagaki","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIiWNgGAWjYBACA2YGAxDNAyIYGwxsQFTjAaK08EC0pIEp/FoYIFoYIFoYDoM5eLWYszNvfMxTwyBjz3784scZBeft1rYfBtpSYxONS4tlM1uxMc8xoMN4coolNxjcTt52JhGo5VhabgMuhx3mMZPmYQP5JSdB8gFQi9kBoBbGhsP4tJj/5vkH1ML/JvnnA4NzyWbnHxLUYsbM2wbUIpF+DOiwA3ZmNwjawlYsObdPgofnxhs2yxkGyQlmN4C2JODzy/nDGz+8+WZjz96f/vhmzx87e7Pz6Q8ffKixwakFBJh4GCSAFA84ghLBKhPwKAcBxh9giv0BiLQnoHgUjIJRMApGIAAA0BVfB1k6lbEAAAAASUVORK5CYII=","orcid":"","institution":"Tohoku Medical and Pharmaceutical University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Hideya","middleName":"","lastName":"Itagaki","suffix":""},{"id":503872293,"identity":"1a5bcfca-a4e2-4a61-87f6-aaa251133473","order_by":1,"name":"Tomoyuki Endo","email":"","orcid":"","institution":"Tohoku Medical and Pharmaceutical University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tomoyuki","middleName":"","lastName":"Endo","suffix":""}],"badges":[],"createdAt":"2025-07-15 14:08:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7131448/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7131448/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89978958,"identity":"f0eb19d9-d9fc-4bf7-9034-4b59f097f202","added_by":"auto","created_at":"2025-08-27 06:17:11","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":443799,"visible":true,"origin":"","legend":"\u003cp\u003eDiagnostic performance (AUC values) of imaging findings in identifying gangrenous cholecystitis. Findings with AUC ≥ 0.6 are presented in descending order.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7131448/v1/01d70d35306f23a2f0f8015f.jpg"},{"id":89978961,"identity":"5827cc58-c9ff-4d7e-95c6-c9812c9baaca","added_by":"auto","created_at":"2025-08-27 06:17:11","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":395010,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of positive likelihood ratios (+LR) for imaging findings. Pericholecystic stranding and intraluminal bile attenuation ≥ 12.5 HU showed the highest diagnostic utility.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7131448/v1/c0fd507305830d4db5a125ed.jpg"},{"id":94474850,"identity":"24d98dca-b262-445b-be79-7623e7fcbd19","added_by":"auto","created_at":"2025-10-27 15:50:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3616569,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7131448/v1/ba9eb217-934b-422a-a72d-d533a81f2275.pdf"},{"id":89978955,"identity":"30f557e8-023a-413e-9561-8a9868a74677","added_by":"auto","created_at":"2025-08-27 06:17:11","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":13662,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7131448/v1/81f0184458ff65dbed31d53d.xlsx"},{"id":89981282,"identity":"48e74577-398b-4efd-a7f8-8f3e1a80e060","added_by":"auto","created_at":"2025-08-27 06:25:12","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":12060,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7131448/v1/421590e58169bd2d6d075d70.xlsx"},{"id":89981274,"identity":"8622ba57-7f24-43b2-bfe2-947c69e39f93","added_by":"auto","created_at":"2025-08-27 06:25:11","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":11035,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7131448/v1/b20ae0f660063b23adb737b2.xlsx"},{"id":89978979,"identity":"f59cd702-3cd9-4d6c-b7d6-19d717c4ce00","added_by":"auto","created_at":"2025-08-27 06:17:12","extension":"xlsx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":12977,"visible":true,"origin":"","legend":"","description":"","filename":"Table4.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7131448/v1/82ba9726e434431fca75fa26.xlsx"},{"id":89978962,"identity":"fab10318-d2ba-4007-b5a1-feb5df8c9903","added_by":"auto","created_at":"2025-08-27 06:17:11","extension":"xlsx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":10442,"visible":true,"origin":"","legend":"","description":"","filename":"Table5.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7131448/v1/8f54120b7bae78336ebfec79.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Preoperative Prediction of Gangrenous Cholecystitis Using CT and MRI Findings: A Retrospective Observational Study in a Single Emergency Center","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAcute cholecystitis is a common clinical condition that typically results from obstruction of the cystic duct or gallbladder neck by gallstones and is one of the most frequent causes of acute abdominal pain in the emergency department (ED)[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. According to the Tokyo Guidelines 2018, ultrasonography is recommended as the first-line diagnostic modality [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, in Japan, the number of computed tomography (CT) scans performed per 1,000 population has reached 221.5, and the use of CT in the ED is increasing, including for the diagnosis of acute cholecystitis [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. CT is considered to have superior diagnostic performance compared to ultrasonography. A meta-analysis by Guilherme et al. reported a sensitivity of 83.9% and specificity of 94% for CT in diagnosing acute cholecystitis [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In particular, for complicated cholecystitis such as gangrenous cholecystitis, CT has demonstrated greater diagnostic utility than ultrasound. Notably, the positive likelihood ratio (LR+) of CT for gangrenous cholecystitis is reported to be as high as 7.8, while that of ultrasound remains around 1.0 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Therefore, CT is considered useful not only for diagnosis but also for determining the need for emergency surgery. Magnetic resonance imaging (MRI) also provides excellent contrast resolution and is effective in delineating gallbladder distention, wall thickening, and pericholecystic inflammation[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In particular, pericholecystic high signal intensity on T2-weighted images is known to have high diagnostic accuracy for acute cholecystitis, with a reported sensitivity of 91% and specificity of 79% [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In the ED setting, timely and accurate assessment of disease severity and determination of treatment strategies are essential. Among various forms of complicated cholecystitis, gangrenous cholecystitis requires especially prompt recognition and intervention to improve outcomes. Therefore, enhancing the diagnostic accuracy of preoperative imaging is crucial. This study aimed to identify imaging features on preoperative CT and MRI that are predictive of gangrenous cholecystitis, to facilitate early risk stratification and clinical decision-making in the emergency setting.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cb\u003eStudy design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis was a single-center retrospective observational study conducted at Tohoku Medical and Pharmaceutical University Hospital. Patients diagnosed with acute cholecystitis between January 2020 and March 2025 were included.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSelection of participants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eInclusion criteria comprised patients aged 18 years or older who visited the ED and were diagnosed with acute cholecystitis, underwent CT or MRI imaging, and received surgical treatment. Exclusion criteria were: age under 18, pregnancy, presence of malignancy, hepatic or renal failure requiring dialysis, concomitant gallstone pancreatitis or cholangitis, and shock vital signs. The Institutional Review Board of Tohoku Medical and Pharmaceutical University granted ethical approval for this study (Approval No. 2025-2-008-0000). The requirement for informed consent was waived due to the study's retrospective nature.