Multi-detector row CT and gallbladder wall blood flow by color doppler US as a useful tool for pre-operative diagnosis in 3 cases of xanthogranulomatous cholecystitis

Xanthogranulomatous cholecystitis (XGC) is comparatively rare and difficult to distinguish from advanced gallbladder cancer (GBC) by imaging studies. It is important to accurately diagnose XGC preop-eratively, because patients undergo unnecessarily extensive surgery, such as liver resection, if GBC is diagnosed. We selected 3 cases of XGC diagnosed by post-operative pathological examination, between April 2007 and March 2009. Multi Detector-row CT (MD-CT) was useful for preoperative diagnosis of XGC, because it could detect an enhanced continuous mucosal line and intramural hypoattenuated nodule that are distinctive of XGC. Furthermore, measurement of gallbladder wall blood flow (GWBF) and both resistance index (RI) and pulsatility index (PI), indicating vascular resistance by color Doppler US, were also useful for making a differential diagnosis between XGC and GBC. However, it is still difficult to precisely diagnose XGC preoperatively despite progress in imaging studies, and because a higher percentage of XGC coexists with GBC. Therefore intraoperative pathological examination plays an important role in selecting the most suitable surgical procedure.