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• Clinical Article •
Nomogram model based on MRI and clinical features to early predict the surgical timing of laparoscopic cholecystectomy in non-severe acute biliary pancreatitis
ZHOU Mengting  WU Jialong  TANG Chaohua  ZHONG Xinyue  ZHANG Ting  ZHANG Xiaoming 

Cite this article as ZHOU M T, WU J L, TANG C H, et al. Nomogram model based on MRI and clinical features to early predict the surgical timing of laparoscopic cholecystectomy in non-severe acute biliary pancreatitis[J]. Chin J Magn Reson Imaging, 2026, 17(6): 86-94. DOI:10.12015/issn.1674-8034.2026.06.011.


[Abstract] Objective To construct and assess an imaging-clinical nomogram model integrating MRI and clinical features to identify candidates for early laparoscopic cholecystectomy (LC) consistent with real-world clinical decision-making in patients with non-severe acute biliary pancreatitis (NSABP), thereby informing surgical timing decisions.Materials and methods This retrospective study analyzed the MRI and clinical characteristics of 217 NSABP patients who underwent LC during hospitalization at the Affiliated Hospital of North Sichuan Medical College (Institution 1) and Nanchong Central Hospital (Institution 2). Data from Institution 1 were randomly divided into a training cohort (n = 114) and an internal validation cohort (n = 50) in a 7∶3 ratio, while data from Institution 2 were used as the external validation cohort (n = 53). Patients were classified into early and delayed groups based on surgical timing. Univariable and multivariable logistic regression analyses were performed to identify predictors for the choice of surgical timing. A combined model incorporating both imaging and clinical features was constructed, alongside imaging-only and clinical-only models. The accuracy and clinical application value of the nomogram were assessed using the receiver operating characteristic curve, area under the curve (AUC), calibration curve, and decision curve analysis.Results Multivariate logistic regression analysis indicated that a maximum gallstone diameter ≤ 5 mm, elevated total cholesterol (TC) level, increased Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, and increased extrapancreatic inflammation on MRI (EPIM) were independent negative predictors for undergoing LC in patients with NSABP in the early phase. In the training cohort, the AUC values of the combined model, imaging model, and clinical model were 0.931 [95% confidence interval (CI): 0.889 to 0.973], 0.707 (95% CI: 0.614 to 0.800), 0.729 (95% CI: 0.641 to 0.817). The Hosmer-Lemeshow test indicated good consistency for the combined model (P = 0.657). Furthermore, the combined model performed well in both the internal and external validation cohorts, with AUC values of 0.891 (95% CI: 0.798 to 0.984), 0.887(95% CI: 0.799 to 0.975), respectively.Conclusions The nomogram model based on MRI characteristics and clinical manifestations can assist in identifying patients with NSABP who may undergo LC in the early phase, and it holds significant value for clinicians in assisting clinicians in selecting appropriate surgical timing.
[Keywords] acute biliary pancreatitis；magnetic resonance imaging；nomogram；cholecystectomy；predict

ZHOU Mengting1   WU Jialong2   TANG Chaohua1   ZHONG Xinyue1   ZHANG Ting1   ZHANG Xiaoming1*  

1 Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan Key Laboratory of Medical Imaging, Nanchong 637001, China

2 Department of Imaging, the Second Clinical School of North Sichuan Medical College/Nanchong Central Hospital, Nanchong 637000, China

Corresponding author: ZHANG X M, E-mail: zhangxm@nsmc.edu.cn

Conflicts of interest   None.

Received  2026-02-06
Accepted  2026-05-08
DOI: 10.12015/issn.1674-8034.2026.06.011
Cite this article as ZHOU M T, WU J L, TANG C H, et al. Nomogram model based on MRI and clinical features to early predict the surgical timing of laparoscopic cholecystectomy in non-severe acute biliary pancreatitis[J]. Chin J Magn Reson Imaging, 2026, 17(6): 86-94. DOI:10.12015/issn.1674-8034.2026.06.011.

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