\u003c/p\u003e\u003cp\u003e\u003cb\u003eProtocol and measurements\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePatients were divided into two groups based on postoperative pathological diagnosis: the gangrenous cholecystitis group and the non-gangrenous cholecystitis group. T Clinical and laboratory data at presentation included: sex, age, height, weight, vital signs (blood pressure [BP], pulse rate [PR], respiratory rate [RR], body temperature [BT]), symptoms (abdominal pain, nausea, vomiting), blood tests (white blood cell count [WBC], neutrophils, lymphocytes, red blood cell count [RBC], platelets [Plat], activated partial thromboplastin time [APTT], prothrombin time [PT], D-dimer), biochemistry (total protein [TP], albumin [Alb], aspartate aminotransferase [AST], alanine aminotransferase [ALT], alkaline phosphatase [ALP], gamma-glutamyl transpeptidase [γGT], C-reactive protein [CRP], procalcitonin [PCT]), imaging (CT and MRI), hospital stay, surgery, and outcomes (discharge or death). The CT findings evaluated were based on previous literature. They included: gallbladder stone, gallbladder wall thickening, pericholecystic stranding, gallbladder distension (length\u0026thinsp;\u0026ge;\u0026thinsp;8 cm and width\u0026thinsp;\u0026ge;\u0026thinsp;4 cm), pericholecystic fluid collections, rim sign, gallbladder wall attenuation\u0026thinsp;\u0026ge;\u0026thinsp;31.5 Hounsfield units, intraluminal gallbladder attenuation\u0026thinsp;\u0026ge;\u0026thinsp;12.5 Hounsfield units, peri-vesicular abscess, solution of continuity, parietal pneumatosis, and free peritoneal effusion. MRI findings included the presence of pericholecystic high-signal-intensity. Attenuation measurements were performed according to the method by Sureka et al. Gallbladder wall attenuation was measured using pixel-based Region of Interests, and intraluminal bile attenuation was calculated based on surface area. Three measurements were taken for each parameter and averaged [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eStatistical analyses were performed using Stata/MP 18.0 (StataCorp, College Station, TX, USA). Continuous variables were expressed as medians (interquartile ranges), and categorical variables as frequencies and percentages. Mann-Whitney U test was used for continuous variables, and Pearson's chi-square test for categorical data. A P-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003cp\u003eReceiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic performance of various parameters. Variables significant in univariate analysis were entered into multivariate logistic regression analysis to identify independent predictors of gangrenous cholecystitis, adjusting for confounders such as age, sex, heart rate, body temperature, Charlson Comorbidity Index (CCI), WBC, CRP, and D-dimer.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOf 160 patients diagnosed with acute cholecystitis during the study period, 119 were included after applying exclusion criteria. Among them, 50 were diagnosed with gangrenous cholecystitis and 69 with non-gangrenous cholecystitis.\u003c/p\u003e\u003cp\u003eClinical characteristics of the two groups are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e\u003cp\u003eThe median age of all patients was 71 years, with the gangrenous group being older (75 vs 67 years, P\u0026thinsp;=\u0026thinsp;0.007). Male predominance was observed overall (64.7%), and this trend was more pronounced in the gangrenous group (78% vs 55%, P\u0026thinsp;=\u0026thinsp;0.01). CCI was significantly higher in the gangrenous group (3 [\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] vs. 2 [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], P\u0026thinsp;=\u0026thinsp;0.004).\u003c/p\u003e\u003cp\u003eVital signs comparison showed significantly lower heart rates (79 [67\u0026ndash;92] vs. 90.5 [76\u0026ndash;106] bpm, P\u0026thinsp;=\u0026thinsp;0.002) and body temperatures (37.0 [36.0\u0026ndash;37.0] \u0026deg;C vs. 37.0 [37.0\u0026ndash;38.0] \u0026deg;C, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in the gangrenous group. No significant differences were found in blood pressure or respiratory rate.\u003c/p\u003e\u003cp\u003eIn terms of biomarkers, the gangrenous group had significantly higher WBC, neutrophils, D-dimer, and CRP (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and lower albumin (P\u0026thinsp;=\u0026thinsp;0.004). APTT and PT-INR were also prolonged in the gangrenous group (P\u0026thinsp;=\u0026thinsp;0.027 and 0.024, respectively). No significant differences were found for lymphocytes, RBC, platelets, total protein, liver enzymes, or PCT.\u003c/p\u003e\u003cp\u003eThere were no significant differences in blood or bile culture positivity. However, hospital stay was longer in the gangrenous group (6 [\u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] vs 5 [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] days, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while mortality rates did not differ significantly (P\u0026thinsp;=\u0026thinsp;0.240).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline clinical, physical, and laboratory parameters in patients with gangrenous and non-gangrenous cholecystitis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParameters\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCholecystitis (N\u0026thinsp;=\u0026thinsp;119)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGangrenous cholecystitis (N\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNon-Gangrenous cholecystitis (N\u0026thinsp;=\u0026thinsp;69)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP values\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical feature\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71 (51\u0026ndash;81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e75 (60\u0026ndash;83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67 (49\u0026ndash;78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex, male, No. (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e77 (64.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39 (78%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38 (55%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBW (kg)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69 (57\u0026ndash;80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69 (57\u0026ndash;81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e69 (57\u0026ndash;77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.692\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHeight (cm)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e161.5 (155\u0026ndash;168)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e163.5 (158\u0026ndash;170)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e160 (153.5\u0026ndash;168)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.074\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI (kg/m2)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (23\u0026ndash;29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26 (23\u0026ndash;29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26 (23.5\u0026ndash;29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.549\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCharlson Comorbidity Index, median (IQR)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (1\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (2\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (1\u0026ndash;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTime from onset to surgery, No. (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.167\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e-24hr\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57 (47.