Abstract: Objective The aim of this study was to investigate the diagnostic performance of revolution CT multi-parameter spectral imaging and iterative reconstruction for microperforation in patients with cholecystitis. Methods A total of 102 patients with cholecystitis were admitted to Department of Radiology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine between April 2022 and April 2025, and all patients underwent revolution CT multi-parameter spectral imaging scan followed by iterative reconstruction. The optimal keV value was explored, and differences in CT values of the gallbladder wall and bile under various keV conditions were observed. Iodine-water-based substance maps were utilized to detect lipid/water concentration (L/W), iodine/water concentration (I/W), spectral curve slope (K) and effective atomic number (Eff-Z) at the perforation site. The efficacy of CT scan for microperforation was evaluated as operational finding was the golden criteria, and the consistence was assessed by Kappa test. Results The CT values of gallbladder wall and bile at low energy levels (40-60 keV) and at high energy levels (90-140 keV) showed statistically significant differences (P<0.05), while at 70-80 keV, the difference in CT values between the two was not statistically significant (P>0.05); iodine-water contrast images showed the clearest representation in lipid/water (L/W) mode, and the gallbladder wall exhibited a much higher L/W, I/W and K values than bile (P<0.05), while Eff-Z value was much lower than bile (P<0.05); of 102 patients with cholecystitis, microperforation of gallbladders was found in 74 cases (72.5%) during operation, and Revolution CT scan diagnosed in 70 cases, with sensitivity of 91.9%, specificity of 92.9% and accuracy of 92.2%, a good consistent with surgery (Kappa =0.811). Conclusion Revolution CT multi-parameter spectral imaging in combination with iterative reconstruction could clearly visualize microperforation in patients with cholecystitis, which might help clinicians make an appropriate plan for operation.

Key words: Cholecystitis, Microperforation, Revolution CT multi-parameter spectral imaging, Iterative reconstruction, Diagnosis