---
title: "CT findings predictive of gangrenous cholecystitis: systematic review and meta-analysis"
id: "pubmed-42764326"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42764326"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42764326/"
doi: "10.1007/s10140-026-02544-5"
published_at: "2026-09-21T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# CT findings predictive of gangrenous cholecystitis: systematic review and meta-analysis
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42764326
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42764326/)
- **DOI:** [10.1007/s10140-026-02544-5](https://doi.org/10.1007%2Fs10140-026-02544-5)
- **Published At:** 2026-09-21T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Gangrenous cholecystitis (GC) is a severe complication of acute cholecystitis linked to perforation, sepsis, and higher mortality. This systematic review and meta-analysis evaluated which **computed tomography (CT)** findings are associated with histopathologically confirmed GC. - The authors searched PubMed, Web of Science, Ichushi-Web, the Cochrane Central Register of Controlled Trials, and Google Scholar through March 1, 2026. Two reviewers independently screened studies, extracted data, and assessed study quality using **QUADAS-2**. - Ten retrospective studies totaling 786 patients (310 GC, 476 non-GC) were included; eight studies (724 patients; 268 GC, 456 non-GC) contributed quantitative data to pooled analyses. - Three CT findings were strongly associated with GC: **absent gallbladder wall enhancement** (OR 10.23, 95% CI 5.67–18.46), **wall irregularity** (OR 10.26, 95% CI 5.80–18.17), and **pericholecystic stranding/inflammatory changes** (OR 4.82, 95% CI 1.76–13.24). - Diagnostic performance: absent wall enhancement showed moderate sensitivity (0.49) and high specificity (0.91) with a positive likelihood ratio of 5.65. Wall irregularity showed sensitivity 0.43 and specificity 0.94 with positive likelihood ratio 7.14. Confidence intervals overlapped and the two findings were not directly compared. - Pooled estimates were robust to assumptions about between-study correlation and to omitting individual studies in sensitivity analyses. - Limitations: included studies were retrospective and derived from surgically treated cohorts; CT findings were not compared head-to-head within studies; prospective validation in unselected patients undergoing CT for suspected acute cholecystitis is required. - The authors declare no competing interests, note that ChatGPT was used for language editing, and report no new human or animal data in this review.
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Online ahead of print. # Computed tomography findings associated with gangrenous cholecystitis: a systematic review and meta-analysis [Hideya Itagaki](https://pubmed.ncbi.nlm.nih.gov/?term=Itagaki+H&cauthor_id=42764326)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42764326/#full-view-affiliation-1 "Division of Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1, Fukumuro, Miyaginoku, Sendai, Miyagi, 983-8512, Japan. hideya.itagaki@gmail.com."), [Tomoyuki Endo](https://pubmed.ncbi.nlm.nih.gov/?term=Endo+T&cauthor_id=42764326)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42764326/#full-view-affiliation-2 "Division of Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1, Fukumuro, Miyaginoku, Sendai, Miyagi, 983-8512, Japan.") Affiliations Expand ### Affiliations * 1 Division of Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1, Fukumuro, Miyaginoku, Sendai, Miyagi, 983-8512, Japan. hideya.itagaki@gmail.com. * 2 Division of Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1, Fukumuro, Miyaginoku, Sendai, Miyagi, 983-8512, Japan. * PMID: **42764326** * DOI: [ 10.1007/s10140-026-02544-5 ](https://doi.org/10.1007/s10140-026-02544-5) Item in Clipboard Review # Computed tomography findings associated with gangrenous cholecystitis: a systematic review and meta-analysis Hideya Itagaki et al. Emerg Radiol. 2026. Show details Display options Display options Format Abstract PubMed PMID Emerg Radiol Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Emerg+Radiol%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Emerg+Radiol%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42764326/) . 2026 Sep 21. doi: 10.1007/s10140-026-02544-5. Online ahead of print. ### Authors [Hideya Itagaki](https://pubmed.ncbi.nlm.nih.gov/?term=Itagaki+H&cauthor_id=42764326)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42764326/#short-view-affiliation-1 "Division of Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1, Fukumuro, Miyaginoku, Sendai, Miyagi, 983-8512, Japan. hideya.itagaki@gmail.com."), [Tomoyuki Endo](https://pubmed.ncbi.nlm.nih.gov/?term=Endo+T&cauthor_id=42764326)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42764326/#short-view-affiliation-2 "Division of Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1, Fukumuro, Miyaginoku, Sendai, Miyagi, 983-8512, Japan.") ### Affiliations * 1 Division of Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1, Fukumuro, Miyaginoku, Sendai, Miyagi, 983-8512, Japan. hideya.itagaki@gmail.com. * 2 Division of Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1, Fukumuro, Miyaginoku, Sendai, Miyagi, 983-8512, Japan. * PMID: **42764326** * DOI: [ 10.1007/s10140-026-02544-5 ](https://doi.org/10.1007/s10140-026-02544-5) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract Gangrenous cholecystitis (GC) is a severe form of acute cholecystitis associated with perforation, sepsis, and increased mortality. Although computed tomography (CT) is useful for evaluating complicated cholecystitis, the relative diagnostic value of