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (36%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39 (56.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e24-48hr\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (16.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (20%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 (14.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e48-72hr\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (15.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (18%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (13%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e72hr-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (20.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (15.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChief complaint\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNausea, n/N. (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29/119 (24.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5/50 (10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24/69 (34.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePain, n/N. (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e113/119 (94.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47/50 (94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66/69 (95.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.684\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePhysical findings\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSystolic blood pressure (mmHg)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e143 (127\u0026ndash;162)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e142 (122\u0026ndash;161)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e146 (132\u0026ndash;162)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiastolic blood pressure (mmHg)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e86 (76\u0026ndash;98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84.5 (73\u0026ndash;96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87 (77\u0026ndash;98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.429\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHeart rate (/min)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e83 (69\u0026ndash;98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90.5 (76\u0026ndash;106)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79 (67\u0026ndash;92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRespiratory rate (cycles/min)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (18\u0026ndash;24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (18\u0026ndash;24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20 (17.5\u0026ndash;24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.117\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBody temperature (℃)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.0 (36.0\u0026ndash;38.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.0 (37.0\u0026ndash;38.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.0 (36.0\u0026ndash;37.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBiomarker\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWhite blood cell count (x1000/\u0026micro;L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.5 (7.5\u0026ndash;13.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.05 (9.7\u0026ndash;15.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.2 (7.20\u0026ndash;11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNeutrophil count (x1000/\u0026micro;L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.82 (5.52\u0026ndash;11.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.02 (9.46\u0026ndash;15.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.09 (4.93\u0026ndash;9.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLymphocyte count (x1000/\u0026micro;L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.90 (0.64\u0026ndash;1.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.85 (0.62\u0026ndash;1.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.92 (0.68\u0026ndash;1.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.196\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRed Blood Cell (x10^4/\u0026micro;L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e430 (400\u0026ndash;480)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e430 (400\u0026ndash;490)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e440 (400\u0026ndash;480)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.918\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePlatelet count (x1000/\u0026micro;L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e212 (160\u0026ndash;269)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e217 (158\u0026ndash;269)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e211 (169\u0026ndash;267)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.884\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eActivated Partial Thromboplastin Time (sec)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34.0 (29.0\u0026ndash;37.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.1 (31.3\u0026ndash;41.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31.8 (28.2\u0026ndash;37.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.027\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProthrombin time-International Normalized Ratio\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.0 (1.0\u0026ndash;1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.0 (1.0\u0026ndash;1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.0 (1.0\u0026ndash;1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.024\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eD-dimer (\u0026micro;g/mL)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.2 (0.8\u0026ndash;3.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.4 (1.6\u0026ndash;5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.9 (0.7\u0026ndash;1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal protein (g/dL)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.0 (6.6\u0026ndash;7.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.0 (6.5\u0026ndash;7.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.2 (6.6\u0026ndash;7.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.134\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlbumin(g/dL)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.0 (3.5\u0026ndash;4.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.8 (3.3\u0026ndash;4.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.1 (3.9\u0026ndash;4.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAspartate aminotransferase (U/L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27.0 (19.0\u0026ndash;41.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.0 (20.0\u0026ndash;37.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.0 (19.0\u0026ndash;45.