Abstract: Objective To evaluate the value of magnetic resonance cholangiopancreatography (MRCP) combined with color ultrasound for preoperative assessment in patients with acute cholecystitis (AC). Methods A total of 90 AC patients admitted to our hospital for surgical treatment from May 2023 to October 2024 were selected. MRCP and color ultrasound were taken before surgical treatment. All patients underwent laparoscopic cholecystectomy (LC), with the operation time > 90min as the critical point. They were divided into the difficult group (operation time > 90min) and the non-difficult group (operation time < 90 min). The basic data of the two groups were compared to analyze the factors affecting surgical difficulties in AC patients and the predictive efficiency of ROC curve analysis on surgical difficulties in AC patients. Results Among 90 patients with AC, 21 cases (23.33%) had operation time > 90 min. In the difficult operation group, 57.14% (12/21) had a history of AC attack, and the thickness of gallbladder wall was ≥3 mm 42.86% (9/21), pericholecystic fluid 76.19% (16/21), bile thickening 61.90% (13/21), gallbladder neck stones 47.62% (10/21), MRCP showed an elongated cystic duct or low insertion 76.19% (16/21). The non-difficult group: 23.19% (16/69), 10.14% (7/69), 36.23% (25/69), 23.19% (16/69), 11.59% (8/69), and 39.13% (27/69), respectively (P<0.05). By binary logistic regression analysis, patients had a history of AC attack [OR=4.417 (95%CI: 1.578~12.363)], pericholecystic fluid [OR=5.632 (95%CI: 1.842~17.222)],gallbladder wall thickness ≥3 mm[OR=6.643 (95%CI: 2.072~21.301)], gallbladder neck stones [OR=1.574 (95%CI: 1.121~2.044)], poor bile quality (thick bile)[OR=5.383 (95%CI: 1.897~15.278)], a rough and blurred gallbladder wall margin [OR=4.900 (95%CI: 1.722~13.943)], and MRCP showed an elongated cystic duct or low insertion [OR=4.978 (95%CI: 1.633~15.173)] were the influential factors of surgical difficulty in AC patients (P<0.05). ROC curve analysis showed that all the aformentioned influencing factors have predictive efficacy for surgical difficulty in AC patients, with the highest efficacy observed in the combined prediction of these factors (AUC=0.885). Conclusion The preoperative evaluation of AC patients with MRCP combined with color Doppler ultrasound can predict the surgical difficulty more accurately. Based on the differences in the surgical difficulty of patients, appropriate clinical coping strategies can help promote the process of medical precision and improve clinical work efficiency.

Key words: Magnetic resonance cholangiopancreatography, Color doppler ultrasound, Acute cholecystitis