individual CT findings for identifying GC remains unclear. This review aimed to evaluate the association between individual CT findings and histopathologically confirmed GC and to summarize the diagnostic performance of these findings for preoperative assessment. We searched PubMed, Web of Science, Ichushi-Web, and the Cochrane Central Register of Controlled Trials from inception to March 1, 2026, and also screened Google Scholar for eligible studies. Eligible studies included those that enrolled patients with acute cholecystitis who underwent CT and had GC confirmed histopathologically. Two reviewers independently screened studies, extracted data, and assessed quality using the QUADAS-2 tool. Pooled odds ratios (ORs) were calculated with a DerSimonian-Laird random-effects model. When 2 × 2 data were available, we estimated pooled sensitivity and specificity using a bivariate random-effects model fitted by restricted maximum likelihood, from which we derived likelihood ratios and their confidence intervals; we examined model stability in sensitivity analyses. Ten retrospective studies involving 786 patients (310 GC and 476 non-GC) were included; eight studies (724 patients; 268 GC and 456 non-GC) contributed to the quantitative synthesis and two to the qualitative synthesis only. Absent gallbladder wall enhancement (OR 10.23, 95% CI 5.67-18.46) and wall irregularity (OR 10.26, 95% CI 5.80-18.17) were strongly associated with GC, as was pericholecystic stranding (OR 4.82, 95% CI 1.76-13.24). Absent wall enhancement (sensitivity 0.49, specificity 0.91, positive likelihood ratio 5.65) and wall irregularity (sensitivity 0.43, specificity 0.94, positive likelihood ratio 7.14) both combined high specificity with moderate sensitivity; their confidence intervals overlapped, and the findings were not compared directly. Pooled estimates were robust to the assumed between-study correlation and to omitting individual studies. Absent wall enhancement, wall irregularity, and pericholecystic inflammatory changes are useful CT findings for the preoperative assessment of suspected GC. Because the available evidence derives from surgically treated cohorts and the findings were not compared directly, these results should be regarded as hypothesis-generating and warrant prospective validation in unselected patients undergoing CT for suspected acute cholecystitis. **Keywords:** Acute cholecystitis; Computed tomography; Diagnostic imaging; Gangrenous cholecystitis; Meta-analysis; Systematic review. © 2026. The Author(s), under exclusive licence to American Society of Emergency Radiology (ASER). [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Ethics approval: Not applicable. This study is a systematic review and meta-analysis of previously published studies and does not involve any new human or animal data. Consent to participate: Not applicable. Consent for publication: Not applicable. Generative AI use: During the preparation of this work, the authors used ChatGPT (OpenAI) to assist with language editing and improve clarity. After using this tool, the authors reviewed and edited the manuscript and take full responsibility for its content. Competing interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ## References 1. 1. Kimura Y, Takada T, Kawarada Y, Nimura Y, Hirata K, Sekimoto M et al (2007) Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg 14:15–26 - [DOI](https://doi.org/10.1007/s00534-006-1152-y) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/17252293/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/2784509/) 2. 1. Chang WC, Sun Y, Wu EH, Kim SY, Wang ZJ, Huang GS et al (2016) CT findings for detecting the presence of gangrenous ischemia in cholecystitis. AJR Am J Roentgenol 207:302–309 - [DOI](https://doi.org/10.2214/ajr.15.15658) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/27249326/) 3. 1. Bennett GL, Rusinek H, Lisi V, Israel GM, Krinsky GA, Slywotzky CM et al (2002) CT findings in acute gangrenous cholecystitis. AJR Am J Roentgenol 178:275–281 - [DOI](https://doi.org/10.2214/ajr.178.2.1780275) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/11804880/) 4. 1. Martellotto S, Dohan A, Pocard M (2020) Evaluation of the CT scan as the first examination for the diagnosis and therapeutic strategy for acute cholecystitis. World J Surg 44:1779–1789 - [DOI](https://doi.org/10.1007/s00268-020-05404-6) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/32030439/) 5. 1. Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K et al (2007) Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg 14:78–82 - [DOI](https://doi.org/10.1007/s00534-006-1159-4) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/17252300/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/2784516/) Show all 23 references ## Publication types * Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42764326/) [x] Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM **Send To** * [Clipboard](https://pubmed.ncbi.nlm.nih.gov/42764326/) * [Email](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42764326%2F%23open-email-panel) * [Save](https://pubmed.ncbi.nlm.nih.gov/42764326/) * [My Bibliography](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42764326%2F%23open-bibliography-panel) * [Collections](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42764326%2F%23open-collections-panel) * [Citation Manager](https://pubmed.ncbi.nlm.nih.gov/42764326/) [x] NCBI Literature Resources [MeSH](https://www.ncbi.nlm.nih.gov/mesh/) [PMC](https://www.ncbi.nlm.nih.gov/pmc/) [Bookshelf](https://www.ncbi.nlm.nih.gov/books) [Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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