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.569\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlanine Aminotransferase (U/L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29.0 (19.0\u0026ndash;49.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.0 (20.0\u0026ndash;47.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31.0 (19.0\u0026ndash;51.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.732\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlkaline phosphatase (U/L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e89.0 (69.0\u0026ndash;114.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e87.0 (68.0\u0026ndash;114.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92.5 (70.5\u0026ndash;113.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.598\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eγ-glutamyl transpeptidase (U/L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49.0 (25.0\u0026ndash;117.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47.5 (28.0\u0026ndash;110.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49.0 (25.0\u0026ndash;118.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.821\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eC-reactive protein (mg/L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.50 (0.20\u0026ndash;11.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.20 (1.70\u0026ndash;20.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.40 (0.10\u0026ndash;2.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProcalcitonin (ng/mL)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.20 (0.10\u0026ndash;0.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.30 (0.10\u0026ndash;1.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.10 (0.00\u0026ndash;0.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.060\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOutcome\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePositive blood culture, n/N. (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11/40(27.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6/25 (24.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5/15 (33.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.527\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePositive bile culture, n/N. (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35/73(47.95%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16/34(47.06%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19/39(48.72%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.882\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLength of hospital stay (days)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (4\u0026ndash;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (5\u0026ndash;10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (4\u0026ndash;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDeath, No. (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.84%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.240\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eLegend: \u003cb\u003eAll categorical variables are shown as n/N (%), where N denotes the number of patients with available data. Continuous variables are expressed as median (interquartile range). The total number of patients is 119, but the denominator may vary due to missing data. Abbreviations: BMI, body mass index; BW, body weight; IQR, interquartile range.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCT and MRI imaging findings are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eThe gangrenous group had significantly higher frequencies of gallbladder wall thickening (84% vs 66.7%, P\u0026thinsp;=\u0026thinsp;0.033), pericholecystic stranding (86% vs 47.8%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), pericholecystic fluid collections (42% vs 18.8%, P\u0026thinsp;=\u0026thinsp;0.006), gallbladder wall attenuation\u0026thinsp;\u0026ge;\u0026thinsp;31.5 HU (30% vs 10.1%, P\u0026thinsp;=\u0026thinsp;0.006), intraluminal bile attenuation\u0026thinsp;\u0026ge;\u0026thinsp;12.5 HU (64% vs 24.6%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), solution of continuity (18.7% vs 5.8%, P\u0026thinsp;=\u0026thinsp;0.028), and free peritoneal effusion (18.0% vs 4.3%, P\u0026thinsp;=\u0026thinsp;0.015).\u003c/p\u003e\u003cp\u003eNo significant differences were observed for gallbladder stones, distension, rim sign, peri-vesicular abscess, parietal pneumatosis, or pericholecystic high signal.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRadiological findings on CT and MRI in patients with gangrenous and non-gangrenous cholecystitis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParameters\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCholecystitis (N\u0026thinsp;=\u0026thinsp;119)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGangrenous cholecystitis (N\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNon-Gangrenous cholecystitis (N\u0026thinsp;=\u0026thinsp;69)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP values\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGallbladder stone, n/N. (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e89/119(74.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38/50(76%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51/69(73.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.796\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGallbladder wall thickening, n/N. (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e88/119(73.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42/50(84%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46/69(66.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.033\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePericholecystic stranding or Pericholecystic fat infiltration, n/N. (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e76/119(63.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4/50(86%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33/69(47.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGallbladder distension measuring 8 cm in length and 4 cm in width, n/N. (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e99/119(83.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45/50(90%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54/69(78.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.091\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePericholecystic fluid collections, n/N. (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34/119(28.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21/50(42%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13/69(18.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRim sign, n/N. (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e80/95(84.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31/37(83.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49/58(84.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.927\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGallbladder wall attenuation\u0026thinsp;\u0026ge;\u0026thinsp;31.5 Hounsfield units, n/N. (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22/119(18.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15/50(30%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7/69(10.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGallbladder attenuation\u0026thinsp;\u0026ge;\u0026thinsp;12.5 Hounsfield units, n/N. (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49/119(41.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32/50(64%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17/69(24.