Publication:

Computed tomography derived imaging surrogates as pre-operative predictors of gall bladder pathologies in cases of cholecystic mural thickening

Background Diffuse or focal wall thickening wall is a common manifestation of most gall bladder pathologies. Identification of features to differentiate malignant from benign causes is hence of prime importance in clinical practice.

Methods Contrast enhanced computed tomography (CT) scan was performed on 100 patients who revealed a gallbladder wall thickening (>5 mm) on screening sonography. The imaging features were charged with the intent of radiomic analysis and post-operative histopathologic correlation was done.

Results The average wall thickness was 22.28±12.51 mm in malignancies and 13.5±6.6 mm in benign conditions with the difference being highly significant (p<0.05). The gallbladder wall thickening was a common feature (76.2%) in benign group while wall thickening with associated focal mass lesion was common (59.5%) in malignant group. Morphologically inhomogeneous lesions were more prone to develop malignancy (53%) compared to benign lesions in which homogeneous wall thickening (52.4%) was common. Type I (39.2%) and type II (39.2%) was seen in malignant conditions, while type I pattern was also seen in xanthogranulomatous cholecystitis (66.7%). Type V was common in benign cases (23.8%).

Conclusions Amongst the charted radiomic features wall thickening and pattern of wall thickening were the most significant with sensitivity and specificity of 59.49​% and 76.19% respectively. The next most common feature was pattern of enhancement on post contrast CT scan.