Diagnosis of acute cholecystitis: sensitivity of sonography, cholescintigraphy, and combined sonography-cholescintigraphy.
BACKGROUND
Radiographic diagnosis of acute cholecystitis can be established using ultrasonography (US), cholecystoscintigraphy (HIDA), or both. Although both modalities have been effective in diagnosing acute cholecystitis (AC), physicians from the emergency department and admitting surgeons continue to request both tests in an attempt to increase the diagnostic accuracy of AC. This article reports the institutional experience of a large tertiary care health care facility, with respect to the sensitivity of US, HIDA, and combined US and HIDA.


METHODS
We conducted a retrospective review of 132 patients diagnosed with AC who underwent laparoscopic cholecystectomy during the same hospitalization. Patients were stratified into three groups: Group 1 (Gp1, n = 50) included patients who underwent US alone, group 2 (Gp2, n = 28) included patients who underwent HIDA scan alone, and group 3 (Gp3, n = 54) included patients who underwent both US and HIDA.


RESULTS
The three groups did not differ with respect to age, liver chemistry, time to operation, and hospital length of stay. The sensitivity of US, HIDA, and combined US/HIDA as diagnostic modalities for acute cholecystitis was referenced to histopathologic confirmation. Sensitivity was 24 of 50 (48%), 24 of 28 (86%), and 49 of 54 (90%) for US, HIDA, and the combination of US/HIDA, respectively.


CONCLUSIONS
HIDA scan is a more sensitive test than US in diagnosing patients with AC. Based on the results of this study, we recommend that HIDA scan should be used as the first diagnostic modality in patients with suspected acute cholecystitis; US should be used to confirm the presence of gallbladder stones rather than to diagnose AC.
Kalimi
R
R
Department of Surgery, North Shore-Long Island Jewish Health System, Albert Einstein College of Medicine, New York, NY, USA.
Gecelter
G R
GR
Caplin
D
D
Brickman
M
M
Tronco
G T
GT
Love
C
C
Yao
J
J
Simms
H H
HH
Marini
C P
CP
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000814:Aniline Compounds; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000000981:diagnostic imaging* / Q000601:surgery; D002769:Cholelithiasis / Q000000981:diagnostic imaging; D005260:Female; D005998:Glycine; D006801:Humans; D007098:Imino Acids; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography
D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C034837:technetium Tc 99m mebrofenin; D005998:Glycine