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePeri-vesicular abscess, n/N. (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1/119(0.84%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1/50(2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0/69(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.238\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSolution of continuity, n/N. (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13/117(11.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9/48(18.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4/69(5.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.028\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eParietal pneumatosis, n/N. (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1/119(0.84%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1/50(2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0/69(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.238\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFree peritoneal effusion, n/N. (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12/119(10.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9/50(18.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3/69(4.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMRI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePericholecystic high signal, n/N. (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e67/71(93.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28/29(96.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39/42(92.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.507\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eLegend: \u003cb\u003eAll values are expressed as n/N (%), where N denotes the number of patients with available data for each variable. Although the total number of patients is 119, the denominator may vary due to missing data.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eROC curve analysis of biomarkers and clinical parameters is summarized in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eThe best discriminator for gangrenous cholecystitis was neutrophil count (AUC\u0026thinsp;=\u0026thinsp;0.8204), followed by CRP (AUC\u0026thinsp;=\u0026thinsp;0.7823) and D-dimer (AUC\u0026thinsp;=\u0026thinsp;0.7909). Clinical features like heart rate, temperature, CCI, and age had moderate predictive value.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDiscriminative Ability of Clinical and Laboratory Parameters for Predicting Gangrenous Cholecystitis Based on ROC Curve Analysis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eROC AUC value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% Cl\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical feature and Physical findings\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.6464\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.5471\u0026ndash;0.7456\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCharlson Comorbidity Index\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.6536\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.5568\u0026ndash;0.7503\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHeart rate (/min)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.6699\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.5705\u0026ndash;0.7691\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBody temperature (℃)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.6675\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.5742\u0026ndash;0.7608\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLaboratory biomarkers\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWhite blood cell count (x1000/\u0026micro;L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.6871\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.5897\u0026ndash;0.7844\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNeutrophil count (x1000/\u0026micro;L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.8204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.7133\u0026ndash;0.9273\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eActivated Partial Thromboplastin Time (sec)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.6291\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.5182-0.7400\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProthrombin time-International Normalized Ratio\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.6300\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.5225\u0026ndash;0.7374\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eD-dimer (\u0026micro;g/mL)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.7909\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.7045\u0026ndash;0.8773\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlbumin(g/dL)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.3407\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.2370\u0026ndash;0.4443\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlkaline phosphatase (U/L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.4713\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.3636\u0026ndash;0.5790\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eγ-glutamyl transpeptidase (U/L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.4878\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.3828\u0026ndash;0.5928\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eC-reactive protein (mg/L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.7823\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.6970\u0026ndash;0.8675\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProcalcitonin (ng/mL)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.6413\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.4976-07848\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eLegend: \u003cb\u003eThis table presents the area under the receiver operating characteristic (ROC) curve (AUC) and corresponding 95% confidence intervals (CIs) for clinical features, physical findings, and biomarkers used to discriminate gangrenous from non-gangrenous cholecystitis. AUC values closer to 1.0 indicate higher discriminative power. Parameters include demographic data, vital signs, and biomarkers related to inflammation or coagulation. AUC, area under the curve; CI, confidence interval; ROC, receiver operating characteristic; INR, international normalized ratio.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDiagnostic accuracy of CT and MRI findings is detailed in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003ePericholecystic stranding had the highest utility (AUC\u0026thinsp;=\u0026thinsp;0.70, sensitivity 56.6%, specificity 83.7%, OR 6.70), followed by intraluminal bile attenuation\u0026thinsp;\u0026ge;\u0026thinsp;12.5 HU (AUC\u0026thinsp;=\u0026thinsp;0.70, OR 5.44) and free peritoneal effusion (AUC\u0026thinsp;=\u0026thinsp;0.68, OR 4.83). Gallbladder wall attenuation\u0026thinsp;\u0026ge;\u0026thinsp;31.5 HU, solution of continuity, and fluid collections showed moderate performance (AUC 0.64\u0026ndash;0.66). The rim sign and gallstones had low AUCs (~\u0026thinsp;0.5). Abscess and pneumatosis had high sensitivity but low prevalence.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDiagnostic Accuracy of Imaging Findings for Identifying Gangrenous Cholecystitis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImaging finding (Variable)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSensitivity (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSpecificity (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePPV (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNPV (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLR+\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eLR\u0026ndash;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eROC AUC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eOdds Ratio\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePericholecystic stranding\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e83.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e86.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e52.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e6.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGallbladder attenuation\u0026thinsp;\u0026ge;\u0026thinsp;12.5 Hounsfield units\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e63.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e74.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e64.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e75.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e5.44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFree peritoneal effusion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e75.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e61.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e95.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e4.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGallbladder wall attenuation\u0026thinsp;\u0026ge;\u0026thinsp;31.5 Hounsfield units\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e68.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e63.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e30.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e89.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSolution of continuity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e69.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e62.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e94.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePericholecystic fluid collections\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e61.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e65.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e42.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e81.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGallbladder wall thickening\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e47.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e74.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e84.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e33.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGallbladder distension\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e90.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e21.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePericholecystic high signal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e41.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e96.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e7.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGallbladder stone\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e42.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e76.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e26.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRim sign\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e83.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e15.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePeri-vesicular abscess\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e100.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e58.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e100.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNot estimable\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eParietal pneumatosis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e100.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e58.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e100.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNot estimable\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eLegend: \u003cb\u003eDiagnostic performance of CT and MRI findings in identifying gangrenous cholecystitis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios (LR), area under the ROC curve (AUC), and odds ratios (OR) were calculated for each finding. \"Not estimable\" indicates values that could not be calculated due to 0 false negatives or low event numbers.\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eA forest plot of positive likelihood ratios (+\u0026thinsp;LR) for each imaging feature is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eResults of univariate and multivariate logistic regression analyses are presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eUnivariate analysis identified pericholecystic stranding (OR: 6.70), intraluminal bile attenuation\u0026thinsp;\u0026ge;\u0026thinsp;12.5 HU (OR: 5.44), free peritoneal effusion (OR: 4.83), gallbladder wall attenuation\u0026thinsp;\u0026ge;\u0026thinsp;31.5 HU (OR: 3.80), and solution of continuity (OR: 3.75) as significant. Multivariate analysis (adjusting for clinical confounders) identified intraluminal bile attenuation\u0026thinsp;\u0026ge;\u0026thinsp;12.5 HU (aOR: 12.80), gallbladder wall attenuation\u0026thinsp;\u0026ge;\u0026thinsp;31.5 HU (aOR: 5.82), and pericholecystic stranding (aOR: 4.35) as independent predictors. Free peritoneal effusion and solution of continuity were not significant after adjustment.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation Between Imaging Findings and Gangrenous Cholecystitis: Results of Univariate and Multivariate Logistic Regression Analyses\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImaging finding\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eaOR (95% CI)*\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePericholecystic stranding\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.701\u003c/p\u003e\u003cp\u003e(2.649\u0026ndash;16.951)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.346\u003c/p\u003e\u003cp\u003e(1.279\u0026ndash;14.771)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGallbladder attenuation\u0026thinsp;\u0026ge;\u0026thinsp;12.5 Hounsfield units\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.437\u003c/p\u003e\u003cp\u003e(2.453\u0026ndash;12.051)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.80\u003c/p\u003e\u003cp\u003e(3.77\u0026ndash;43.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFree peritoneal effusion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.829\u003c/p\u003e\u003cp\u003e(1.235\u0026ndash;18.882)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.87\u003c/p\u003e\u003cp\u003e(0.8389\u0026ndash;28.276)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.078\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGallbladder wall attenuation\u0026thinsp;\u0026ge;\u0026thinsp;31.5 Hounsfield units\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.795\u003c/p\u003e\u003cp\u003e(1.412\u0026ndash;10.197)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.82\u003c/p\u003e\u003cp\u003e(1.5160\u0026ndash;22.344)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSolution of continuity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.750\u003c/p\u003e\u003cp\u003e(1.082\u0026ndash;12.996)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.037\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003cp\u003e(0.1956\u0026ndash;5.104)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.999\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eLegend: \u003cb\u003eUnivariate and multivariate logistic regression analyses were performed to assess the association between imaging findings and the presence of gangrenous cholecystitis. The multivariate model was adjusted for potential confounding factors, including age, sex, heart rate (HR), body temperature (BT), Charlson Comorbidity Index (CCI), white blood cell count (WBC), C-reactive protein (CRP), and D-dimer (DD). OR\u0026thinsp;=\u0026thinsp;odds ratio; CI\u0026thinsp;=\u0026thinsp;confidence interval; aOR\u0026thinsp;=\u0026thinsp;adjusted odds ratio.\u003c/b\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we directly compared preoperative CT and MRI findings with postoperative pathological diagnoses in patients with acute cholecystitis to identify imaging features predictive of gangrenous cholecystitis. Notably, a gallbladder intraluminal CT value\u0026thinsp;\u0026ge;\u0026thinsp;12.5 HU, a gallbladder wall CT value\u0026thinsp;\u0026ge;\u0026thinsp;31.5 HU, and pericholecystic fat stranding were all found to be independent predictive factors in multivariate analysis.\u003c/p\u003e\u003cp\u003ePrevious studies have reported various imaging features associated with gangrenous cholecystitis, including perfusion defects of the gallbladder wall, pericholecystic stranding, CT attenuation values of the wall\u0026thinsp;\u0026gt;\u0026thinsp;31.5 HU and bile\u0026thinsp;\u0026gt;\u0026thinsp;12.5 HU, irregular or discontinuous mucosal enhancement, the rim sign, and gallbladder distension [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12 CR13 CR14\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, most of these studies relied on descriptive analysis or univariate comparisons and did not perform multivariate analyses to adjust for potential confounders.\u003c/p\u003e\u003cp\u003eOur study is methodologically rigorous in that all included patients underwent preoperative CT, and the presence or absence of gangrenous cholecystitis was definitively diagnosed via postoperative histopathology. In terms of sample size, our study represents one of the most extensive single-center investigations of this topic to date. Moreover, to our knowledge, this is the first study to comprehensively analyze previously reported imaging findings using multivariate logistic regression, thereby identifying independent and clinically useful predictors of gangrenous cholecystitis.\u003c/p\u003e\u003cp\u003eGangrenous cholecystitis is a severe form of acute cholecystitis that occurs in approximately 10\u0026ndash;30% of cases and can lead to serious complications such as gallbladder perforation, peritonitis, and septic shock [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Therefore, accurate preoperative risk prediction is critical for timely intervention and appropriate surgical decision-making. The imaging markers identified in this study are all objective, quantifiable, and measurable without the use of contrast agents, making them particularly practical in emergency settings. These findings may support rapid and accurate risk stratification in resource-limited situations such as emergency departments and overnight shifts.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study has several limitations. First, it was a retrospective observational study conducted at a single center, which may introduce selection bias and unmeasured confounding. Furthermore, the results are based on a specific institutional setting, limiting their external generalizability. Prospective, multicenter studies are warranted to validate our findings.\u003c/p\u003e\u003cp\u003eSecond, although multiple physicians performed image interpretation, inter-reader variability is unavoidable, and subjectivity in evaluating certain imaging features may have affected the results. We did not assess inter-observer agreement, which should be addressed in future research.\u003c/p\u003e\u003cp\u003eThird, the relatively limited sample size may have restricted the statistical power to detect associations with less frequent findings, such as parietal pneumatosis or peri-vesicular abscesses. Larger studies are needed to validate the clinical relevance of these rarer imaging features.\u003c/p\u003e\u003cp\u003eFourth, MRI was not performed in all patients and was selectively applied to a subset of cases. Therefore, there is a potential for selection bias in the analysis of MRI findings, and caution is required in generalizing those results.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFuture Directions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWhile this study identified key imaging predictors of gangrenous cholecystitis in patients with acute cholecystitis, external validation is necessary. Multicenter prospective studies should aim to determine whether the cutoff values for gallbladder intraluminal and wall CT attenuation observed in this study are reproducible across institutions and imaging protocols.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study demonstrated that a gallbladder intraluminal CT value\u0026thinsp;\u0026ge;\u0026thinsp;12.5 HU, a gallbladder wall CT value\u0026thinsp;\u0026ge;\u0026thinsp;31.5 HU, and pericholecystic fat stranding are independent predictive imaging markers of gangrenous cholecystitis. These findings, which are quantifiable, objective, and assessable without contrast, may enhance early risk stratification and surgical decision-making in patients with acute cholecystitis.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eComputed Tomography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMRI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMagnetic Resonance Imaging\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHU\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHounsfield Unit\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAUC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eArea Under the Curve\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOdds Ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eaOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eConfidence Interval\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCharlson Comorbidity Index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCRP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eC-Reactive Protein\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWBC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWhite Blood Cell count\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eProthrombin Time\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAPTT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eActivated Partial Thromboplastin Time\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTotal Protein\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAlb\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAlbumin\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAST\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAspartate Aminotransferase\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eALT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAlanine Aminotransferase\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eALP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAlkaline Phosphatase\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eγGT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGamma-Glutamyl Transpeptidase\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePCT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eProcalcitonin\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStandard Deviation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInterquartile Range\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHI conceptualized and designed the study. HI performed the literature search and data extraction. HI and TE contributed to data interpretation and manuscript revision. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This study is a systematic review of previously published case reports and does not involve any new human or animal data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKimura Y, et al. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14(1):15\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eErlichman DB, et al. Diagnostic significance of the CT rim sign in cases of gangrenous cholecystitis. Clin Imaging. 2021;73:53\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYokoe M, et al. Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25(1):41\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKoyama T, et al. Patterns of CT use in Japan, 2014: A nationwide cross-sectional study. Eur J Radiol. 2017;97:96\u0026ndash;100.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePark YS et al. Use of Gallbladder Width Measurement by Computed Tomography in the Diagnosis of Acute Cholecystitis. Diagnostics (Basel), 2022. 12(3).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWertz JR, et al. Comparing the Diagnostic Accuracy of Ultrasound and CT in Evaluating Acute Cholecystitis. AJR Am J Roentgenol. 2018;211(2):W92\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhafaji MA, et al. Accuracy of Ultrasound and Computed Tomography in Diagnosing Acute Cholecystitis Patients in a Tertiary Care Center in Saudi Arabia. Cureus. 2023;15(9):e44934.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ede Oliveira GS, et al. Computed tomography versus ultrasound for the diagnosis of acute cholecystitis: a systematic review and meta-analysis. Eur Radiol. 2024;34(11):6967\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMartellotto S, Dohan A, Pocard M. Evaluation of the CT Scan as the First Examination for the Diagnosis and Therapeutic Strategy for Acute Cholecystitis. World J Surg. 2020;44(6):1779\u0026ndash;89.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRegan F, et al. The diagnostic utility of HASTE MRI in the evaluation of acute cholecystitis. Half-Fourier acquisition single-shot turbo SE. J Comput Assist Tomogr. 1998;22(4):638\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSureka B, et al. Combined hyperdense gallbladder wall-lumen sign: new computed tomography sign in acute gangrenous cholecystitis. Pol J Radiol. 2020;85:e183\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWu CH, et al. Discrimination of gangrenous from uncomplicated acute cholecystitis: accuracy of CT findings. Abdom Imaging. 2011;36(2):174\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSingh AK, Sagar P. Gangrenous cholecystitis: prediction with CT imaging. Abdom Imaging. 2005;30(2):218\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChang WC, et al. CT Findings for Detecting the Presence of Gangrenous Ischemia in Cholecystitis. AJR Am J Roentgenol. 2016;207(2):302\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBennett GL, et al. CT findings in acute gangrenous cholecystitis. AJR Am J Roentgenol. 2002;178(2):275\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAydin C, et al. Prognostic parameters for the prediction of acute gangrenous cholecystitis. J Hepatobiliary Pancreat Surg. 2006;13(2):155\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWeiss CA 3rd, Lakshman TV, Schwartz RW. Current diagnosis and treatment of cholecystitis. Curr Surg. 2002;59(1):51\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Gangrenous cholecystitis, Acute cholecystitis, Computed tomography, Magnetic resonance imaging, Non-contrast CT, Hounsfield unit, Risk stratification","lastPublishedDoi":"10.21203/rs.3.rs-7131448/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7131448/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eGangrenous cholecystitis is a severe form of acute cholecystitis that requires prompt surgical intervention. While ultrasound is often the first-line diagnostic tool, CT and MRI are increasingly utilized for their superior diagnostic accuracy. However, reliable imaging markers for predicting gangrenous cholecystitis remain unclear.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003eTo identify preoperative CT and MRI findings that are predictive of gangrenous cholecystitis in patients with acute cholecystitis.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted a retrospective observational study of 119 patients with acute cholecystitis who underwent CT or MRI prior to surgery between January 2020 and March 2025. Patients were divided into two groups: gangrenous cholecystitis and non-gangrenous cholecystitis, based on postoperative histopathology. Clinical characteristics, laboratory data, and imaging findings were compared. Multivariate logistic regression and ROC analysis were performed to identify independent predictors of gangrenous cholecystitis and evaluate diagnostic performance.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eFifty patients were diagnosed with gangrenous cholecystitis and 69 with non-gangrenous cholecystitis. CT findings significantly associated with gangrenous cholecystitis included gallbladder wall thickening, pericholecystic stranding, pericholecystic fluid, intraluminal bile attenuation\u0026thinsp;\u0026ge;\u0026thinsp;12.5 HU, gallbladder wall attenuation\u0026thinsp;\u0026ge;\u0026thinsp;31.5 HU, solution of continuity, and free peritoneal effusion. Multivariate analysis identified intraluminal bile attenuation\u0026thinsp;\u0026ge;\u0026thinsp;12.5 HU (aOR: 12.80), gallbladder wall attenuation\u0026thinsp;\u0026ge;\u0026thinsp;31.5 HU (aOR: 5.82), and pericholecystic stranding (aOR: 4.35) as independent predictors. Among biomarkers, neutrophil count (AUC\u0026thinsp;=\u0026thinsp;0.820), CRP (AUC\u0026thinsp;=\u0026thinsp;0.782), and D-dimer (AUC\u0026thinsp;=\u0026thinsp;0.791) demonstrated high diagnostic performance.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eGallbladder wall and intraluminal bile attenuation values on non-contrast CT and pericholecystic stranding are practical, objective imaging predictors of gangrenous cholecystitis. These findings can facilitate early risk stratification and surgical decision-making in the emergency setting without the need for contrast agents.\u003c/p\u003e","manuscriptTitle":"Preoperative Prediction of Gangrenous Cholecystitis Using CT and MRI Findings: A Retrospective Observational Study in a Single Emergency Center","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 06:17:06","doi":"10.21203/rs.3.rs-7131448/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3bfe3d3f-0e34-4f0b-8175-89aa9fbb17e8","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-27T14:37:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-27 06:17:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7131448","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7131448","identity":"rs-7131448","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}